Health and Medical News and Resources

General interest items edited by Janice Flahiff

Gulf War Illness (Gulf War Syndrome) Resources of Note

Approximate area and major clashes in which DU...

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Gulf War syndrome

Image via WikipediaGulf War Illness (Gulf War Syndrome) Resources of Note

Gulf War Illness (Gulf War Syndrome) Resources of Note

A few good relatively comprehensive Web sites

The VA recognizes certain infectious diseases as related to military service in Southwest Asia during the first Gulf War starting August 2, 1990, through the conflict in Iraq and on or after September 19, 2001, in Afghanistan.
Regions of the brain affected by PTSD and stress.

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Some examples
Some links at this Web page

Military and Veterans Health Care(Henry J. Kaiser Family Foundation)
Military Mental Health(American Psychiatric Association)
Resources for Returning Veterans and Their Families(Substance Abuse and Mental Health Services Administration)

Organizations

Medical Librarian Karen Estrada is the publisher. Mrs. Estrada serves clinical medical professionals state-side and abroad (military & civilian), members of the military, veterans, military families, military medicine/health researchers, and organizations (mil/vet) located all over the globe including ‘in theater’ (Afghanistan, Iraq and Kuwait).”

A few more Web sites

February 8, 2011 Posted by | Uncategorized | , , , , , , , | 1 Comment

Kids of Deployed Soldiers May Face More Mental Health Woes

HealthDay news image

Study found they needed more doctor visits to handle issues from parent‘s absence

 

From a November 8, 2010 Health Day news item

MONDAY, Nov. 8 (HealthDay News) — Mental and behavioral problems cause children of U.S. soldiers deployed to Iraq, Afghanistan and other war zones to need considerably more outpatient medical visits than those with non-deployed parents, a new study suggests.

Researchers examined the medical records of more than 640,000 military children between the ages of 3 and 8, and found that those separated from deployed parents sought treatment 11 percent more often for cases of mood, anxiety and adjustment disorders. Visits for conditions such as autism and attention-deficit disorder, whose causes are not linked to deployment, also increased.

The study, reported online Nov. 8 and in the December issue of the journal Pediatrics [article is free through this link], also revealed larger increases in mental and behavioral visits among older children, children with military fathers and children of married military parents.

“It’s statistically significant, but I also think it’s clinically significant,” said lead researcher Dr. Gregory Gorman, an assistant professor of pediatrics at Uniformed Services University of the Health Sciences in Bethesda, Md. “These are also probably the worst cases.”

Gorman said he was surprised to find that while these types of medical visits went up, the rates of visits for all other medical conditions dropped.

“I have no direct evidence, but we hypothesize that when a parent is deployed . . . and the other parent has to do all of the duties, they may want to handle other problems at home,” Gorman said. “These parents who remain at home need to multi-task even more.”…

…In Gorman’s study, the most frequent primary diagnosis during mental and behavioral health visits was attention-deficit disorder (ADD). Adjustment and autistic disorders came next, while farther down the list were mood and anxiety disorders, oppositional defiant disorder, developmental delays, post-traumatic stress disorder, bedwetting and separation anxiety.

SOURCES: Gregory Gorman, M.D., assistant professor, pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Md.; Rick Olson, retired Army general, director, strategic communications, Child, Adolescent and Family Behavioral Health Proponency, Fort Lewis, Wash.; December 2010 Pediatrics

 

November 12, 2010 Posted by | Consumer Health, Health News Items | , , , , , , , , | Leave a comment

Severe Lack of Psychiatric Resources in the US

National Institute of Mental Health Clinical C...

National Institute of Mental Health Clinical Center (Photo credit: Wikipedia)

From a Military Health Matters! blog item by Karen Estrada, MS

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.”

Prisons: The New Psych Ward.

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.

Emergency Rooms.

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

  1. 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
  2. President’s mental health commission recommends transforming America’s mental health care system. Mental Health Commission Web site. Available at: http://www.mentalhealthcommission.gov/press/july03press.htm. Accessed September 13, 2010.
  3. As economy takes toll, mental health budgets shrink. Stateline Website. Available at: http://www.stateline.org/live/details/story?contentId=499181. Accessed September 3, 2010.
  4. Torrey EF. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. Available at: http://www.treatmentadvocacycenter.org/storage/tac/documents/final_jails_v_hospitals_study.pdf Accessed September 3, 2010.
  5. Wing JK. How many psychiatric beds? Psychol Med. 1971;1:188-190.
  6. Goplerud EN. Assessing methods of predicting the need for psychiatric beds. Hosp Community Psychiatry. 1986;37:391-395. Abstract
  7. 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
  8. 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.
  9. 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.
  10. Hagedorn H. A Manual on State Mental Health Planning. NIMH, DHEW Publication No. ADM77-473. Washington, DC: U.S. Government Printing Office; 1977.
  11. 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
  12. Kuehn BM. Mental health courts show promise. JAMA. 2007;297:1641-1643.Abstract
  13. 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
  14. 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
  15. Biesecker M. Mentally ill often turned away, end up in ER. Raleigh News and Observer. August 7, 2010. Available at:http://www.newsobserver.com/2010/08/07/618475/mentallyilloftenturnedaway.html Accessed September 13, 2010.
  16. 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.
  17. Pies R. “Prescribing psychologists:” practicing medicine without a license? March 29, 2010. Psychiatric Times. Available at:http://www.psychiatrictimes.com/geriatricpsychiatry/content/article/10168/1545667 Accessed September 15, 2010.

SOURCE

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].

Please See More: Severe Lack of Psychiatric Resources in the US  – Today on Milhealth’s Directory – MHD http://www.milhealthsdirectory.org/today-on-milhealths-directory/severe-lack-of-psychiatric-resources-in-the-us.html#ixzz10ivE2ipf
Under Creative Commons License: Attribution Non-Commercial No Derivatives

September 27, 2010 Posted by | Health News Items, Psychiatry, Psychology | , , , , , | 3 Comments

Military suicide prevention efforts fail: report & related items from a military health Web site

Excerpts from a Reuters news item

WASHINGTON (Reuters) – Efforts to prevent suicides among U.S. war veterans are failing, in part because distressed troops do not trust the military to help them, top military officials said on Thursday.

Poor training, a lack of coördination and an overstretched military are also factors, but a new 76-point plan lays out ways to improve this, Colonel John Bradley, chief of psychiatry at Walter Reed Army Hospital in Washington, told a conference.

Each branch of the services — the Army, Air Force, Navy and Marines — rushed to create a suicide prevention program, but there was no coördination. The report recommends that the defense secretary’s office take over coördination of suicide prevention efforts.

On-the-ground prevention training often failed because those running the sessions did not understand their importance, Bradley said.

“They are mocked and they are probably harmful,” he said.

According to the report, available at http://www.health.mil/dhb/default.cfm, 1,100 servicemen and women committed suicide in 2005 to 2009 — one suicide every day and a half. The Army’s suicide rate doubled in that time.

—————————————————–

Librarian Karen Estrada publishes Milhealth’s Directory of Military Health Information
Her recent postings on military suicides

**Complex Puzzle of Military Suicides: Is it Really? (a personal observation)

**Shoulder to Shoulder: I Will Never Quit on Life posting at the site’s home page

SOURCES

http://www.army.mil Army releases new video to combat suicides. 17 July 2010. By Alexandra Hemmerly-Brown. Available at:    http://www.army.mil/-news/2010/07/17/42436-army-releases-new-video-to-combat-suicides/?ref=news-home-title0 [Accessed 19JUL2010].

http://www.army.mil. Shoulder to Shoulder: DA civilian training. July 15, 2010. Available at: http://www.army.mil/media/amp/?bctid=115348558001 [Accessed 19 July 2010].

National Institutes of Health. MedlinePlus, the Magazine. Winter 2010. Preventing Suicides in the Military. pp 5-6. Available at: http://www.nlm.nih.gov/medlineplus/magazine/issues/pdf/MLP_Winter_2010.pdf [Accessed 19 July 2010].

Related News Items

Improved behavioral health needed to respond to rising number of suicides among US Armed Forces

February 17, 2011 12:00:00 AM EST

(RAND Corporation) Suicide rates in the US military have increased sharply since 2001 as the nation fights two wars. A new study sponsored by the Department of Defense finds that military officials should improve efforts to identify those at-risk and improve both the quality and access to behavioral health treatment to combat the problem. Needed changes include promoting the advantages of using behavioral health care and assuring that service members can receive help confidentially.


September 26, 2010 Posted by | Consumer Health, Finding Aids/Directories, Health News Items, Librarian Resources, Professional Health Care Resources | , , , , , , , | 1 Comment

War Damages Future Work Prospects of Many U.S. Vets: Data

Soldiers exposed to combat more likely to be disabled, unemployed throughout life, study shows

Excerpt: “Veterans who saw combat started their work lives at a relative disadvantage that they were unable to overcome. Soldiers exposed to combat were more likely than non-combat veterans to be disabled and unemployed in their mid-20s and to remain so throughout their worklife,” Alair MacLean, an assistant professor in the sociology department at Washington State University Vancouver, said in an American Sociological Association news release.

The full text of the associated scholarly article may be found here.

August 11, 2010 Posted by | Health News Items | , | Leave a comment

   

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