Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Access to Mental Health Services. Show all posts
Showing posts with label Access to Mental Health Services. Show all posts

Thursday, April 30, 2020

Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm?

Reger MA, Stanley IH, Joiner TE.
JAMA Psychiatry. 
Published online April 10, 2020.
doi:10.1001/jamapsychiatry.2020.1060

Suicide rates have been rising in the US over the last 2 decades. The latest data available (2018) show the highest age-adjusted suicide rate in the US since 1941.1 It is within this context that coronavirus disease 2019 (COVID-19) struck the US. Concerning disease models have led to historic and unprecedented public health actions to curb the spread of the virus. Remarkable social distancing interventions have been implemented to fundamentally reduce human contact. While these steps are expected to reduce the rate of new infections, the potential for adverse outcomes on suicide risk is high. Actions could be taken to mitigate potential unintended consequences on suicide prevention efforts, which also represent a national public health priority.

COVID-19 Public Health Interventions and Suicide Risk

Secondary consequences of social distancing may increase the risk of suicide. It is important to consider changes in a variety of economic, psychosocial, and health-associated risk factors.

Economic Stress

There are fears that the combination of canceled public events, closed businesses, and shelter-in-place strategies will lead to a recession. Economic downturns are usually associated with higher suicide rates compared with periods of relative prosperity.2 Since the COVID-19 crisis, businesses have faced adversity and laying off employees. Schools have been closed for indeterminable periods, forcing some parents and guardians to take time off work. The stock market has experienced historic drops, resulting in significant changes in retirement funds. Existing research suggests that sustained economic stress could be associated with higher US suicide rates in the future.

Social Isolation

Leading theories of suicide emphasize the key role that social connections play in suicide prevention. Individuals experiencing suicidal ideation may lack connections to other people and often disconnect from others as suicide risk rises.3 Suicidal thoughts and behaviors are associated with social isolation and loneliness.3 Therefore, from a suicide prevention perspective, it is concerning that the most critical public health strategy for the COVID-19 crisis is social distancing. Furthermore, family and friends remain isolated from individuals who are hospitalized, even when their deaths are imminent. To the extent that these strategies increase social isolation and loneliness, they may increase suicide risk.

The info is here.

Thursday, June 20, 2019

Legal Promise Of Equal Mental Health Treatment Often Falls Short

Graison Dangor
Kaiser Health News
Originally pubished June 7, 2019

Here is an excerpt:

The laws have been partially successful. Insurers can no longer write policies that charge higher copays and deductibles for mental health care, nor can they set annual or lifetime limits on how much they will pay for it. But patient advocates say insurance companies still interpret mental health claims more stringently.

“Insurance companies can easily circumvent mental health parity mandates by imposing restrictive standards of medical necessity,” said Meiram Bendat, a lawyer leading a class-action lawsuit against a mental health subsidiary of UnitedHealthcare.

In a closely watched ruling, a federal court in March sided with Bendat and patients alleging the insurer was deliberately shortchanging mental health claims. Chief Magistrate Judge Joseph Spero of the U.S. District Court for the Northern District of California ruled that United Behavioral Health wrote its guidelines for treatment much more narrowly than common medical standards, covering only enough to stabilize patients “while ignoring the effective treatment of members’ underlying conditions.”

UnitedHealthcare works to “ensure our products meet the needs of our members and comply with state and federal law,” said spokeswoman Tracey Lempner.

Several studies, though, have found evidence of disparities in insurers’ decisions.

The info is here.

Thursday, April 12, 2018

CA’s Tax On Millionaires Yields Big Benefits For People With Mental Illness

Anna Gorman
Kaiser Health News
Originally published March 14, 2018

A statewide tax on the wealthy has significantly boosted mental health programs in California’s largest county, helping to reduce homelessness, incarceration and hospitalization, according to a report released Tuesday.

Revenue from the tax, the result of a statewide initiative passed in 2004, also expanded access to therapy and case management to almost 130,000 people up to age 25 in Los Angeles County, according to the report by the Rand Corp. Many were poor and from minority communities, the researchers said.

“Our results are encouraging about the impact these programs are having,” said Scott Ashwood, one of the authors and an associate policy researcher at Rand. “Overall we are seeing that these services are reaching a vulnerable population that needs them.”

The positive findings came just a few weeks after a critical state audit accused California counties of hoarding the mental health money — and the state of failing to ensure that the money was being spent. The February audit said that the California Department of Health Care Services allowed local mental health departments to accumulate $231 million in unspent funds by the end of the 2015-16 fiscal year — which should have been returned to the state because it was not spent in the allowed time frame.

Proposition 63, now known as the Mental Health Services Act, imposed a 1 percent tax on people who earn more than $1 million annually to pay for expanded mental health care in California. The measure raises about $2 billion each year for such services, such as preventing mental illness from progressing, reducing stigma and improving treatment. Altogether, counties have received $16.53 billion.

The information is here.

Thursday, November 30, 2017

Artificial Intelligence & Mental Health

Smriti Joshi
Chatbot News Daily
Originally posted

Here is an excerpt:

There are many barriers to getting quality mental healthcare, from searching for a provider who practices in a user's geographical location to screening multiple potential therapists in order to find someone you feel comfortable speaking with. The stigma associated with seeking mental health treatment often leaves people silently suffering from a psychological issue. These barriers stop many people from finding help and AI is being looked at a potential tool to bridge this gap between service providers and service users.

Imagine how many people would be benefitted if artificial intelligence could bring quality and affordable mental health support to anyone with an internet connection. A psychiatrist or psychologist examines a person’s tone, word choice, and the length of a phrase etc and these are all crucial cues to understanding what’s going on in someone’s mind. Machine learning is now being applied by researchers to diagnose people with mental disorders. Harvard University and University of Vermont researchers are working on integrating machine learning tools and Instagram to improve depression screening. Using color analysis, metadata, and algorithmic face detection, they were able to reach 70 percent accuracy in detecting signs of depression. The research wing at IBM is using transcripts and audio from psychiatric interviews, coupled with machine learning techniques, to find patterns in speech to help clinicians accurately predict and monitor psychosis, schizophrenia, mania, and depression. A research, led by John Pestian, a professor at Cincinnati Children’s Hospital Medical Centre showed that machine learning is up to 93 percent accurate in identifying a suicidal person.

The post is here.

Saturday, November 4, 2017

Prince Harry: mental health should be at heart of armed forces training

Caroline Davies
The Guardian
Originally posted October 9, 2017

Prince Harry has said mental health strategies for armed forces personnel are crucial to create a “more confident, focused and, ultimately, more combat-ready military”.

In a speech at the Ministry of Defence, the 33-year-old prince, who spent 10 years in the army, said that as the number of active-duty personnel had been reduced there was a premium on “every individual being fighting fit and deployable”.

Announcing a joint initiative between the MoD and the Royal Foundation, created by the prince and the Duke and Duchess of Cambridge to tackle mental health issues, Harry said mental health strategies needed to be at the forefront of armed forces personnel training.

“Quite simply, these men and women are prized assets which need to be continually invested in. We surely have to think of them as high-performance athletes, carrying all their kit, equipment and a rifle,” he said. “Crucially, fighting fitness is not just about physical fitness. It is just as much about mental fitness too.”

The MoD said the move would build upon a recently launched government strategy aimed at improving mental health among military workers, civilian staff, their families and veterans.

The article is here.

Friday, May 12, 2017

US Suicide Rates Display Growing Geographic Disparity.

JAMA.
2017;317(16):1616. doi:10.1001/jama.2017.4076

As the overall US suicide rate increases, a CDC study showed that the trend toward higher rates in less populated parts of the country and lower rates in large urban areas has become more pronounced.

Using data from the National Vital Statistics System and the US Census Bureau, the researchers reported that from 1999 to 2015, the annual suicide rate increased by 14%, from 12.6 to 14.4 per 100, 000 US residents aged 10 years or older.

(cut)

Higher suicide rates in less urban areas could be linked with limited access to mental health care, the opioid overdose epidemic, and social isolation, the investigators suggested. The 2007-2009 economic recession may have caused the sharp upswing, they added, because rural areas and small towns were hardest hit.

The article is here

Friday, March 3, 2017

California Regulator Slams Health Insurers Over Faulty Doctor Lists

Chad Terhune
Kaiser Health News
Originally published February 13, 2017

California’s biggest health insurers reported inaccurate information to the state on which doctors are in their networks, offering conflicting lists that differed by several thousand physicians, according to a new state report.

Shelley Rouillard, director of the California Department of Managed Health Care, said 36 of 40 health insurers she reviewed — including industry giants like Aetna and UnitedHealthcare — could face fines for failing to submit accurate data or comply with state rules.

Rouillard said she told health plan executives in a meeting last week that such widespread errors made it impossible for regulators to tell whether patients have timely access to care in accordance with state law.

“I told the CEOs it looks to me like nobody cared. We will be holding their feet to the fire on this,” Rouillard said in an interview with California Healthline. “I am frustrated with the health plans because the data we got was unacceptable. It was a mess.”

The article is here.

Sunday, December 18, 2016

There may be no worse place for mentally ill people to receive treatment than prison

By The Spotlight Team
The Boston Globe
Originally posted November 25, 2016

Here is an excerpt:

Last year, more than 15,000 prisoners walked out of Massachusetts jails and prisons. More than one-third suffer from mental illness; more than half have a history of addiction. Thousands are coping with both kinds of disorders, their risk of problems amplified as they reenter society.

Within three years of being released, 37 percent of inmates who leave state prisons with mental illnesses are locked up again, compared with 30 percent of those who do not have mental health problems, according to a Department of Correction analysis of 2012 releases. Inmates battling addiction fare worse: About half are convicted of a new crime within three years, according to one state study. And inmates with a “dual diagnosis” of addiction and mental illness, like Nick Lynch, do the worst of all, national studies show.

Despite the vast need — and the potential payoff in reduced recidivism — mental health and substance abuse treatment for many Massachusetts inmates is chronically undermined by clinician shortages, shrinking access to medication, and the widespread use of segregation as discipline. The prison environment itself is a major obstacle to treatment: In a culture ruled by aggression and fear, the trust and openness required for therapy are exponentially harder to achieve.

And when their incarcerations end, many mentally ill and drug-addicted prisoners are sent back into the world without basic tools they need to succeed, such as ready access to medication, addiction counseling, or adequate support and oversight. Such omissions can be critical: The Harvard-led Boston Reentry Study found in 2014 that inmates with a mix of mental illness and addiction are significantly less likely than others to find stable housing, work income, and family support in the critical initial period after leaving prison, leaving them insecure, isolated, and at risk of falling into “diminished mental health, drug use and relapse.”

The article is here.

Wednesday, November 23, 2016

Increase in US Suicide Rates and the Critical Decline in Psychiatric Beds

Tarun Bastiampillai, Steven S. Sharfstein, & Stephen Allison
JAMA. Published online November 3, 2016

The closure of most US public mental hospital beds and the reduction in acute general psychiatric beds over recent decades have led to a crisis, as overall inpatient capacity has not kept pace with the needs of patients with psychiatric disorders. Currently, state-funded psychiatric beds are almost entirely forensic (ie, allocated to people within the criminal justice system who have been charged or convicted). Very limited access to nonforensic psychiatric inpatient care is contributing to the risks of violence, incarceration, homelessness, premature mortality, and suicide among patients with psychiatric disorders. In particular, a safe minimum number of psychiatric beds is required to respond to suicide risk given the well-established and unchanging prevalence of mental illness, relapse rates, treatment resistance, nonadherence with treatment, and presentations after acute social crisis. Very limited access to inpatient care is likely a contributing factor for the increasing US suicide rate. In 2014, suicide was the second-leading cause of death for people aged between 10 and 34 years and the tenth-leading cause of death for all age groups, with firearm trauma being the leading method.

Currently, the United States has a relatively low 22 psychiatric beds per 100 000 population compared with the Organisation for Economic Cooperation and Development (OECD) average of 71 beds per 100 000 population. Only 4 of the 35 OECD countries (Italy, Chile, Turkey, and Mexico) have fewer psychiatric beds per 100 000 population than the United States. Although European health systems are very different from the US health system, they provide a useful comparison. For instance, Germany, Switzerland, and France have 127, 91, and 87 psychiatric beds per 100 000 population, respectively.

The article is here.

Saturday, November 12, 2016

Why Suicide Keeps Rising for Middle-Aged Men

By Lisa Esposito
US News and World Report
Originally published Oct. 19, 2016

Suicide rates in the U.S. continue to rise, and working-age adults – particularly men – make up the largest increase, according to the Centers for Disease Control and Prevention. Middle-aged men in the 45 to 60 range experienced a 43 percent increase in suicide deaths from 1997 to 2014, and the rise has been even sharper since 2005. Untreated mental illness, the Great Recession, work-related issues and men's reluctance to reach out for help converge to put them at greater risk for taking their own lives. And because men are more likely than women to use a gun, their suicide attempts are more often fatal.

Historically, suicide rates have always been higher for men, says Dr. Alex Crosby, surveillance branch chief in the CDC's Division of Violence Prevention. "But what we've seen in these past few years is rates have been going up among males and females," he told journalists attending a National Press Foundation conference in September. "Still, rates are higher among males – about four times higher." For suicide attempts that don't prove fatal, the balance changes, with two to three times more females than males trying to take their own lives.

"In about half of the suicides in the United States, the mechanism or the method was a firearm," Crosby says. Males are more likely to use firearms, while poison is more common for females. However, he notes, "When you look at suicide in the military, females choose firearms almost as much as men."

The article is here.

Friday, November 11, 2016

Psychiatric patients wait the longest in emergency rooms

By Amy Ellis Nutt
The Washington Post
Originally published October 18, 2016

Here is an excerpt:

Many studies over the past decade have shown that ER overcrowding results in higher mortality rates of ER patients, higher costs and higher stress levels for medical professionals.

That overcrowding won’t end anytime soon, Parker said, unless access to outpatient treatment centers expands. But in the latest survey, more than half of the ER physicians said mental health resources in their communities had declined in the past year.

The paradox at the heart of the problem is almost beyond comprehension, in Lippert’s view.

“Nowhere else in medicine,” she said, “do we have our most severely ill patients staying the longest.”

The article is here.

Wednesday, November 9, 2016

Report: More than half of mentally ill U.S. adults get no treatment

By Amy Ellis Nutt
The Washington Post
Originally published October 19, 2016

Mental Health America just released its annual assessment of Americans with mental illness, the treatment they receive and the resources available to them — and the conclusions are sobering: Twenty percent of adults (43.7 million people) have a mental health condition, and more than half of them do not receive treatment. Among youth, the rates of depression are rising, but 80 percent of children and adolescents get either insufficient treatment or none at all.

“Once again, our report shows that too many Americans are suffering and far too many are not receiving the treatment they need to live healthy and productive lives,” Paul Gionfriddo, president of Mental Health America, said in a statement. “We must improve access to care and treatments, and we need to put a premium on early identification and early intervention for everyone with mental health concerns.”

The article is here.

Wednesday, November 2, 2016

Hard Time or Hospital Treatment? Mental Illness and the Criminal Justice System

Christine Montross
N Engl J Med 2016; 375:1407-1409
October 13, 2016

Here is an excerpt:

When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.

It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.

When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.

The article is here.

Monday, October 10, 2016

Why do suicidal patients wait hours for a hospital bed?

By Corinne Segal
PBS News Hour
September 18, 2016

Here is an excerpt:

Health workers and lawmakers are working to accommodate patients like Durant as America endures a suicide surge, with suicide deaths rising from 29,000 people to 43,000 people between 1999 and 2014. Some have tried to increase the number of psychiatric beds available to suicidal patients, a disappearing resource in recent years that forces patients like Durant to wait longs hours for care. Meanwhile, others are assessing whether the hospital is even the right place to start considering treatment.

In recent decades, “We closed thousands of beds and we didn’t cure mental health,” David Mattodeo, Executive Director of the Massachusetts Association of Behavioral Health Systems, said. “The problem didn’t go away.”

The article is here.

Federal Court Certifies Nationwide Class Action Challenging UBH Coverage Criteria

Press Release
Originally released September 20, 2016

In a significant mental health ruling, the United States District Court for the Northern District of California has come one step closer to ordering health insurance giant United Behavioral Health (UBH) to revamp its medical necessity criteria and reprocess thousands of outpatient, intensive outpatient and residential treatment claims it denied since 2011. Plaintiffs in two companion class-action lawsuits, Wit et al. v. UnitedHealthcare et al. and Alexander et al. v. United Behavioral Health, allege that UBH systematically denies coverage for mental health treatment by developing and applying "medical necessity" criteria that are far more stringent than generally accepted standards of care.

"Yesterday's class certification order is an important victory in the fight for mental health parity," said Meiram Bendat, president of Psych-Appeal, Inc. and co-counsel for the plaintiffs. "It signals that health insurers can be held responsible, on a class-wide basis, for denying insurance coverage for mental health treatment to those desperately in need. Without class certification, few, if any, patients will have the financial or emotional resources necessary to challenge this type of misconduct individually."

The plaintiffs' health plans, governed by the Employee Retirement Income Security Act (ERISA), require UBH to evaluate medical necessity according to generally accepted standards of care. UBH's proprietary medical necessity criteria purport to reflect these standards. However, the plaintiffs allege that a push for profits has led UBH to develop criteria that overemphasize acute mental health and substance use disorder symptoms and disregard chronic or complex conditions that require ongoing care, in contravention of generally accepted standards.

UBH is a subsidiary of UnitedHealth Group and is the country's largest managed behavioral health care organization, serving more than 60 million members.

Psych-Appeal, Inc. and Zuckerman Spaeder LLP have been appointed class counsel by the federal court and also represent plaintiffs in similar cases against Health Care Service Corporation (Blue Cross and Blue Shield of Illinois, Texas, New Mexico, Montana and Oklahoma), Magellan Health Services of California and Blue Shield of California.

The pressor is here.

Wednesday, August 10, 2016

Why are doctors plagued by depression and suicide?

By Judith Graham @judith_graham
STAT News
Originally published July 21, 2016

Here is an excerpt:

The starkest sign of the crisis gripping medicine is the number of physicians who commit suicide every year — 300 to 400, about the size of three average medical school classes. Male doctors are 1.4 times more likely to kill themselves than men in the general population; female physicians, 2.3 times more likely.

The grim tally is probably an under-count, since many suicides aren’t listed as such on death certificates. And it doesn’t include suicides among medical students, which aren’t tracked systematically in the United States.

In one study of six medical schools, nearly 1 in 4 students reported clinically significant symptoms of depression. Almost 7 percent said they had thought of ending their lives in the last two weeks.

The article is here.

Thursday, July 28, 2016

We live in a culture of mental health haves and have nots

Naomi Freundlich
KevinMD.com
Originally published July 4, 2016

Here is an excerpt:

Let’s start with enforcement. Multiple agencies oversee compliance with the parity laws, including state insurance boards, Medicaid, HHS or the Department of Labor, depending on how and where an individual is insured. Figuring out who to contact when there’s been a violation of parity laws can be difficult, especially when people are experiencing mental health problems.

Furthermore, although obvious discrepancies between behavioral and medical coverage are not all that common, according to Kaiser Health News, many insurers have figured out how to limit mental health costs through more subtle strategies that are harder to track. These include frequent and rigorous utilization review and so-called “fail first” therapies that require providers to try the least expensive therapies first even if they might not be the most effective. The KHN authors note, “Among the more murky areas is ‘medical necessity’ review — in which insurers decide whether a patient requires a certain treatment and at what frequency.”

A survey conducted by the National Alliance on Mental Illness found that patients were twice as likely to be denied mental health care (29 percent) based on “medical necessity” review than other medical care (14 percent).

The article is here.

Sunday, July 24, 2016

Nation’s psychiatric bed count falls to record low

By Lateshia Beachum
The Washington Post
Originally published July 1, 2016

The number of psychiatric beds in state hospitals has dropped to a historic low, and nearly half of the beds that are available are filled with patients from the criminal justice system.

Both statistics, reported in a new national study, reflect the sweeping changes that have taken place in the half-century since the United States began deinstitutionalizing mental illness in favor of outpatient treatment. But the promise of that shift was never fulfilled, and experts and advocates say the result is seen even today in the increasing ranks of homeless and incarcerated Americans suffering from serious mental conditions.

The article is here.

Monday, July 4, 2016

Experts worry high military suicide rates are 'new normal'

by Gregg Zoroya
USA Today
Originally published June 12, 2016

Seven years after the rate of suicides by soldiers more than doubled, the Army has failed to reduce the tragic pace of self-destruction, and experts worry the problem is a "new normal."

"It's very clear that nothing that the Army has done has resulted in the suicide rates coming down," said Carl Castro, a psychologist who retired from the Army in 2013, when he was a colonel overseeing behavioral health research programs.

The sharp rise in the Army's suicide rate from 2004 through 2009 coincided with unusually heavy demands on the nation's all-volunteer military, as hundreds of thousands of troops, most of them in the Army, deployed to Iraq and Afghanistan. The vast majority have since come home, but suicide rates remain stubbornly high.

The Army's suicide rate for active-duty soldiers averaged nearly 11-per-100-000 from Sept. 11, 2001, until shortly after the Iraq invasion in 2004. It more than doubled over the next five years, and, with the exception of a spike in 2012, has remained largely constant at 24-to-25-per-100,000, roughly 20% to 25% higher than a civilian population of the same age and gender makeup as the military.

The article is here.

Thursday, June 23, 2016

How to Fix a Broken Mental-Health System

by Norm Ornstein
The Atlantic
Originally published June 8, 2016

Here is an excerpt:

And, for people with the most serious diseases, who cannot recognize they are ill or who have deep psychoses that leave them detached from much of reality, we need to recalibrate the balance between civil liberties and the need to provide real treatment—the kind of wraparound, assisted outpatient treatment (AOT) that Leifman has pioneered in Florida—while making it easier, with appropriate safeguards, for family members to intervene to help their loved ones.

In Washington, the good news is that reforming the system to deal with mental illness is one of the few areas where there is serious bipartisan cooperation and action—including, in the Senate, Democrats like Debbie Stabenow, Chris Murphy, and Al Franken, and Republicans like Roy Blunt, Bill Cassidy, and John Cornyn. In the House, there’s a major bill cosponsored by Republican Tim Murphy, the body’s only psychologist, and Democrat Eddie Bernice Johnson, a former psychiatric nurse.

Of course, there is bad news—this is American politics in 2016. The highly dysfunctional Congress is stymied from action so far even in areas that have broad and deep bipartisan support, like  Puerto Rico’s debt crisis, the opioid crisis, and criminal-justice reform.

The article is here.