Just half of parents of school-aged children would discuss anxiety or temper tantrums that seemed worse than peers
ANN ARBOR, Mich. — Parents often bring their school-aged children to check-ups or sick visits armed with questions. What should he put on that rash? What about her cough that won’t go away?
But when children’s temper tantrums or mood swings are beyond the norm, or they are overwhelmed by homework organization, do parents speak up?
Today’s University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health finds that many parents of children age 5-17 wouldn’t discuss behavioral or emotional issues that could be signs of potential health problems with their doctors. While more than 60 percent of parents definitely would talk to the doctor if their child was extremely sad for more than a month, only half would discuss temper tantrums that seemed worse than peers or if their child seemed more worried or anxious than normal. Just 37 percent would tell the doctor if their child had trouble organizing homework.
The most common reason for not sharing these details with their children’s doctors? Nearly half of parents believed that these simply were not medical problems. Another 40 percent of parents say they would rather handle it themselves and about 30 percent would rather speak to someone other than a doctor.
“Behavioral health and emotional health are closely tied to a child’s physical health, well-being and development, but our findings suggest that we are often missing the boat in catching issues early,” says Sarah J. Clark, M.P.H., associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.
We could stop almost all psychotropic drug use without deleterious effect, says Peter C Gøtzsche, questioning trial designs that underplay harms and overplay benefits. Allan H Young and John Crace disagree, arguing that evidence supports long term use
Yes—Peter C Gøtzsche
Psychiatric drugs are responsible for the deaths of more than half a million people aged 65 and older each year in the Western world, as I show below.1 Their benefits would need to be colossal to justify this, but they are minimal.123456
Overstated benefits and understated deaths
The randomised trials that have been conducted do not properly evaluate the drugs’ effects. Almost all of them are biased because they included patients already taking another psychiatric drug.178910 Patients, who after a short wash-out period are randomised to placebo, go “cold turkey” and often experience withdrawal symptoms. This design exaggerates the benefits of treatment and increases the harms in the placebo group, and it has driven patients taking placebo to suicide in trials in schizophrenia.8
Under-reporting of deaths in industry funded trials is another major flaw.Based on some of the randomised trials that were included in a meta-analysis of 100 000 patients by the US Food and Drug Administration, I have estimated that there are likely to have been 15 times more suicides among people taking antidepressants than reported by the FDA—for example, there were 14 suicides in 9956 patients in trials with fluoxetine and paroxetine, whereas the FDA had only five suicides in 52 960 patients, partly because the FDA only included events up to 24 hours after patients stopped taking the drug.1
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No—Allan H Young, John Crace
Psychiatric conditions are common, complex, costly, and often long term illnesses. More than a fifth of all health related disability is caused by mental ill health, studies suggest, and people with poor mental health often have poor physical health and poorer (long term) outcomes in both aspects of health.26
Raised standardised mortality rates and reduced life expectancy have been reported in people with psychiatric disorders such as psychosis and mood and personality disorders.27 These increased death rates are only partly because of suicide and mostly attributable to coexisting physical health disorders. There is thus a clear need for psychiatric disorders to be treated to attempt to reduce the long term harm associated with them. The key question is whether psychiatric drugs do more harm than good.
All therapeutic interventions may potentially do both good and harm, and thorough evaluation of the relative benefits and harms of a treatment should be done for psychiatric drugs no less than for any others.28 These evaluations of benefits and harms are based on group data, which have to be applied to judgments for individual patients and can therefore be advisory only; the individual’s subjective experience is crucially important to consider.
What about harms?
Worldwide, regulatory agencies are responsible for ensuring that drugs work and are acceptably safe. Postmarketing surveillance continues after drugs are licensed. This can further refine, or confirm or deny, the safety of a drug in the general population, which unlike study populations includes people with varied medical conditions. Several approaches are used to monitor the safety of licensed drugs, including spontaneous reporting databases, prescription event monitoring, electronic health records, patient registries, and record linkage between health databases.30 These safeguards work to ensure drugs available do more good than harm.30
Nevertheless, many concerns have been expressed about psychiatric drugs, and for some critics the onus often seems to be on the drug needing to prove innocence from causing harm rather than a balanced approach to evaluating the available evidence.
Overinflated concerns
Whether concerns are genuine or an expression of prejudice is not clear, but over time many concerns have been found to be overinflated. A few examples may be illustrative.
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Author Michael Stone, MD, Columbia College of Physicians and Surgeons and Mid-Hudson Forensic Psychiatric Hospital, New York, NY, provides an in-depth look at the scope of mass murders committed in the U.S. during recent decades, describing the crime as “an almost exclusively male phenomenon.” Most mass murderers have a mental illness characterized by a paranoid personality disorder that includes a deep sense of unfairness and a skewed version of reality. Unfortunately, this profile of the men who have committed mass murders has often led to the unwarranted stigmatization of the mentally ill as a group as being inherently dangerous, which is not the case.
Dr. Stone points in particular to the growing availability of semiautomatic weapons as a key factor contributing to the increasing rate of random mass shootings in the U.S. during the past 65 years. The number of events nearly doubles in the 1990s compared to the 1980s, for example.
Voices in people’s heads are far more varied and complex than previously thought, according to new research by Durham and Stanford universities, published in The Lancet Psychiatrytoday.
One of the largest and most detailed studies to date on the experience of auditory hallucinations, commonly referred to as voice hearing, found that the majority of voice-hearers hear multiple voices with distinct character-like qualities, with many also experiencing physical effects on their bodies.
The study also confirmed that both people with and without psychiatric diagnoses hear voices.
The findings question some of the current assumptions about the nature of hearing voices and suggest there is a greater variation in the way voices are experienced than is typically recognised.
The researchers say this variation means different types of therapies could be needed for voice-hearers, such as tailored Cognitive Behavioural Therapy (CBT) geared towards distinct voice sub-types or patterns of voice hearing.
Current common approaches to help with voices include medication, CBT, voice dialogue techniques and other forms of therapy and self-help.
Auditory hallucinations are a common feature of many psychiatric disorders, such as psychosis, schizophrenia and bipolar disorder, but are also experienced by people without psychiatric conditions. It is estimated that between five and 15 per cent of adults will experience auditory hallucinations during their lifetimes.
This is one of the first studies to shed light on the nature of voice-hearing both inside and outside schizophrenia, across many different mental health diagnoses.
Major rethink in order for some of us, including me? Or is the jury still out, so to speak. Perhaps a major rethink of some substances in light of the emerging role of personalized medicine.
Personal flashback to 1979 and Peace Corps training in Nashville TN. We were housed in motel rooms during our 1 1/2 month stateside training. One evening I returned to my room, where my two roommates were lounging. One told me the other was tripping on LSD (it had come to her on the back of the postage stamp from a mailed letter from a friend). Well, I about lost it, I had smoked (but not inhaled!) some marijuana once, but my perception of LSD was that it, well, took control of you and made you do things you wouldn’t normally do. The other roommate told me I just had to accept it. I said I didn’t have to and left the room for a few others and hung out with other volunteers. I was well, a bit scared that if the roommate was caught or reported, I could get kicked out of the Peace Corps program. Well, we never talked about the LSD, and had about 3 weeks to go in the program. And we all managed to get along fairly well after this incident. Stayed home while I attended college, so I guess this was a version of college roommate “drama”.
U.S. adults with a history of using some nonaddictive psychedelic drugs had reduced likelihood of psychological distress and suicidal thoughts, plans, and attempts, according to data from a nationwide survey.
While these psychedelic drugs are illegal, a Johns Hopkins researcher and study author recommends reconsidering their status, as they may be useful in treating depression.
Some people have serious adverse reactions to these drugs, which may not stand out in the survey data because they are less numerous than positive outcomes.
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The observational nature of the study cannot definitively show that psychedelics caused these effects, Johnson says, because those who chose to use psychedelics may have been psychologically healthier before using these drugs. However, the results probably reflect a benefit from psychedelics — the study controlled for many relevant variables and found that, as the researchers expected, other drugs assessed in the study were linked to increased harms, he says. The use of nonaddictive psychedelic drugs may exacerbate schizophrenia or other psychotic disorders and can sometimes elicit feelings of anxiety, fear, panic and paranoia, which can lead to dangerous behavior, Johnson says. But these instances of individual harm, while serious, may not stand out in the survey data because they occur less often than the positive outcomes that some people experience.
“Our general societal impression of these drugs is they make people go crazy or are associated with psychological harm, but our data point to the potential psychological benefits from these drugs,” he says. Current research at Johns Hopkins and several other universities is examining the therapeutic potential of one of the psychedelics, psilocybin, when administered in carefully controlled, monitored medical studies.
The use of psychedelics, such as LSD and magic mushrooms, does not increase a person’s risk of developing mental health problems, according to an analysis of information from more than 135,000 randomly chosen people, including 19,000 people who had used psychedelics. The results are published today in Journal of Psychopharmacology.
Clinical psychologist Pål-&Ostroke;rjan Johansen (http://www.EmmaSofia.org) and neuroscientist Teri Krebs (Norwegian University of Science and Technology) used data from the US National Health Survey (2008-2011) to study the relationship between psychedelic drug use and psychological distress, depression, anxiety, suicidal thoughts, plans, and attempts. The researchers found no link.
Johansen and Krebs previous population study, which used data from 2001-2004, also failed to find evidence for a link between psychedelic use and mental health problems.
“Over 30 million US adults have tried psychedelics and there just is not much evidence of health problems,” says Johansen.
“Drug experts consistently rank LSD and psilocybin mushrooms as much less harmful to the individual user and to society compared to alcohol and other controlled substances,” adds Krebs. In contrast to alcohol, psychedelics are not addictive.
Possible benefits
Johansen and Krebs found that, on a number of measures, the use of psychedelic drugs is correlated with fewer mental health problems. “Many people report deeply meaningful experiences and lasting beneficial effects from using psychedelics,” says Krebs. However, “Given the design of our study, we cannot exclude the possibility that use of psychedelics might have a negative effect on mental health for some individuals or groups, perhaps counterbalanced at a population level by a positive effect on mental health in others,” adds Johansen.
Psychedelics and human rights
“With these robust findings, it is difficult to see how prohibition of psychedelics can be justified as a public health measure,” Johansen argues. Krebs adds that the prohibition of psychedelics is also a human rights issue: “Concerns have been raised that the ban on use of psychedelics is a violation of the human rights to belief and spiritual practice, full development of the personalty, and free-time and play.”
In a study of 159 women who had been exposed to at least one assault-related potentially traumatic event, 30% developed major depressive disorder, which may be attributed to self-blame common to survivors of assault. Fewer women (21%) developed chronic posttraumatic stress disorder.
Mastery–the degree to which an individual perceives control and influence over life circumstances–and social support were most prevalent in women who did not develop a trauma-related psychiatric disorder after assault exposure, while mastery and posttraumatic growth were related to psychiatric recovery. These factors were less established in women with a current psychiatric disorder.
The Brain and Behavior findings have significance for the health and wellbeing of women, and for identifying individuals who are most in need of resilience-promoting interventions. “Women exposed to assault may present with post-trauma depression in lieu of posttraumatic stress disorder. Resilience factors like mastery and social support may attenuate the deleterious effects of an assault,” said lead author Heather L. Rusch. “The next step is to determine the extent that these factors may be fostered through clinical intervention.”
Among other issues, this is definitely a mental health concern. As quoted above, Serious mental illness affects men and women in jail at rates four to six times higher in the general population.
Regions of the brain affected by PTSD and stress. (Photo credit: Wikipedia)
New approach focuses on the appraisal of stressful or threatening situations by the brain
Researchers at the Research Center Translational Neurosciences of Johannes Gutenberg University Mainz (JGU) in Germany have advanced a generalized concept as the basis for future studies of mental resilience. Their new approach is based on a mechanistic theory which takes as its starting point the appraisals made by the brain in response to exposure to stressful or threatening situations. Previously social, psychological, and genetic factors were in the foreground of resilience research. The Mainz-based team has published its conclusions in the renowned journal Behavioral and Brain Sciences.
Stress, traumatic events, and difficult life situations play a significant role in the development of many mental illnesses, such as depression, anxiety, addiction. However, not everyone exposed to such circumstances develops a psychological disorder as a result. Every person has a greater or lesser mental stabilizing capacity and this inherent potential is called ‘resilience’ by psychologists. Resilience helps to effectively master challenges, stress, and difficult situations, thus maintaining mental health. The fact that some individuals either develop only short -term problems or do not become ill at all on experiencing major psychological or physical pressures suggests that there are certain protective mechanisms – in other words, defensive, self-healing processes – which can prevent the development of stress-related illnesses.
The core concern of the Mainz team of researchers is to identify these mechanisms. By means of a thorough review and analysis of the results of previous studies of and investigations into the subject of resilience, they were able to identify a common principle that can be used as a general basis for future studies of resilience. In order to achieve this, the researchers combined various parameters and research concepts – from psychological and social approaches to the results of genetic and even neurobiological investigations. “To date, research into resilience has tended to take into account a very extensive range of social, psychological, and even genetic factors that positively influence mental flexibility, such as social support, certain personality traits, and typical behavior patterns,” explained Professor Raffael Kalisch, one of the authors of the current publication and the director of the Neuroimaging Center, a central research platform of the Mainz University Medical Center and the Research Center on Translational Neurosciences. “We wondered whether there might be a common denominator behind all of these individual approaches and so we systematically examined various examples. As a result, in our new hypothesis we focus less on the already well-known social, psychological, or genetic factors and much more on cognitive processes happening in the brain.We thus consider that the appropriate way forward is to determine how the brain assesses each situation or stimulus. It is quite possibly the positive evaluation of potentially aversive stimuli that is the central mechanism which ultimately determines an individual’s level of resilience. The many already identified factors only impact on resilience indirectly by influencing the way the brain assesses a certain situation.” Assuming this theory is correct and it is the mental processes of evaluation that are of central relevance, this would mean that it is not necessarily the threatening situations or stimuli that decide whether stress develops but rather the manner in which the individual appraises the situation. A person who tends to more positively evaluate such factors would be protected against stress-related illnesses over the long term because the frequency and degree of stress reactions in that person would be reduced. The Mainz-based researchers call their new mechanistic hypothesis ‘Positive Appraisal Style Theory of Resilience’ (PASTOR).
A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends — many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.
SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key aspects of behavioral healthcare issues affecting American communities including rates of serious mental illness, suicidal thoughts, substance use, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.
The Barometer indicates that the behavioral health of our nation is improving in some areas, particularly among adolescents. For example, past month use of both illicit drugs and cigarettes has fallen for youth ages 12-17 from 2009 to 2013 (from 10.1 percent to 8.8 percent for illicit drugs and 9.0 percent to 5.6 percent for cigarettes). Past month binge drinking among children ages 12-17 has also fallen from 2009 to 2013 (from 8.9 percent to 6.2 percent).
The Barometer also shows more people are getting the help they need in some crucial areas. The number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013. It also shows that the level of adults experiencing serious mental illness who received treatment rose from 62.9 percent in 2012 to 68.5 percent in 2013.
The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.
“The Barometer provides new insight into what is happening on the ground in states across the country,” said SAMHSA’s Administrator, Pamela S. Hyde. “It provides vital information on the progress being made in each state as well as the challenges before them. States and local communities use this data to determine the most effective ways of addressing their behavioral healthcare needs.”
The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.
For the first time, the Barometer provides analyses broken down by poverty level (above or below) and health insurance status. This data can help provide researchers, policy makers, public health authorities and others a better understanding of how income and insurance coverage affect access and utilization of behavioral healthcare services.
For more information, contact the SAMHSA Press Office at 240-276-2130.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
English: A bottle of LSD from a Swiss clinical trial for end-of-life anxiety in cancer patients, circa 2007, conducted by Dr. Peter Gasser, sponsored by the Multidisciplinary Association for Psychedelic Studies. The opaque bottle has a red cap and a yellow, cyan, and white label. The label says in part: Clinical Study, EK # 2007/016, d-LSD hydrate Capsule, Only for research purposes. (Photo credit: Wikipedia) http://www.gettyimages.com/detail/81622620
Date:January 21, 2015
Source:SAGE Publications
Summary:Classic psychedelics, such as LSD, psilocybin mushrooms and mescaline, previously have been shown to occasion lasting improvements in mental health. But researchers, through a new study, wanted to advance the existing research and determine whether classic psychedelics might be protective with regard to suicidal thoughts and behaviors.
Classic psychedelics, such as LSD, psilocybin mushrooms and mescaline, previously have been shown to occasion lasting improvements in mental health. But researchers led by University of Alabama at Birmingham School of Public Health investigators wanted to advance the existing research and determine whether classic psychedelics might be protective with regard to suicidal thoughts and behaviors.
Approximately 30,000 lives in the United States are claimed by suicide every year, and more than 90 percent of victims have been diagnosed with mental illness, according to the National Alliance on Mental Illness.
Using data from more than 190,000 respondents of the National Survey on Drug Use and Health from 2008-2012, the researchers found that those who reported ever having used a classic psychedelic drug in their lifetime had a decreased likelihood of psychological distress in the past month, and decreased suicidal thinking, planning and attempts in the past year.
“Despite advances in mental health treatments, suicide rates generally have not declined in the past 60 years. Novel and potentially more effective interventions need to be explored,” said Peter S. Hendricks, Ph.D., assistant professor in the Department of Health Behavior and lead study author. “This study sets the stage for future research to test the efficacy of classic psychedelics in addressing suicidality as well as pathologies associated with increased suicide risk (e.g., affective disturbance, addiction and impulsive-aggressive personality traits).”
Hendricks says the take-home message from this study is that classic psychedelics may hold great promise in the prevention of suicide and evaluating the therapeutic effectiveness of classic psychedelics should be a priority for future research.
Logo for mitochondrial DNA (Photo credit: Wikipedia)
From the 20 January 2015 press release
PROVIDENCE, R.I. – In a new study published online in Biological Psychiatry on January 16, 2015, researchers from Butler Hospital identify an association between biological changes on the cellular level and both childhood adversity and psychiatric disorders. These changes in the form of telomere shortening and alterations of mitochondrial DNA (mtDNA), are important in the aging process, and this new research provides evidence that psychosocial factors–specifically childhood adversity and psychiatric disorders– may also influence these cellular changes and could lead to accelerated aging.
Mitochondria convert molecules from food into energy that can be used by cells and also play a key role in cellular growth, signaling, and death. Telomere shortening is also a measure of advanced cellular aging. Recent studies have examined the possible connection between mitochondria and psychiatric disorders, but the research is very limited, and no prior work has examined the relationship of mitochondrial DNA to psychosocial stress. “We are interested in these relationships because there is now clear evidence that stress exposure and psychiatric conditions are associated with inflammation and health conditions like diabetes and heart disease. Identifying the changes that occur at a cellular level due to these psychosocial factors allows us to understand the causes of these poor health conditions and possibly the overall aging process.” said Audrey Tyrka, MD, PhD, Director of the Laboratory for Clinical and Translational Neuroscience at Butler Hospital and Associate Professor of Psychiatry and Human Behavior at Brown University.
Mass incarceration in the United States goes beyond the logistical issues of overcrowded prisons. A shallow mindset wouldn’t identify the connection between mass incarceration and public health, but it’s prevalent and significance is being recognized. An article published in the New York Times briefly discusses the impact mass incarceration has on public health. It touches on a report published by the Vera Institute of Justice, which is an organization that focuses on making justice systems fairer through research and innovation. Most people in prisons come from impoverished communities, and therefore have low health-status. Specifically, people in prisons have higher rates of chronic disease, mental illness, and substance abuse.
But that’s really the obvious part of the mass incarceration-public health relationship. Overcrowding exacerbates health problems, especially communicable diseases such as flu and other viral infections. In a previous post, I shared how social reform in Russia led to mass incarceration and in turn one of the largest outbreaks of tuberculosis in history. Mental illness and substance abuse are major problems in jails, and the problem isn’t being addressed adequately. Although over 45% of incarcerated people have a mental illness and over 68% have substance abuse issues, only 15% receive proper treatment.
But that’s not even the real problem. [My emphasis] Our justice system is focused on penalizing, so vulnerable people coming out of prison are unable to receive any assistance because their actions have removed their eligibility. On first glance, the conservative argument would be that felons shouldn’t be privy to housing, medical, and financial assistance. But the whole picture has to be taken into consideration. Families can be easily torn apart by a family member being incarcerated, especially when parents are taken away from children.
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Mass incarceration in the United States goes beyond the logistical issues of overcrowded prisons. A shallow mindset wouldn’t identify the connection between mass incarceration and public health, but it’s prevalent and significance is being recognized. An article published in the New York Times briefly discusses the impact mass incarceration has on public health. It touches on a report published by the Vera Institute of Justice, which is an organization that focuses on making justice systems fairer through research and innovation. Most people in prisons come from impoverished communities, and therefore have low health-status. Specifically, people in prisons have higher rates of chronic disease, mental illness, and substance abuse.
But that’s really the obvious part of the mass incarceration-public health relationship. Overcrowding exacerbates health problems, especially communicable diseases such as flu and other viral infections. In a previous post, I shared how social reform in Russia led to mass incarceration and in turn one of the largest outbreaks of tuberculosis in history. Mental illness and substance abuse are major problems in jails, and the problem isn’t being addressed adequately. Although over 45% of incarcerated people have a mental illness and over 68% have substance abuse issues, only 15% receive proper treatment.
Mass incarceration in the United States goes beyond the logistical issues of overcrowded prisons. A shallow mindset wouldn’t identify the connection between mass incarceration and public health, but it’s prevalent and significance is being recognized. An article published in the New York Times briefly discusses the impact mass incarceration has on public health. It touches on a report published by the Vera Institute of Justice, which is an organization that focuses on making justice systems fairer through research and innovation. Most people in prisons come from impoverished communities, and therefore have low health-status. Specifically, people in prisons have higher rates of chronic disease, mental illness, and substance abuse.
But that’s really the obvious part of the mass incarceration-public health relationship. Overcrowding exacerbates health problems, especially communicable diseases such as flu and other viral infections. In a previous post, I shared how social reform in Russia led to mass incarceration and in turn one of the largest outbreaks of tuberculosis in history. Mental illness and substance abuse are major problems in jails, and the problem isn’t being addressed adequately. Although over 45% of incarcerated people have a mental illness and over 68% have substance abuse issues, only 15% receive proper treatment.
But that’s not even the real problem. Our justice system is focused on penalizing, so vulnerable people coming out of prison are unable to receive any assistance because their actions have removed their eligibility. On first glance, the conservative argument would be that felons shouldn’t be privy to housing, medical, and financial assistance. But the whole picture has to be taken into consideration. Families can be easily torn apart by a family member being incarcerated, especially when parents are taken away from children.
Suicides and violence are also common in prisons. In the Vera Institute study it was found that 1/3 of deaths in prisons are due to suicide. Everything considered, mass incarceration is an epidemic and it’s public health ramifications are significant. The justice system in the United States needs to work with public health agencies to improve services, education, and awareness in prisons. The system needs to consider cases of penalizing on an individual by individual basis when evaluating eligibility for financial, housing, and medical assistance.
UC Berkeley study finds self-worth key to diagnoses of psychopathologies
Donald Trump’s ego may be the size of his financial empire, but that doesn’t mean he’s the picture of mental health. The same can be said about the self-esteem of people who are living from paycheck to paycheck, or unemployed. New research from the University of California, Berkeley, underscores this mind-wallet connection.
UC Berkeley researchers have linked inflated or deflated feelings of self-worth to such afflictions as bipolar disorder, narcissistic personality disorder, anxiety and depression, providing yet more evidence that the widening gulf between rich and poor can be bad for your health.
The social self. (Photo credit: Wikipedia)
“We found that it is important to consider the motivation to pursue power, beliefs about how much power one has attained, pro-social and aggressive strategies for attaining power, and emotions related to attaining power,” said Sheri Johnson, a UC Berkeley psychologist and senior author of the study published in the journal Psychology and Psychotherapy: Theory, Research and Practice.
In a study of more than 600 young men and women conducted at UC Berkeley, researchers concluded that one’s perceived social status – or lack thereof – is at the heart of a wide range of mental illnesses. The findings make a strong case for assessing such traits as “ruthless ambition,” “discomfort with leadership” and “hubristic pride” to understand psychopathologies.
“People prone to depression or anxiety reported feeling little sense of pride in their accomplishments and little sense of power,” Johnson said. “In contrast, people at risk for mania tended to report high levels of pride and an emphasis on the pursuit of power despite interpersonal costs.”
Specifically, Johnson and fellow researchers Eliot Tang-Smith of the University of Miami and Stephen Chen of Wellesley College looked at how study participants fit into the “dominance behavioral system,” a construct in which humans and other mammals assess their place in the social hierarchy and respond accordingly to promote cooperation and avoid conflict and aggression. The concept is rooted in the evolutionary principle that dominant mammals gain easier access to resources for the sake of reproductive success and the survival of the species.
Studies have long established that feelings of powerlessness and helplessness weaken the immune system, making one more vulnerable to physical and mental ailments. Conversely, an inflated sense of power is among the behaviors associated with bipolar disorder and narcissistic personality disorder, which can be both personally and socially corrosive.
esponding to the large number of people with serious mental illnesses in the criminal justice system will require more than mental health services, according to a new report.
In many ways, the criminal justice system is the largest provider of mental health services in the country. Estimates vary, but previous research has found that about 14 percent of persons in the criminal justice system have a serious mental illness, and that number is as high as 31 percent for female inmates. Researchers are defining serious mental illnesses to include such things as schizophrenia, bipolar spectrum disorders and major depressive disorders.
“It has been assumed that untreated symptoms of mental illness caused criminal justice involvement, but now we’re seeing that there is little evidence to support that claim,” said Matthew Epperson, assistant professor at the University of Chicago School of Social Service Administration. Specialized interventions for people with mental illness in the criminal justice system have been developed over the past 20 years, such as mental health courts and jail diversion programs, Epperson said.
“But we need a new generation of interventions for people with serious mental health issues who are involved in the criminal justice system, whether it be interactions with police, jails, probation programs and courts,” he said. “Research shows that people with serious mental illnesses, in general, display many of the same risk factors for criminal involvement as persons without these conditions.”
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: Criminal Justice Center (Photo credit: Wikipedia)
SAMHSA News Release Date: 9/4/2014 9:30 AM Report reveals the scope of substance use and mental illness affecting the nation Released in conjunction with the 25th anniversary of National Recovery Month
A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides insight into the nature and scope of substance use and mental illness issues affecting America. Today, 2013 national survey data as well as information on the efforts and resources being taken to address these problems is being released in conjunction with the 25th annual observance of National Recovery Month.
The report shows that 24.6 million Americans aged 12 or older were current (past month) illicit drug users – 9.4 percent of this age group.
Marijuana was by far the most commonly used illicit drug with approximately 19.8 million current users aged 12 and older.
In terms of other illicit drugs, the report indicates that among those aged 12 and older, there were 4.5 million current nonmedical users of prescription pain relievers (1.7 percent), 1.5 million current cocaine users (0.6 percent), 595,000 methamphetamine users (0.2 percent), and 289,000 current heroin users (0.1 percent). Although an estimated 22.7 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem, only 2.5 million persons received treatment at a specialty facility.
The SAMHSA report also shows that 34.6 million adults aged 18 or older (14.6 percent of the population aged 18 or older) received mental health treatment or counseling during the past 12 months. Nearly one in five American adults (18.5 percent), or 43.8 million adults, had a mental illness in 2013. Ten million adults (4.2 percent of the adult population) had a serious mental illness in the past year. Serious mental illness is defined as mental illness that resulted in serious functional impairment, which substantially interfered with, or limited, one or more major life activities.
Background
Doctors, lawyers and criminal justice agencies need methods to assess vulnerability to violent radicalization. In synergy, public health interventions aim to prevent the emergence of risk behaviours as well as prevent and treat new illness events. This paper describes a new method of assessing vulnerability to violent radicalization, and then investigates the role of previously reported causes, including poor self-reported health, anxiety and depression, adverse life events, poverty, and migration and socio-political factors. The aim is to identify foci for preventive intervention.
Methods A cross-sectional survey of a representative population sample of men and women aged 18–45, of Muslim heritage and recruited by quota sampling by age, gender, working status, in two English cities. The main outcomes include self-reported health, symptoms of anxiety and depression (common mental disorders), and vulnerability to violent…
I’ve been in houses where one can just barely walk through a room. Remember being invited over to lunch at a friend’s. She said it took a whole week to clear the kitchen table so we could sit down and eat. Also remember my bother-in-law’s apartment. I kept on insisting she at least have a path form the door to her living room chair clear at all times, for the sake of safety.
Well, after reading this article, I have summoned up some compassion for folks who hoard.
Hoarding isn’t just about accumulating piles of stuff most of us would throw away. It’s more than the ceiling-high mounds of newspapers, books and dolls as shown on reality television shows like A&E’s “Hoarders” and TLC’s “Buried Alive.”
It’s about people paralyzed by the thought of getting rid of personal belongings, no matter how much – or little – they are worth. It’s about the social, physical and emotional isolation their hoarding behaviors cause. It’s about safety, not just for the hoarder but for those who live near them as well.
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Initially, hoarding was considered a type of obsessive-compulsive disorder. More recently, researchers have found that only about 20 percent of people who hoard also have OCD. Depression is much more common, occurring in about 50 percent of those with hoarding disorder.
Earlier this year, the American Psychiatric Association included hoarding as a distinct disorder in its updated Diagnostic and Statistic Manual of Mental Disorders, known as the DSM.
Several factors influence the likelihood that a person may be affected by hoarding, Schwartz said. At least 50 percent of people diagnosed with hoarding disorder also have a first-degree relative – such as a parent or sibling – who also has the problem.
Trauma also can trigger hoarding behaviors, such as a death in the family or an adult child leaving for college. In some cases, people who had a tendency to accumulate items may have had someone who helped keep them from going overboard in their hoarding. When that person is no longer there – such as because of a death – the hoarding may increase. People over age 55 are three times more likely to have a hoarding disorder, Schwartz said.
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A study last year of people who struggle with hoarding tendencies found that hoarders tend to have unique brain activity when faced with making decisions about their possessions, compared with people who don’t have the disorder. In general, hoarders tend to struggle with organizational, attention and information processing, which makes it hard for them to toss out what most people would consider to be unnecessary.
“This isn’t just someone who is dirty and lazy. It’s a mental disorder,” said Chalmers, who has been featured as an expert on A&E’s “Hoarders.” “To a person who doesn’t suffer, you may think why is that such a struggle to get rid of what you don’t need. But to them, just to make a decision, their brain is complete chaos. They’re not thinking clearly like us.”
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Hoarders don’t just fill their homes with books, papers and knickknack collections. In some cases, well-meaning people wind up collecting animals as well.
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Treatment may involve helping hoarders to understand their own behavior and connect with the emotions they’re feeling. Although it may seem counterintuitive, the cleanup is actually one of the last steps people should take when dealing with a severe hoarding problem, said Chalmers, who runs a hoarding task force in San Bernadino that was developed in 2010.
“Without appropriate intervention, it will be a never-ending cycle of response,” Brown said. “If that person is allowed to go back to their typical life and receives no ongoing support, the likelihood they will start hoarding again is very, very high. That’s another reason we need this task force.”
English: Close up shot of some high quality marijuana. (Photo credit: Wikipedia)
While I believe the so called War on Drugs has largely been a failure, I am concerned about young folks indulging in substances that can have permanent health effects.
Regular marijuana use in adolescence, but not adulthood, may permanently impair brain function and cognition, and may increase the risk of developing serious psychiatric disorders such as schizophrenia, according to a recent study from the University of Maryland School of Medicine. Researchers hope that the study, published in Neuropsychopharmacology — a publication of the journal Nature — will help to shed light on the potential long-term effects of marijuana use, particularly as lawmakers in Maryland and elsewhere contemplate legalizing the drug.
“Over the past 20 years, there has been a major controversy about the long-term effects of marijuana, with some evidence that use in adolescence could be damaging,” says the study’s senior author Asaf Keller, Ph.D., Professor of Anatomy and Neurobiology at the University of Maryland School of Medicine. “Previous research has shown that children who started using marijuana before the age of 16 are at greater risk of permanent cognitive deficits, and have a significantly higher incidence of psychiatric disorders such as schizophrenia. There likely is a genetic susceptibility, and then you add marijuana during adolescence and it becomes the trigger.”
“Adolescence is the critical period during which marijuana use can be damaging,” says the study’s lead author, Sylvina Mullins Raver, a Ph.D. candidate in the Program in Neuroscience in the Department of Anatomy and Neurobiology at the University of Maryland School of Medicine. “We wanted to identify the biological underpinnings and determine whether there is a real, permanent health risk to marijuana use.”
“It don’t matter how many men you shot in Memphis,” the saying goes, “if your name is Sierra or Sequoia, you can’t sing the blues”. In a sense, this adage reworks an older, more bitter joke from the civil rights era, the one that begins “some of my best friends are …” and ends with “but you wouldn’t want your sister to marry one.” Both statements embody stigma, the social effects of being someone who violates others’ expectations or fails to fit into an assigned social niche.
Stigma attached to illness has a long, ignoble history. The most classic example, the devalued social role of lepers, illustrates its classic elements: fear and avoidance. Deformities elicit basic revulsion in many, while infections also trigger fear of contagion. Historically, some of the positive stigma that doctors enjoy reflects our ability to transcend our fears and provide care to those whom society would consign to the desert beyond the pale of a socially integrated life.
In modern times, patients with psychiatric disorders (including addictions) experience stigma in painful and damaging ways. The American Journal of Public Health devoted its entire May edition to the consequences of the stigma that plagues those with mental illness and the disordered behaviors that it often causes. The bottom line of the Journal’s complex assessment across many articles: stigma kilIs. According to Hautzenbuehler et al, increased health care costs, poorer health outcomes and, most tellingly, premature death are all consequences of having a psychiatric disorder of any kind. While we all intuitively “get” why people with schizophrenia or addictions might face stigma based on their disruptive, non conforming behavior and the frustration caused by the intractability of their conditions, the negative consequences of having a psychiatric disorder also extend to otherwise normal appearing people with depression and anxiety, and, most tragically, to children.
Am wondering if murder, planning to murder, and domestic violence are brain disorders…
If so, or even probably so, this is a real wake up call for prison reform…
From the 23 April 2013 item at the National Institute of Mental Health
A rethink is needed in terms of how we view mental illness, stated National Institute of Mental Health Director Thomas Insel, M.D., in a recent TEDx talkat the California Institute of Technology (Caltech) in Pasadena.
Deaths from medical causes such as leukemia and heart disease have decreased over the past 30 years. The same cannot be said of the suicide rate, which has remained the same. A vast majority of suicides—90 percent—are related to mental illnesses such as depression and schizophrenia.
Insel believes part of the problem is that mental illness is referred to either as a mental or behavioral disorder. “We need to think of these as brain disorders,” he said, adding that for these brain disorders, behavior is the last thing to change.
Insel walked the audience through recent advances in neuroscience, including the Human Connectome, which indicates that mental illness may be more of a neuronal connection or circuit disorder. The earlier these circuits are identified, he said, the earlier preventive treatments could be used to save the lives of people with mental illnesses.
“If we waited for the ‘heart attack,’ we would be sacrificing 1.1 million lives every year in this country,” he said. “That is precisely what we do today when we decide that everyone with one of these brain disorders, brain circuit disorders, has a behavior disorder. We wait until the behavior emerges. That’s not early detection, that’s not early prevention.”
Yoga on our minds: The 5,000-year-old Indian practice may have positive effects on major psychiatric disorders, including depression, schizophrenia, ADHD and sleep complaints
Yoga has positive effects on mild depression and sleep complaints, even in the absence of drug treatments, and improves symptoms associated with schizophrenia and ADHD in patients on medication, according to a systematic review of the exercise on major clinical psychiatric disorders.
Published in the open-access journal, Frontiers in Psychiatry, on January 25th, 2013, the review of more than one hundred studies focusing on 16 high-quality controlled studies looked at the effects of yoga on depression, schizophrenia, ADHD, sleep complaints, eating disorders and cognition problems.
Yoga in popular culture
Yoga is a popular exercise and is practiced by 15.8 million adults in the United States alone, according to a survey by the Harris Interactive Service Bureau, and its holistic goal of promoting psychical and mental health is widely held in popular belief.
“However, yoga has become such a cultural phenomenon that it has become difficult for physicians and patients to differentiate legitimate claims from hype,” wrote the authors in their study. “Our goal was to examine whether the evidence matched the promise.”
Psychotherapy is effective, helps reduce the overall need for health services and produces long-term health improvements, according to a review of research studies conducted by the American Psychological Association.
Yet, the use of psychotherapy to treat people with mental and behavioral health issues decreased over the last decade while the use of medications to address such problems has increased, according to government and insurance industry data.
“Every day, consumers are bombarded with ads that tout drugs as the answer to their problems. Our goal is to help consumers weigh those messages with research-based information about how psychotherapy can provide them with safe, effective and long-lasting improvements in their mental and physical health,” said Melba J. T. Vazquez, PhD, past president of the American Psychological Association who led the psychotherapy effectiveness review project…
The resolution also states Key findings of the resolution:
• Research demonstrates that psychotherapy is effective for a variety of mental and behavioral health issues and across a spectrum of population groups. The average effects of psychotherapy are larger than the effects produced by many medical treatments.
• Large multi-site and meta-analytic studies have demonstrated that psychotherapy reduces disability, morbidity and mortality; improve work functioning; and decrease psychiatric hospitalization.
• Psychotherapy teaches patients life skills that last beyond the course of treatment. The results of psychotherapy tend to last longer than psychopharmacological treatments and rarely produce harmful side effects
• While medication is appropriate in some instances, research shows that a combination of medication and psychotherapy is often most effective in treating depression and anxiety. It should also be noted that the effects produced by psychotherapy, including those for different age groups and across a spectrum of mental and physical health disorders, are often comparable to or better than the effects produced by drug treatments for the same disorders without the potential for harmful side effects that drugs often carry.
“As Americans grapple with the ever-increasing cost of health care, it is important that consumers and those who make decisions about health care access understand the potential value in both improved outcomes and cost-saving of psychotherapies,” Vasquez said. “APA applauds and continues to support collaboration of psychologists with other health care providers as part of integrated health care teams. Psychotherapies are highly effective, but only when consumers have access to them.”
Much of the debate over the future edition of the Diagnostic and Statistical Manual of Mental Disorders(DSM-5) has centered on what disorders will be added, modified or dropped. But lost in the discussion is a change that will align disorders along a developmental continuum—one that looks at them across the lifespan. This shift will provide clinicians with a critical perspective that until now has been missing.
Historically, disorders were classified in DSM by symptom manifestation and patient presentation. As a result, they generally were grouped by discreet stages of life, as if there were no connections or implications from one stage to another. In particular, the opening chapter of DSM-IV, “Disorders Usually First Diagnosed in Infancy, Childhood, Adolescence,” segregated such conditions as attention-deficit/hyperactivity disorder, pica, rumination and autism disorder from the rest of the manual. The implication was that disorders in the “child” chapter affect only children and disorders in the rest of the manual affect only adults….
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he need for these changes is obvious: The real world doesn’t work within distinct boundaries, and clinicians are not best able to understand potential connections, interrelations and ramifications when they only consider a single, narrow point in time. A young girl who lashes out with persistent and significant anger could presage a young adult with similarly explosive behavior, for example. Conversely, a middle-aged man’s extreme anxiety might reflect a difficult recent event, such as a divorce or layoff. But it also might be a problem that first manifested itself decades earlier, in panic attacks or a fear of leaving the house. In both cases, diagnosis as well as treatment will be more clinically useful if the factors involved are evaluated through a longitudinal lens.
This different perspective will especially benefit women, for whom mental disorders are often linked to specific ages or periods of life. We know that young women between 15 and 22 are much more likely to have negative body image than young men and to develop eating disorders, low self-esteem, depression, self-harm and, in the most extreme cases, suicide. But what happens after 22? Even with treatment, the risk of recurrent depression remains, and it often needs to be assessed in terms of the extra emotional and physical issues many women face throughout their lives—because of lower income, discrimination, sexual harassment and violence….
Although not addressed in this study, I couldn’t help but wonder if anger is “fed” by factors not easily determined as how we think about and treat people on an everyday basis.
This morning on Facebook, a friend posted an item about snarkiness and how this affects one’s productivity. However, I think snakiness not only affects oneself but the thoughts and actions of others.I couldn’t help but think that maybe snarky attitudes can somehow draw out anger in others. Yes, we are all ultimately responsible for our actions and thoughts. But we are also “our brother’s keeper”.
This article made me more aware of how I think and act towards teens, and how I need to rethink my thoughts and actions.
Nearly two-thirds of U.S. adolescents have experienced an anger attack that involved threatening violence, destroying property or engaging in violence toward others at some point in their lives. These severe attacks of uncontrollable anger are much more common among adolescents than previously recognized, a new study led by researchers from Harvard Medical School finds.
The study, based on the National Comorbidity Survey Replication Adolescent Supplement, a national face-to-face household survey of 10,148 U.S. adolescents, found that nearly two-thirds of adolescents in the U.S. have a history of anger attacks. It also found that one in 12 young people — close to six million adolescents — meet criteria for a diagnosis of Intermittent Explosive Disorder (IED), a syndrome characterized by persistent uncontrollable anger attacks not accounted for by other mental disorders.
Katherine Gluck blurts out to the judge, “I’m guilty.”
Gluck, 47, is charged on this March morning with threatening her former husband with a hammer. Police who arrested her in Burlington, Vermont, know those tired eyes and stringy blond hair. In December, Gluck was charged but not jailed or hospitalized after she slammed a dead raccoon against the front door of City Hall. Her family urged her to get help for her bipolar disorder, which usually involves getting back on medication. She refused.
June 4 (Bloomberg) — Hurricane Irene wiped out the last state-operated psychiatric beds in Vermont nine months ago. As the only U.S. state with no government-operated psychiatric beds, Vermont’s experience reflects a growing realization among mental-health experts and advocates that the decades-long trend toward outpatient care has reached its limit and public outcry against the latest round of cuts is beginning to change the game. Bloomberg’s Tom Moroney reports. (Source: Bloomberg)
Now, court-appointed lawyer Sarah Reed hopes Judge Thomas Devine will send Gluck to a hospital. The odds aren’t good. Hurricane Irene wiped out the last state-operated psychiatric beds in Vermont nine months ago.
Since then, private-hospital emergency rooms have been backed up with mentally ill patients — some handcuffed to ER beds for as long as two days. Dozens of people are turned away each month without being admitted, and calls to Burlington police about mental-health issues increased 32 percent over the prior year.
As the only U.S. state with no government-operated psychiatric beds, Vermont’s experience reflects a growing realization among mental-health experts and advocates that the decades-long trend toward outpatient care has reached its limit — and public outcry against the latest round of cuts is beginning to change the game….
The Diagnostic and Statistical Manual of Mental Disorders (DSM), long the master reference work in psychiatry, is seriously flawed and needs radical change from its current “field guide” form, according to an essay by two Johns Hopkins psychiatrists published in the New England Journal of Medicine.
“A generation ago it served useful purposes, but now it needs clear alterations,” says Paul R. McHugh, M.D., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and co-author of the paper with Phillip R. Slavney, M.D., a professor emeritus in the same department. “They say they can’t do any better. We disagree and can show how.”
The original DSM, published in the 1950s, was intended as a public health service documenting the incidence and prevalence of mental illnesses. By its third edition in 1980 (DSM-III), however, it had evolved into a reference book prescribing how clinicians should identify and classify psychiatric disorders.
Today, the Johns Hopkins psychiatrists say, DSM provides checklists of symptoms, offering few clues to the underlying causes of mental disease and making it difficult to direct treatment or investigate the disorders it details. A new edition, DSM-5, is due out in 2013.
The manual, put together by the American Psychiatric Association, currently identifies hundreds of conditions via lists of diagnostic criteria and symptoms, functioning exactly as does a naturalist’s field guide but for mental illness. It offers no way to make sense of mental disorders and no way to distinguish illnesses that appear to be similar but actually are quite different and require different treatments, the psychiatrists argue.
“If you just name things and don’t explain what the causes are, you do not know how to rationally treat or study the diseases,” says McHugh, former director of Hopkins’ psychiatry department. “The DSM gives everything a name but not a nature.”….
The team found that higher levels of parental education meant fewer mental health issues for their adult children. “However, we also found much of that association may be due to the fact that parents with more education tend to have children with more education and better paying jobs themselves,” explained Quesnel-Vallée. “What this means is that the whole process of climbing up the social ladder that is rooted in a parent’s education is a crucial pathway for the mental health of adult children.”
These findings suggest that policies aimed at increasing educational opportunities for all, regardless of social background, may help break the intergenerational cycle of low socioeconomic status and poor mental health. “Children don’t get to choose where they come from. I think we have a responsibility to address health inequalities borne out of the conditions of early childhood,” said Quesnel-Vallée.
School absenteeism is a significant problem, and students who are frequently absent from school more often have symptoms of psychiatric disorders. A new longitudinal study of more than 17,000 youths has found that frequently missing school is associated with a higher prevalence of mental health problems later on in adolescence, and that mental health problems during one year also predict missing additional school days in the following year for students in middle and high school….
Date: 12/22/2011 10:00 AM Media Contact: SAMHSA Press Office Telephone: 240-276-2130
SAMHSA announces a working definition of “recovery” from mental disorders and substance use disorders
A new working definition of recovery from mental disorders and substance use disorders is being announced by the Substance Abuse and Mental Health Services Administration (SAMHSA). The definition is the product of a year-long effort by SAMHSA and a wide range of partners in the behavioral health care community and other fields to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental disorders and substance use disorders, along with major guiding principles that support the recovery definition. SAMHSA led this effort as part of its Recovery Support Strategic Initiative.
The new working definition of Recovery from Mental Disorders and Substance Use Disorders is as follows:
A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
“Over the years it has become increasingly apparent that a practical, comprehensive working definition of recovery would enable policy makers, providers, and others to better design, deliver, and measure integrated and holistic services to those in need,” said SAMHSA Administrator Pamela S. Hyde. “By working with all elements of the behavioral health community and others to develop this definition, I believe SAMHSA has achieved a significant milestone in promoting greater public awareness and appreciation for the importance of recovery, and widespread support for the services that can make it a reality for millions of Americans.”…
Through the Recovery Support Strategic Initiative, SAMHSA has also delineated four major dimensions that support a life in recovery:
Health : overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
Home: a stable and safe place to live;
Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
Community : relationships and social networks that provide support, friendship, love, and hope.
Guiding Principles of Recovery
Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them.
Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s).
Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds ? including trauma experiences ? that affect and determine their pathway(s) to recovery. Abstinence is the safest approach for those with substance use disorders.
Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. The array of services and supports available should be integrated and coordinated.
Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery
Recovery is supported through relationship and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change.
Recovery is culturally-based and influenced : Culture and cultural background in all of its diverse representations ? including values, traditions, and beliefs ? are keys in determining a person’s journey and unique pathway to recovery.
Recovery is supported by addressing trauma : Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.
Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery.
Recovery is based on respect : Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery.
For further detailed information about the new working recovery definition or the guiding principles of recovery please visit: http://www.samhsa.gov/recovery/
SAMHSA is a public health agency within the Department of Health and Human Services. Its mission is to reduce the impact of substance abuse and mental illness on America’s communities.
Back in the late 70’s I was in a graduate Community Information program (similar to a library science program..but not accredited by the American Library Association)
My internship was at the local state hospital for the mentally ill. The program I was in had a partnership with the state hospital.
The program set up an information and referral (I&R) center
The I & R center included pamphlets, brochures, and other handouts in areas the newly released would find handy. I remember social services, food pantries, legal aid societies, health clinics, and churches.
The social workers and other staff, as well as the university program interns, would interview the patients about to be released about their information needs. Then relevant information would be collected from the I & R center and be discussed with the patients.
To this day, I wonder just how helpful this whole process was..I remember follow up studies were done, but never saw the final reports. Still, patients were being released at an astounding rate, and while not perfect, it did somewhat address the need…
When the university program was abolished in the 80s, I believe the “database” of information..it was all in paper format..eventually went over to the United Way to supplement their information on local agencies)
Abstract:Fifty years ago, America began a grand experiment by transferring to the federal government the fiscal responsibility for individuals with mental illnesses. During that half-century, it has become increasingly clear that the experiment has been a costly failure, both in terms of human lives and in terms of dollars. The outcome was, in fact, clear as early as 1984, when the chief architect of the federal community mental health centers program proclaimed it to be a failure: “The result is not what we intended, and perhaps we didn’t ask the questions that should have been asked when developing a new concept….” Bringing sanity to our present mental health system is dependent on one essential change: Return the primary responsibility for such services to the states.
In 1963, the United States embarked upon a grand social experiment. Since the nation’s founding, responsibility for providing services for mentally disabled individuals had been assumed by state and local governments. The new plan proposed by President John F. Kennedy envisioned the closing of state psychiatric hospitals and the opening of federally funded community mental health centers (CMHCs) to provide psychiatric services. This effectively shifted the burden of responsibility from the states to the federal government. The states viewed it as a way to save state funds and effectively ceased their efforts to develop or improve existing services on their own.
Half a century later, the results of this noble experiment are clear. Rarely in the history of American government has a program conceived with such good intentions produced such bad results. The patients were deinstitutionalized from the state hospitals, but most of the 763 federally funded CMHCs failed to provide services for them. The majority of the discharged patients, and those who became mentally ill after the hospitals closed, ended up homeless, incarcerated in jails and prisons, or living in board-and-care homes and nursing homes that were often worse than the hospitals that had been closed….
…The consequences of this failed experiment for mentally ill individuals, for their families, and for the public at large are legion. Mentally ill homeless persons live on our streets like urban gargoyles and expropriate parks, playgrounds, libraries, and other public spaces. Jails and prisons have become progressively filled with mentally ill inmates, thereby transforming these institutions into the nation’s new psychiatric inpatient system….
…here are ways to bring sanity to our present mental health system, but they are dependent on one essential change: Return the primary responsibility for such services to the states. …
From the Medical News Today article, Tue Nov 22, 2011 13:00
A new brain imaging study led by researchers at Yale University shows how people who regularly practise meditation are able to switch off areas of the brain linked to daydreaming, anxiety, schizophrenia and other psychiatric disorders. The brains of experienced meditators appear to show less activity in an area known as the “default mode network”, which is linked to largely self-centred thinking. The researchers suggest through monitoring and suppressing or “tuning out” the “me” thoughts, meditators develop a new default mode, which is more present-centred…
In this week’s PLoS Medicine, Shekhar Saxena of the WHO in Geneva, Switzerland and colleagues summarize the recent WHO Mental Health Gap Action Programme (mhGAP) intervention guide that provides evidence-based management recommendations for mental, neurological, and substance use (MNS) disorders.
This guide is aimed at reducing the treatment gap for MNS disorders, which is more than 75% in many low- and middle-income countries (LMICs). Further details and background material to the guide can be accessed on the WHO website:http://bit.ly/vKPSRF
The authors recommend that: “In the near future, further efforts should be made to introduce formal evaluations of the capability of [treatment] programs to induce relevant and persistent changes, and to generate useful insights on how implementation in [low- and middle-income countries] should be conducted to maximize benefit at sustainable costs.”
— Football players experience repeated head trauma throughout their careers, which results in short and long-term effects to their cognitive function, physical and mental health. University of Missouri researchers are investigating how other lifestyle factors, including diet and exercise, impact the late-life health of former collision-sport athletes.
The researchers found that former football players experience more late-life cognitive difficulties and worse physical and mental health than other former athletes and non-athletes. In addition, former football players who consumed high-fat diets had greater cognitive difficulties with recalling information, orientation and engaging and applying ideas. Frequent, vigorous exercise was associated with higher physical and mental health ratings.
Here is an article that denotes a personal struggle with OCD, an anxiety disorder. She is one of the lucky ones who got help and then went out to find a way to help others. OCD is a terrifying illness and I am so happy she was able to overcome it enough to participate in learning to help others with this and other mental illnesses.
Mental illness is an equal opportunity player. No one is excused or exempt from playing in this game.
Learning the skills to help a mentally ill person is fairly easy to do. What is hard is challenging your own beliefs about the mentally ill and making changes in your own behavior toward them.
I am reposting this article for NPR in its entirety because I believe the more people that are exposed to this message the better. Please do click over and leave them a comment at the original site.
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by Kelley Weiss
October 10, 2011
When Nikki Perez was in her 20s, she had a job as a lab tech at a hospital in Sacramento, Calif. She said everything was going well until one day, when something changed.
“I worked in a very sterile environment, and so part of the procedure was to wash your hands,” she said. “I found myself washing my hands more and more, to the point where they were raw, and sometimes they would bleed.”
Perez went to the doctor and was diagnosed with something she had never even heard of — obsessive-compulsive disorder. At the time she was living with her parents. She quit her job and went on short-term disability.
Researchers say 1 in 4 adults has a mental disorder. But while many Americans are trained in first aid and CPR to respond to medical emergencies, few are prepared to help others experiencing a mental health crisis.
Perez said her illness turned her life upside down. She would sit in her parents’ room watching TV on the floor, afraid to move. She didn’t want to get caught up in the obsessive routines around the house.
“You check locks, check the washer, check the doors, check the window — I did a lot of checking,” she said.
Overall, it was profoundly isolating. Her family, like many people, didn’t know how to handle mental illness.
Finally, she got treatment, but her experience made her want to learn more about mental health issues so she could help others in crisis.
Emotional Crises More Common Than Heart Attacks
She found just the right class, called Mental Health First Aid. Bryan Gibb is the director of public education for the National Council for Community Behavioral Healthcare, which runs the course.
“We often train to know CPR or the Heimlich maneuver or first aid. But the reality is, it’s much more likely that we’re going to come in contact with someone suffering from an emotional crisis than someone suffering a heart attack or choking in a restaurant,” he said.
In a 12-hour course, Gibb teaches people how to identify different types of mental illness: depression, anxiety disorders, psychosis, eating disorders and substance abuse.
Part of the learning process involves group exercises. Nikki Perez participated in one that simulated what it’s like for people who hear voices. She tried to have a conversation while someone whispered in her ear “don’t trust him,” “you’re a failure,” and “is he looking at you?”
After the class, members who get this firsthand perspective of the different symptoms of mental illness then learn how to approach someone who’s having a psychotic episode. They’re told to speak calmly and clearly, and not to dismiss or challenge the person about their hallucinations.
Direct Questions For The Suicidal
As with any first-aid course, there’s an Action Plan for what to do if someone’s in crisis: assess the person for risk of harm or suicide, listen non-judgmentally, give reassurance, and encourage the person to seek professional help.
Gibb says that for this to work, people need to force themselves to ask direct questions:Are you thinking of killing yourself? Do you have a plan? Do you have the things you need to complete that plan?
Gibb told the class to never leave an actively suicidal person alone and to call the police if the person has a weapon or is acting aggressively.
Longtime mental health advocates with the National Alliance on Mental Illness, or NAMI, say courses like this raise awareness about mental illness. Jessica Cruz, executive director of NAMI California, said this reduces the stigma around getting help.
“If people know that others are trained in how to deal with a crisis situation, they may even reach out for help before they even get to that crisis point,” she said.
Cruz is so impressed with the course, her own staff is going to be trained next month.
“It seems like it could be just universally applied, just like CPR,” Cruz said.
That’s already under way at schools, the workplace and churches. Since it started three years ago, more than 30,000 people have been trained around the country; another 20,000 are expected to get training by the end of the year.
Perez says she would recommend this course to anyone.
“I think it’s one of the best things that I’ve ever done for myself so far,” she said.
The National Council for Community Behavioral Healthcare said thousands of people like Perez now have the skills to help those experiencing a mental health crisis. But the group emphasized that this is first-aid training and should be used to keep someone safe and stabilized until the professional help arrives, just like if you’re responding to someone having a heart attack.
Short-stay inpatient hospitalizations for children and adolescents with a psychiatric diagnosis increased significantly over a 12-year period (1996 to 2007) and decreased for the elderly, according to a report in the early online edition in Archives of General Psychiatry by Joseph C. Blader, Ph.D., Assistant Professor, Department of Psychiatry & Behavioral Science at Stony Brook University School of Medicine…
59.5% of antidepressant prescriptions were made with no diagnosis in 1996, in 2007 the figure rose to 72.7%, researchers reported in Health Affairs. Antidepressant drugs are today the third most commonly prescribed class of drugs in the USA.
Nearly 8.9% of the American population had at least one antidepressant prescription during any given month during the period 2005-2008.
A good proportion of this growth in antidepressant prescription has been by non-specialist providers whose patients were not diagnosed by a psychiatrist.
This is a brand new published interview-series (7 parts), with psychiatrists Dr. Joe Parks, Dr. Richard H. Weisler, and Dr. Henry A. Nasrallah on the magnitude, impact, and means of addressing this critical situation. I highly recommend not only reading this synopsis but to read through the entire series as well.
Summary:
Evidence shows that this country is short 45,000 psychiatrists.
According to the National Association of State Mental Health Program Directors (NASMHPD),[3] mental health spending dropped 5% from 2009 to 2010 and it is predicted to go down another 8% in 2011.
The National Alliance on Mental Illness study in North Carolina found that there were 3000 people on a waiting list for admission in only the first 6 months of the year; 212 people out of 3000 waited more than a week and 900 just quit looking — they just left.
References.
Editor’s Note:
“The United States is facing a severe lack of psychiatric care resources. Given the current economic crisis, the problem is only getting worse as state budgets for mental health care continue to be cut.”
Evidence shows that this country is short 45,000 psychiatrists.
At times of stress, like we have had in the last few years with the economy, there is an increase in psychiatric demand, particularly in terms of depression, anxiety, suicidality, and drug abuse.
The seriously mentally ill patients are not well served for numerous reasons. Beyond just a lack of resources, the system is a problem unto itself.
Psychiatry is the number-one area in which more professionals are needed.
According to the National Association of State Mental Health Program Directors (NASMHPD),[3] mental health spending dropped 5% from 2009 to 2010 and it is predicted to go down another 8% in 2011.
Is the Economy to Blame?
“The economy is an easy scapegoat for the recent decline in mental health resources, but it sounds like the consensus is that the system has been at least partially broken for quite a while. “
The single biggest cause of suffering for many of our patients is that they cannot be admitted to a hospital when they relapse during medical treatment. According to a 2010 report by the Treatment Advocacy Center,[4] there was 1 bed per 300 people in the United States in 1955; currently, we have 1 bed for every 3000 people.
Maldistribution.
There are wide variances in overall funding for mental health resources, whether it’s hospital beds or community resources. There are huge maldistributions in terms of psychiatrists per 100,000 people.
There are about 3 or 4 times the number or psychiatrists in New York or Massachusetts per capita, compared with states like Texas. There are fewer psychiatrists for severely ill patients than it appears because only a small percentage of them are really seeing the very sick patients. Relatively few psychiatrists choose to work in community mental health centers or state or VA hospitals, where the sickest and most disabled patients are.
The key thing is not to treat patients in isolation, you have to reach out and develop relationships.
The recent removal of consultation codes for Medicare and some other insurance providers may undermine efforts to increase interdisciplinary consultations and collaboration because of reduced reimbursements.
Model of collaborative care.
The primary care of the seriously mentally ill is in this country, especially after the CATIE study found that a large proportion of persons with schizophrenia in the outpatient setting in the United States had their serious medical problems ignored.[11] There is hardly any relationship between community mental health centers and primary care clinics.
The CATIE study showed:
● 60% of patients with schizophrenia who had frank hypertension had never received an antihypertensive drug.
● 90% of those who had high cholesterol or triglycerides had never received a statin.
● 30% of those with clinical diabetes have never received treatment for diabetes.
“This reflects an unconscionable neglect of the physical health of the mentally ill, and it is a result of this lack of bridging between primary care and psychiatry, especially in community mental health centers.”
What are the ramifications of inadequate mental health resources?
There needs to be about 40 beds per 100,000 people, there is only 17 per 100,000. Hundreds of thousands of psychiatric patients are now being sent to correctional facilities.
According to some studies and statistics:
● 35%-54% of prisoners have symptoms of mania.
● 16%-30% have major depression.
● 10%-24% have some psychotic symptoms, such as delusions or hallucinations (Table 2).[4,12]
● Even more conservative estimates reflect that 16% of prisoners have mental illness.[13]
Many of the people with mental illness have co-occurring substance abuse and disorders, and many of their convictions are substance abuse related. Prisons are releasing to the community people with chronic mental illness; this only predisposes them to repetitive rehospitalization for psychotic and manic episodes due to poor adherence or, more likely, incarceration.
The ER is where everybody goes when they have a medical illness but no primary care provider, and the same thing happens with the mentally ill. A substantial number of those who present to the ER have a mental illness.
The National Alliance on Mental Illness study in North Carolina found that there were 3000 people on a waiting list for admission in only the first 6 months of the year; 212 people out of 3000 waited more than a week and 900 just quit looking — they just left.[15]
Is Healthcare Reform the Answer?
By improving the reimbursement for mental illness — the hospitalized mentally ill — would definitely incentivize hospitals to stop closing those units and maybe even to open new ones.
A report entitled “Recommendations to Foster System Reform for Adults With Serious Mental Illness,”[16] identifying 5 key priorities for legislative, policy, and program implementation as part of National Health Reform.
The 5 key priorities are:
● Developing a set of performance measures specific to treatment of mental illness.
● Designating persons with mental illness a health disparities population.
● Including mental health treatment providers in federal funding and policy related to health information technology initiatives.
● Making sure that the new healthcare home initiatives adequately address mental illness.
● Developing a national definition of “medical necessity” that adequately meets the needs of persons with mental illness.
References
Konrad TR, Ellis AR, Thomas KC, Holzer CE, Morrissey JP. County-level estimates of mental health professional shortage in the United States. Psychiatr Serv. 2009;60:1323-1328. Abstract
Wing JK. How many psychiatric beds? Psychol Med. 1971;1:188-190.
Goplerud EN. Assessing methods of predicting the need for psychiatric beds. Hosp Community Psychiatry. 1986;37:391-395. Abstract
Häfner H. Do we still need beds for psychiatric patients? An analysis of changing patterns of mental health care. Acta Psychiatr Scand. 1987;75:113-126. Abstract
Hirsch SR, Gerrard B, Malin H, et al. Psychiatric Beds and Resources: Factors Influencing Bed Use and Service Planning. Report of a Working Party of the Section for Social and Community Psychiatry of the Royal College of Psychiatrists. London: Gaskell; 1988.
Davis GE, Lowell WE, Davis GL. Determining the number of state psychiatric hospital beds by measuring quality of care with artificial neural networks. Am J Medical Quality. 1998;13:13-24.
Hagedorn H. A Manual on State Mental Health Planning. NIMH, DHEW Publication No. ADM77-473. Washington, DC: U.S. Government Printing Office; 1977.
Nasrallah HA, Meyer JM, Goff DC, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res. 2006;86:15-22.Abstract
Kuehn BM. Mental health courts show promise. JAMA. 2007;297:1641-1643.Abstract
Lamb RH, Weinberger LE. The shift of psychiatric inpatient care from hospitals to jails and prisons. J Am Acad Psychiatry Law. 2005;33:529-534.Abstract
Swartz MS, Swanson JW, Wagner HR, Burns BJ, Hiday VA, Borum R. Can involuntary outpatient commitment reduce hospital recidivism?: Findings from a randomized trial with severely mentally ill individuals. Am J Psychiatry. 1999;156:1968-1975.Abstract
National Association of County Behavioral Health and Developmental Disability Directors. Recommendations to Foster System Reform for Adults With Serious Mental Illness. Available at:http://nacbhdd.org/content/Fostering%20System%20Reform%209-8-10.pdf Accessed September 14, 2010.
Stetka B. “US Psychiatric Resources: A Country in Crisis” September 22, 2010. Medscape Psychiatry & Mental Health. Available at: http://www.medscape.com/viewarticle/728676 [Accessed 22 Sept 2010].
This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.
Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.
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September 15, 2010.
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