ScienceDaily (Dec. 5, 2011) — Over a 10-year period, spending for Medicaid-enrolled patients with depression increased substantially but only minimal improvements in quality of care were observed, according to a report in the December issue of Archives of General Psychiatry, one of theJAMA/Archives journals…
“In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care,” the authors conclude. “Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community.”
Biologists have shown in rats that chronic stress makes stem cells in the brain produce more myelin-producing cells and fewer neurons, possibly affecting the speed of connections between cells as well as memory and learning. This could explain why stress leads to mental illness, such as PTSD, anxiety and mood disorders, later in life.…
Does stress affect brain connectivity?
Kaufer’s findings suggest a mechanism that may explain some changes in brain connectivity in people with PTSD, for example. One can imagine, she said, that PTSD patients could develop a stronger connectivity between the hippocampus and the amygdala — the seat of the brain’s fight or flight response — and lower than normal connectivity between the hippocampus and prefrontal cortex, which moderates our responses.
“You can imagine that if your amygdala and hippocampus are better connected, that could mean that your fear responses are much quicker, which is something you see in stress survivors,” she said. “On the other hand, if your connections are not so good to the prefrontal cortex, your ability to shut down responses is impaired. So, when you are in a stressful situation, the inhibitory pathways from the prefrontal cortex telling you not to get stressed don’t work as well as the amygdala shouting to the hippocampus, ‘This is terrible!’ You have a much bigger response than you should.”
Stress tweaks stem cells
Kaufer’s lab, which conducts research on the molecular and cellular effects of acute and chronic stress, focused in this study on neural stem cells in the hippocampus of the brains of adult rats. These stem cells were previously thought to mature only into neurons or a type of glial cell called an astrocyte. The researchers found, however, that chronic stress also made stem cells in the hippocampus mature into another type of glial cell called an oligodendrocyte, which produces the myelin that sheaths nerve cells.
The fact that chronic stress also decreases the number of stem cells that mature into neurons could provide an explanation for how chronic stress also affects learning and memory, she said.
Kaufer is now conducting experiments to determine how stress in infancy affects the brain’s white matter, and whether chronic early-life stress decreases resilience later in life. She also is looking at the effects of therapies, ranging from exercise to antidepressant drugs, that reduce the impact of stress and stress hormones.
Strongly believe solitary confinement is a mental health issue.
How we treat the least of us is a reliable measure of just how human we are.
I’ve been know to take to the streets, so to speak, against war & the death penalty.
Most recently at the Supreme Court at the annual Starvin’ for Justice event this past June/July.
These days, when I don’t take to the streets I voice through other means, including this blog.
That’s me on the left holding up the sign. Kirk Bloodsworth, the speaker, is the first person exonerated from death row using DNA technology. The gentleman on the right holding up a sign is another Returned Peace Corps Volunteer (the preferred title of those of us who served). We shared stories, and perhaps reflected on how our overseas service shaped our views on peace and justice.
(For anyone who would say “get a job”, well my reply is witnessing against injustice is my job.)
(Oh, and for the record, I am now gainfully employed for the first time in three long years of job hunting.
Being unemployed against one’s will certainly is a mental health issue, but nothing compared to greater injustices)
Ever since solitary confinement came into existence, it has been used as a tool of repression. While it is justified by corrections officials as necessary to protect prisoners and guards from violent superpredators, all too often it is imposed on individuals, particularly prisoners of color, who threaten prison administrations in an altogether different way. Consistently, jailhouse lawyers and jailhouse doctors, who administer to the needs of their fellow prisoners behind bars, are placed in solitary confinement. They are joined by political prisoners from various civil rights and independence movements.
CCR’s Challenges to Solitary Confinement
In May 2012, the Center for Constitutional Rights (CCR) filed a lawsuit against the state of California for its use of prolonged solitary confinement in the infamous Pelican Bay prison. Ruiz, et al. v. Brown, Jr., et al., is a federal class action challenging prolonged solitary confinement and deprivation of due process, based on the rights guaranteed under the Eighth and Fourteenth Amendments, at Pelican Bay. The case challenges inhumane, unconstitutional conditions under which thousands of prisoners live. Ruiz reasserts the importance of fundamental human rights and the Constitution’s guarantee that no one may be subjected to cruel and unusual punishment, and that all are entitled to the due process of law.
CCR’s case against solitary confinement at Pelican Bay is the latest in a long history of challenges to the use of isolation in prisons. InWilkinson v. Austin, the U.S. Supreme Court unanimously ruled in support of CCR’s claims that prison officials cannot confine prisoners in long-term solitary confinement in a
super maximum prison without first giving them the opportunity to challenge their placement. CCR has engaged in solidarity efforts alongside hunger striking prisoners, as well as engaged in advocacy and education efforts around the impact of the use of isolation in prisons.
Solitary Confinement is Torture
The devastating psychological and physical effects of prolonged solitary confinement are well documented by social scientists: prolonged solitary confinement causes prisoners significant mental harm and places them at grave risk of even more devastating future psychological harm.
Researchers have demonstrated that prolonged solitary confinement causes a persistent and heightened state of anxiety and nervousness, headaches, insomnia, lethargy or chronic tiredness, nightmares, heart palpitations, and fear of impending nervous breakdowns. Other documented effects include obsessive ruminations, confused thought processes, an oversensitivity to
stimuli, irrational anger, social withdrawal, hallucinations, violent fantasies, emotional flatness, mood swings, chronic depression, feelings of overall deterioration, as well as suicidal ideation.
Exposure to such life-shattering conditions clearly constitutes cruel and unusual punishment – in violation of the Eighth Amendment to the U.S. Constitution. Further, the brutal use of solitary has been condemned as torture by the international community.
A Growing Human Rights Movement against the Use of Solitary Confinement
Across the United States and the world, there is an emerging movement calling for the end of solitary confinement.
In the U.S., prisoner-led movements have attracted media attention and public scrutiny to harsh conditions of confinement, including overcrowding, the use of isolation, deplorable health conditions, substandard medical care, and the discriminatory and careless treatment of people with mental illnesses. Several prisoner-led hunger strikes have drawn attention to these harsh
conditions, including efforts in Georgia, Ohio and California. Advocates have joined in solidarity and alongside prisoners to protest the use of solitary confinement.
International human rights experts and bodies have also condemned indefinite or prolonged solitary confinement, recommended that the practice be abolished entirely and argued that solitary confinement is a human rights abuse that can amount to torture. In August 2011, Juan Mendez, the United Nations Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, concluded that even 15 days in solitary confinement constitutes torture or cruel, inhuman or degrading treatment or punishment, and 15 days is the limit after which irreversible harmful psychological effects can occur. However, many prisoners in the United States have been isolated for far longer.
Read more at http://ccrjustice.org/solitary-factsheet
- Citing Solitary Confinement Concerns, UN Demands Access To California Prisons (mintpressnews.com)
- Wasted Minds: An Insider’s Look at the Torturous Effects of U.S. Solitary Confinement (moorbey.wordpress.com)
- California lawmakers examine solitary confinement (sacbee.com)
- Solitary Confinement and the Criminal Justice Debate (ppgreview.ca)
- UN Top Torture Investigator Wants Access to American Prisons (alternet.org)
- Does Solitary Confinement in U.S. Prisons Qualify as Torture? (sitehighway.com)
- Two notable new ACLU reports on solitary confinement in US prisons (sentencing.typepad.com)
- Prison overcrowding could amount to torture: UN (abc.net.au)
- California And Louisiana Death Row Conditions Result In Torture, Report Finds (eurasiareview.com)
- !Virginia takes a STAND AGAINST SOLITARY CONFINEMENT! (halleluja) (childreninprison.wordpress.com)
So what is the one thing that I see over and over and over again in the management of emergency room psychiatric patients that makes me fear for our survival as a country and even as a species?
Is it the severity of psychotic illness? The rampant drug and alcohol use that starts now when kids are pre-adolescent? Is it the broken families that are producing another generation of children who have one parent or no parents and are raised by distant relatives? Is it financial poverty? Is it reliance on government assistance?
Well, I could write about any of these and make a case for all of them, but that’s not what keeps hitting me right between the eyes most days that I sit in my chair and talk to people via the Polycom screen.
Lack of education.
One of my standard questions when taking a medical history is, “How far did you go in school?” I ask everyone this question because it is so very important in understanding someone’s frame of reference and their ability to assess a problem and deal with it realistically, be it a kidney stone or an episode of depression. I get answers to this question that are all over the map. I have seen teens who have graduated college already. I see old women who never graduated high school but raised entire families on their own. I see proud aging men who ply their trades, hard workers with calloused hands who had formal schooling up to the third grade and no further. I have seen professionals with decades of formal training and multiple degrees who are as psychotic as they can be, completely out of touch with reality due to drug use or mental illness.
- High school is getting tougher, and the GED is catching up (kansascity.com)
- CBE’s top official surprised by depth of high school cuts despite giving order: Emails (metronews.ca)
There are times where I believe medications are the only answer to moderate to severe mental conditions.
However, as one of the comments stated, is the exponential increase in diagnoses largely due to the influence of BigPharma???
The American Psychiatric Association recently published a new version of the Diagnostic and Statistical Manual (DSM). The DSM-5 is what medical, mental health, and chemical dependency professionals use to diagnose developmental, mental health, substance abuse and dependence, learning, and personality “disorders.” Now in its 5th edition, the DSM was first published in 1952. At that time, the DSM was 129 pages containing 106 diagnoses.
Now, 61 years later, the DSM-5 consists of approximately 950 pages and roughly 375 diagnoses. The DSM-5, while researched far more than previous editions, is based on the medical model or the model of disease. Simply put, the medical model finds the causes of disease and illness and then prescribes a treatment to cure the disease or illness. This means a person has a pathology or pathogen that needs to be treated and cured.
Without going into detail about some of the changes in the newest edition of the DSM, some diagnostic categories have been added and some diagnosis “thresholds” have been lowered. This means that you need fewer symptoms to “meet diagnostic criteria.” Here are some examples of concerns with the new DSM-5:
- Temper tantrums will now be diagnosed as Disruptive Mood Dysregulation Disorder
- Normal forgetting will now be diagnosed as Minor Neurocognitive Disorder
- Gluttony will be diagnosed as Binge Eating Disorder
- Grief will be diagnosed as Major Depression
- First time substance users and college partiers will get a diagnosis of Substance Use Disorder
- Everyday Worry will be diagnosed as Generalized Anxiety Disorder
And what’s the number one treatment for all of these diagnoses? Medication.
- Diagnosis of toddlers with autism spectrum disorder supported by changes to symptom structure in DSM-5 (medicalnewstoday.com)
- How our society breeds anxiety, depression and dysfunction (salon.com)
- Harm Reduction or the Elephant in the Room: Ending Clinicians’ DSM Dependency (madinamerica.com)
- Living in America will drive you insane – literally (salon.com)
- ‘Do these really exist in nature or not?’: Latest edition of psychiatry’s diagnostic manual draws fierce criticism (news.nationalpost.com)
- Why the Dramatic Rise of Mental Illness? Diseasing Normal Behaviors, Drug Adverse Effects, and a Peculiar Rebellion (madinamerica.com)
- [Reblog] A prominent psychiatrist admits helping invent ADHD as a disease (jflahiff.wordpress.com)
- Psychiatrists: the drug pushers (theguardian.com)
From the 10 August 2013 post at League of Bloggers for a Better World
Here’s a scary fact: A single hospital admission for a mentally ill patient paid for by the taxpayer-financed state medical-assistance program costs more than a year of private outpatient care. It makes little financial sense, yet it happens every single day in America.
Everyday, a mentally ill person is admitted to an ER in the throes of a psychiatric emergency, desperately needing care and having nowhere else to go. No psychiatrist, no therapist, no case manager, no nothing. So they rely on ER doctors and nurses- and tax payers. But after the patient gets emergency care, they are back on their own. Until it happens again.
So why do these patients lack proper, long term psychiatric care that could provide regular treatment? Why do they end up in this endless cycle? The answer is simple, yet still disturbing- they have no health insurance.
Psychiatrist Christine Montross wrote an article,”The Woman Who Ate Cutlery,” about this quandary that many mentally ill people who lack health insurance face on a regular basis. The article was featured in the New York Times on August 3, 2013.
PROVIDENCE, R.I. — M is a 33-year old woman who swallowed silverware. Each time she ingested utensils, she went to the emergency room so that doctors could remove them from her esophagus and stomach.
Then the hospital transferred M to the psychiatric unit, where she was assigned to my care. When I met M she had already been hospitalized 72 times.
M’s case is dramatic. But she is one of countless psychiatric patients who have nowhere to turn for care, other than the E.R.
It is well known that millions of uninsured Americans, who can’t afford regular medical care, use the country’s emergency rooms for primary health care. The costs — to patients’ health, to their wallets, and to the health care system — are well documented. Less visible is the grievous effect this shift is having on psychiatric care and on the mentally ill.
How could this cycle of self-injury be disrupted? M and other psychiatric patients who turn to emergency rooms for care need regular outpatient appointments with a doctor they know and trust who can monitor their symptoms and assess the efficacy of their often complicated medication regimens.
Sadly, M’s history of recurrent hospital admissions is not uncommon. Recently I treated a 65-year-old man caught in a chronic cycle of homelessness and suicide attempts who had been in and out of the E.R. 246 times. If M had insurance, or enough money to pay out of pocket, she might see a therapist every week for an hour and a psychiatrist once or twice a month.
For full article, go to nytimes.com.
- South Carolina Psychiatric Patient Stuck 38 Days in ER – Bloomberg (bloomberg.com)
- Mental health services lacking in poorer areas, study says (modbee.com)
- The stigma experienced by patients with psychiatric disorders (kevinmd.com)
- How Well Do We Really Understand Mental lllness? (theatlantic.com)
- Emergency room wait times for Vermont psychiatric patients hit a high (vtdigger.org)
- Psychiatrists: the drug pushers (theguardian.com)
Young men who are gang members suffer unprecedented levels of psychiatric illness, placing a heavy burden on mental health services, according to new research led by Queen Mary, University of London.
The National Institute for Health Research (NIHR) and Maurice & Jacqueline Bennett Charitable Trust funded study surveyed 4,664 men aged 18 to 34 in Britain. The survey covered measures of psychiatric illness, violence and gang membership. It is the first time research has looked into whether gang violence is associated with psychiatric illness, other than substance misuse.
In terms of mental health, gang members and violent men were significantly more likely to suffer from a mental disorder and access psychiatric services than non-violent men. The exception was depression, which was significantly less common among gang members and violent men.
Violent ruminative thinking, violent victimisation and fear of further victimisation were significantly higher in gang members and believed to account for high levels of psychosis and anxiety disorder in gang members.
The findings showed that, of the 108 gang members surveyed:
- 85.8 per cent had an antisocial personality disorder;
- Two-thirds were alcohol dependent;
- 25.1 per cent screened positive for psychosis;
- More than half (57.4 per cent) were drug dependent;
- Around a third (34.2 per cent) had attempted suicide; and
- More than half (58.9 per cent) had an anxiety disorder.
The authors suggest that the higher rate of attempted suicide attempts among gang members may be associated with other psychiatric illness, but could also correspond with the notion that impulsive violence may be directed both outwardly and inwardly.
Street gangs are concentrated in inner urban areas characterised by socioeconomic deprivation, high crime rates and multiple social problems. The authors report that around one per cent of 18 to 34-year-old men in Britain are gang members. The level rises to 8.6 per cent in the London borough of Hackney, where one in five black men reported gang membership….
- Unprecedented Levels Of Psychiatric Illness Found In Gang Members (medicalnewstoday.com)
- Gang Members at an Increased Risk of Psychiatric Illnesses (counselheal.com)
- Most Gang Members Have a Diagnosable Mental Illness (motherboard.vice.com)
- Gang Members May Suffer From Unprecedented Illnesses (scienceworldreport.com)
- Gang Membership Tied To Mental Health Problems (medicalnewstoday.com)
It is beginning…….
Here is an article from NBC Los Angeles that show the beginning of the end. We should all be paying attention to this event, as the rest of the nation’s health care usually follows California’s lead. Where will these people go? How will these people get any help? This is so sad.
Please go to the site and read this article in full, then come back here and leave me a comment about your thoughts on this topic, won’t you?
Psych Care at Risk in Cedars Shutdown
Cedars Sinai says it will to close most of its mental health services, worrying providers and patients.
The decision by Cedars Sinai Medical Center to phase out most of its mental health services will rip a hole an already tenuous network of care, rattled providers said Thursday.
The news that within a year the non-profit hospital system would shut down its 51 psychiatric beds and release the 1,800 people who come for outpatient counseling and medication ripped through the region’s mental health community.
Free clinics braced for an onslaught of new patients, and doctors in nearby neighborhoods wondered where they would refer people in need of care.
“It’s devastating news,” said Sheila Forman, who practices in Santa Monica and is also a spokeswoman for the Los Angeles County Psychological Association. “The idea that a big facility like Cedars Sinai would close its doors is a very big deal. A lot of people are in crisis right now, and they need services.”…