Mental-Health Crunch on Campus

By Melissa Korn and  Angela Chen
The Wall Street Journal
Originally published April 28, 2015

Universities are hiring more social workers, psychologists and psychiatrists as demand for campus mental-health services rises. But persistent budget gaps mean that students in some cases foot much of the cost of the positions.

Students at George Washington University will be charged an additional $1,667 in tuition next year, a jump of 3.4%. More than $830,000 of the resulting new revenue will pay for mental-health services.

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“The demand [by students] so outpaces the supply of appointments that it’s very hard to get a weekly appointment, even for students having pretty serious symptoms that interfere with their academic function,” said Elizabeth Gong-Guy, executive director of counseling and psychological services at UCLA and president of the Association for University and College Counseling Center Directors.

The entire article is here.

What Brand Is Your Therapist?

by Lori Gottlieb
The New York Times
Originally published November 23, 2012

Here is an excerpt:


What nobody taught me in grad school was that psychotherapy, a practice that had sustained itself for more than a century, is losing its customers. If this came as a shock to me, the American Psychological Association tried to send out warnings in a 2010 paper titled, “Where Has all the Psychotherapy Gone?” According to the author, 30 percent fewer patients received psychological interventions in 2008 than they did 11 years earlier; since the 1990s, managed care has increasingly limited visits and reimbursements for talk therapy but not for drug treatment; and in 2005 alone, pharmaceutical companies spent $4.2 billion on direct-to-consumer advertising and $7.2 billion on promotion to physicians, nearly twice what they spent on research and development.

According to the A.P.A., therapists had to start paying attention to what the marketplace demanded or we risked our livelihoods. It wasn’t long before I learned that an entirely new specialized industry had cropped up: branding consultants for therapists.

I couldn’t imagine hiring a branding consultant to lure people to the couch. Psychotherapy is perhaps one of the few commercial businesses that doesn’t see itself as one, that views financial gain as unseemly when connected to the delicate work of emotional insight. Moreover, the field is predicated on strict concepts of authenticity, privacy and therapist-patient boundaries. Branding was the antithesis of what we did.

The entire article is here.

Life in a Mental Hospital

"Erasing the Past at the Ghost Hospital"
By Lawrence Downes
The New York Times
Originally published on August 4, 2012

Engineers and earth movers have now joined nature and vandals in the slow dismantling of the Kings Park Psychiatric Center, an all-but-abandoned city of the sick on the North Shore of Long Island, on thickly wooded bluffs above Long Island Sound.
      

Kings Park was one of the island’s four giant state mental institutions — part farm, part warehouse — that treated hundreds of thousands of patients from New York City. It began in the 1880s and kept growing into the 1960s and ’70s until, like its counterparts on the island and across the country, it was made obsolete by new drug therapies and a new understanding of the rights of the mentally ill.

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New York State has largely abandoned its comprehensive commitment to caring for the mentally ill and disabled. When the hospitals emptied out, patients were sent to group homes to be better cared for; many were forsaken there, too. A recent series of articles in The Times found that abuse and neglect plague the mental-health system to this day. It would be wonderful if someday profitable redevelopment of Kings Park led to a surge in financing for care of the mentally ill. I’m not counting on it.

This article is here.

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A Letter to the Editor by Lucy Winer about this story is here.

I was committed to Kings Park Psychiatric Center on Long Island as a teenager in the 1960s after a series of suicide attempts. Having experienced the abuses of institutional life, I expected to rejoice at news of the hospital’s bulldozing. Instead, I feel grief.

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State hospitals were closed to save money. The promise was that savings would be invested in community mental health care. This never happened, and we are living with the fallout from this broken social contract.

Mental problems top illness for GIs

By Sig Christenson
San Antonio Express-News
Originally published May 19, 2012

More active-duty troops were hospitalized for mental illnesses last year than any other major malady, a new military report says.

The Armed Forces Health Surveillance Center said 21,735 troops from the services were admitted to hospitals because of mental problems, up dramatically from previous years.

Most were men, with mental disorders the leading cause of hospitalizations for soldiers and Marines — the services that have carried the greatest burden in Iraq and Afghanistan.

Hospitalization rates for all causes among active-duty troops were up during the past decade, with one in every 15 troops treated, but mental-illness admissions grew 50 percent over the past five years.

The entire story is here.

Addiction Diagnoses May Rise Under Guideline Changes

By Ian Urbina
The New York Times
Originally published May 11, 2012

In what could prove to be one of their most far-reaching decisions, psychiatrists and other specialists who are rewriting the manual that serves as the nation’s arbiter of mental illness have agreed to revise the definition of addiction, which could result in millions more people being diagnosed as addicts and pose huge consequences for health insurers and taxpayers.

The revision to the manual, known as the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to proposed changes posted on the Web site of the American Psychiatric Association, which produces the book.

In addition, the manual for the first time would include gambling as an addiction, and it might introduce a catchall category — “behavioral addiction — not otherwise specified” — that some public health experts warn would be too readily used by doctors, despite a dearth of research, to diagnose addictions to shopping, sex, using the Internet or playing video games.

The entire story is here.

Prisons Rethink Isolation, Saving Money, Lives and Sanity

By Erica Goode
The New Yor Times - US
Originally published March 10, 2012

The heat was suffocating, and the inmates locked alone in cells in Unit 32, the state’s super-maximum-security prison, wiped away sweat as they lay on concrete slab beds.

Kept in solitary confinement for up to 23 hours each day, allowed out only in shackles and escorted by guards, they were restless and angry — made more so by the excrement-smeared walls, the insects, the filthy food trays and the mentally ill inmates who screamed in the night, conditions that a judge had already ruled unacceptable.

So it was not really surprising when violence erupted in 2007: an inmate stabbed to death with a homemade spear that May; in June, a suicide; in July, another stabbing; in August, a prisoner killed by a member of a rival gang.

What was surprising was what happened next. Instead of tightening restrictions further, prison officials loosened them.

They allowed most inmates out of their cells for hours each day. They built a basketball court and a group dining area. They put rehabilitation programs in place and let prisoners work their way to greater privileges.

In response, the inmates became better behaved. Violence went down. The number of prisoners in isolation dropped to about 300 from more than 1,000. So many inmates were moved into the general population of other prisons that Unit 32 was closed in 2010, saving the state more than $5 million.

The transformation of the Mississippi prison has become a focal point for a growing number of states that are rethinking the use of long-term isolation and re-evaluating how many inmates really require it, how long they should be kept there and how best to move them out. Colorado, Illinois, Maine, Ohio and Washington State have been taking steps to reduce the number of prisoners in long-term isolation; others have plans to do so. On Friday, officials in California announced a plan for policy changes that could result in fewer prisoners being sent to the state’s three super-maximum-security units.

The whole story is here.

Need to heal thyself?

Up to a third of all graduate students are coping with mental health problems alongside the demands of school. To whom can they turn for help?

By Cassandra Willyard

gradPSYCH

Print version: page 28

The last six years of graduate school haven't been easy for Gretchen Foster (not her real name), who describes herself as a "high-achiever who wants to do everything right." Her clinical psychology program was exceedingly competitive, and she had trouble figuring out the complex politics of her department. Foster often had more work than she could handle, so she had to let some assignments go unfinished. And being new to the area, she had few friends outside of the department.

Those issues might sound familiar to many graduate students, but they were especially trying for Foster, who was diagnosed with an anxiety disorder at age 17. "I would push myself really hard and feel sort of like I had exhausted my supply of energy," she says. Medication helped her cope, but some days the anxiety overwhelmed her. "I would just have to go home and give up the day and know that there was no way I would be able to get work done," she says. Foster feared that those lost days would cause her to fall behind her peers, and she felt frustrated with herself.

Trying to handle grad school's heavy workload while still having a social life and maintaining a healthy lifestyle can be enough to stress anyone out, says John C. Norcross, PhD, a psychology professor at the University of Scranton in Pennsylvania who studies self-care and personal therapy among psychologists. These challenges can be especially daunting for students suffering from a mental illness, he notes.

"Most studies of full-time doctoral students show they are routinely working 60-plus hours [a week]," he says. "And when you're working that many hours, self-care tends to plummet."

Just how prevalent mental health problems are among graduate students is an open question. Only a few surveys have been conducted, and the magnitude of the problem appears to vary from school to school, depending in part on how they define mental health issues.

A 2008 survey at the University of California–Irvine, for example, found 17 percent of students reported having a serious mental disorder and nearly 30 percent reported having a mental health concern that affected their well-being or academic performance. A survey from 2006 at Berkeley found that 45 percent of graduate students polled said they had a mental health issue that affected their well-being or academic performance, and almost 10 percent of respondents reported they had considered suicide in the past year.

The entire article is here.

Mental-health cuts: Experts fear long-term costs

By Mary Reinhart
The Arizona Republic
azcentral.com

Arizona taxpayers are providing fewer services to fewer people with serious mental illnesses than they were last year, for annual savings of roughly $50 million.

But the short-term savings from state budget cuts threaten to have long-term consequences for patients, providers and the community, mental-health experts say.

The budget reductions eliminated services for about 12,000 Arizonans who don't qualify for Medicaid, removing the foundation of a system intended to keep the seriously mentally ill healthy and out of emergency rooms, hospitals, jails and prisons.

State lawmakers instead provided money for generic medication and additional funding to beef up a statewide crisis-response system to help prevent people from falling through the cracks. But in the 15 months since this population lost case management, brand-name prescription drugs, therapy, transportation and other benefits, more than 2,000 people have stopped receiving any state-funded services and are unaccounted for.

Local and county jails, emergency responders and hospitals often shoulder the costs when people with untreated serious mental illness, such as schizophrenia and bipolar disorder, fall into crisis.

The precise financial costs to those entities are unknown, but health professionals do know that it's far more expensive to treat people who have spiraled into crisis than to keep them stable. And once in crisis, health professionals say, it's more difficult for people to rebound, which means those higher costs continue to recur.

"It's a penny-wise and pound-foolish approach," said Bill Kennard, former executive director of the National Alliance on Mental Illness' office in Phoenix. "More people in jail and prison with mental illness, more time that law enforcement spends dealing with a health issue as opposed to a public-safety issue."

The costs

The state has not conducted an analysis that compares ongoing treatment with crisis costs.

But a March 2011 study that examined proposed mental-health cuts in Texas put the average daily cost of services at $12 for adults, compared with $401 a day in the state's mental hospital, $137 a day for a jail inmate with mental illness and $986 for an emergency-room visit.

The study, by Health Management Associates for the Texas Conference of Urban Counties, also showed that gaps in services put those discharged from psychiatric hospitals and jail at greater risk of relapse, readmission and recidivism.

Janey Durham, who is in charge of a workshop program at Mesa's Marc Center, said she lost 120 people to the budget cuts, including a man diagnosed with schizophrenia who deteriorated almost before her eyes. The non-profit agency center provides job training and other services to the mentally ill and developmentally disabled.

Durham said the man, a former alcoholic in his 50s, worked hard at his job in the manufacturing warehouse, at maintaining his sobriety and in treating his mental illness. But soon after the budget cuts forced him to switch to a generic medication, Durham said, he stopped taking his medication, started drinking again and grew increasingly paranoid, plagued by voices in his head.

Over the past year his erratic, disruptive behavior led Marc Center employees to call Mesa police at least once. He is believed to be homeless, she said, but contact with him has been sporadic since last winter.

Read the entire story here.

Nation's Jails Struggle With Mentally Ill Prisoners

By NPR staff

Three hundred and fifty thousand: That's a conservative estimate for the number of offenders with mental illness confined in America's prisons and jails.

More Americans receive mental health treatment in prisons and jails than in hospitals or treatment centers. In fact, the three largest inpatient psychiatric facilities in the country are jails: Los Angeles County Jail, Rikers Island Jail in New York City and Cook County Jail in Illinois.

"We have a criminal justice system which has a very clear purpose: You get arrested. We want justice. We try you, and justice hopefully prevails. It was never built to handle people that were very, very ill, at least with mental illness," Judge Steve Leifman tells Laura Sullivan, guest host of weekends on All Things Considered.

A failing system

When the government began closing state-run hospitals in the 1980s, people with mental illness had nowhere to turn; many ended up in jail. Leifman saw the problem first-hand decades ago in the courtroom. When individuals suffering from mental illness came before him accused of petty crimes, he didn't have many options.

"What we used to do, which I tell people was the definition of insanity [...] was they would commit an offense, the police would arrest them, they'd come to court, they'd be acting out so we would order two or three psychological evaluations at great expense, we would determine that they were incompetent to stand trial and we'd re-release them back to the community and kind of held our breath and crossed our fingers and hoped that somehow they'd get better and come back and we could try them," he says.

Instead, many disappeared and got re-arrested. Sometimes within minutes.

"They'd walk out the door, they were ill, they'd act out, because [the jail] is next to the courthouse there are several officers out there, and they'd get re-arrested," he says.

Not only was the system inefficient, it was costly as well. When Leifman asked the University of South Florida to look at who the highest users of criminal justice and mental health services in Miami-Dade County, researchers found the prime users were 97 people, individuals diagnosed primarily with schizophrenia.

"Over a five-year period, these 97 individuals were arrested almost 2,200 times and spent 27,000 days in the Miami-Dade Jail," Leifman says. "It cost the tax payers $13 million."

More information can be found here.