Responding to Medical Errors—Implementing the Modern Ethical Paradigm

T. H. Gallagher &  A. Kachalia

The New England Journal of Medicine

January 13, 2024

DOI: 10.1056/NEJMp2309554

Here are some excerpts:

Traditionally, recommendations regarding responding to medical errors focused mostly on whether to disclose mistakes to patients. Over time, empirical research, ethical analyses, and stakeholder engagement began to inform expectations - which are now embodied in communication and resolution programs (CRPS) — for how health care professionals and organizations should respond not just to errors but any time patients have been harmed by medical care (adverse events). CRPs require several steps: quickly detecting adverse events, communicating openly and empathetically with patients and families about the event, apologizing and taking responsibility for errors, analyzing events and redesigning processes to prevent recurrences, supporting patients and clinicians, and proactively working with patients toward reconciliation. In this modern ethical paradigm, any time harm occurs, clinicians and health care organizations are accountable for minimizing suffering and promoting learning. However, implementing this ethical paradigm is challenging, especially when the harm was due to an error.

Historically, the individual physician was deemed the "captain of the ship," solely accountable for patient outcomes. Bioethical analyses emphasized the fiduciary nature of the doctor-patient relationship (i.e., doctors are in a position of greater knowledge and power) and noted that telling patients...about harmful errors supported patient autonomy and facilitated informed consent for future decisions. However, under U.S. tort law, physicians and organizations can be held accountable and financially liable for damages when they make negligent errors. As a result, ethical recommendations for openness were drowned out by fears of lawsuits and payouts, leading to a "deny and defend" response. Several factors initiated a paradigm shift. In the early 2000s, reports from the Institute of Medicine transformed the way the health care profession conceptualized patient safety.1 The imperative became creating cultures of safety that encouraged everyone to report errors to enable learning and foster more reliable systems. Transparency assumed greater importance, since you cannot fix problems you don't know about. The ethical imperative for openness was further supported when rising consumerism made it clear that patients expected responses to harm to include disclosure of what happened, an apology, reconciliation, and organizational learning.

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CRP Model for Responding to Harmful Medical Errors

Research has been critical to CRP expansion. Several studies have demonstrated that CRPs can enjoy physician support and operate without increasing liability risk. Nonetheless, research also shows that physicians remain concerned about their ability to communicate with patients and families after a harmful error and worry about liability risks including being sued, having their malpractice premiums raised, and having the event reported to the National Practitioner Data Bank (NPDB).5 Successful CRPS typically deploy a formal team, prioritize clinician and leadership buy-in, and engage liability insurers in their efforts. The table details the steps associated with the CRP model, the ethical rationale for each step, barriers to implementation, and strategies for overcoming them.

The growth of CRPs also reflects collaboration among diverse stakeholder groups, including patient advocates, health care organizations, plaintiff and defense attorneys, liability insurers, state medical associations, and legislators. Sustained stakeholder engagement that respects the diverse perspectives of each group has been vital, given the often opposing views these groups have espoused.

As CRPS proliferate, it will be important to address a few key challenges and open questions in implementing this ethical paradigm.

The article is paywalled here.

The article provides a number of recommendations for how healthcare providers can implement these principles. These include:

• Developing open and honest communication with patients.
• Providing timely and accurate information about the error.
• Offering apologies and expressing empathy for the harm that has been caused.
• Working with patients to develop a plan to address the consequences of the error.
• Conducting a thorough investigation of the error to identify the root causes and prevent future errors.
• Sharing the results of the investigation with patients and the public.

On Edge: Understanding and Preventing Young Adults’ Mental Health Challenges

Making Caring Common. (2023).

https://mcc.gse.harvard.edu/reports/on-edge

From the Executive Summary

Our recent data suggests that the young adults of Generation Z are experiencing emotional struggles at alarming rates. While the emotional struggles of teens have been in the national spotlight since the pandemic—and this attention has been vital—according to our nationally representative survey, young adults report roughly twice the rates of anxiety and depression as teens. Compared to 18% of teens, a whopping 36% of young adults in our survey reported anxiety; in contrast to 15% of teens, 29% of young adults reported depression. Far too many young adults report that they feel on edge, lonely, unmoored, directionless, and that they worry about financial security. Many are “achieving to achieve” and find little meaning in either school or work. Yet these struggles of young adults have been largely off the public radar.

From the Press Release:

The report identifies a variety of stressors that may be driving young adults’ high rates of anxiety and

depression. The top drivers of young adults’ mental health challenges include:

• A lack of meaning, purpose, and direction: Nearly 3 in 5 young adults (58%) reported that they lacked “meaning or purpose” in their lives in the previous month. Half of young adults reported that their mental health was negatively influenced by “not knowing what to do with my life.
• Financial worries and achievement pressure: More than half of young adults reported that financial worries (56%) and achievement pressure (51%) were negatively impacting their mental health.
• A perception that the world is unraveling: Forty-five percent (45%) of young adults reported that a general "sense that things are falling apart” was impairing their mental health.
• Relationship deficits: Forty-four percent (44%) of young adults reported a sense of not mattering to others and 34% reported loneliness.
• Social and political issues: Forty-two percent (42%) reported the negative influence on their mental health of gun violence in schools, 34% cited climate change, and 30% cited worries that our political leaders are incompetent or corrupt.

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The report also suggests strategies for promoting young adults’ mental health and mitigating their

emotional challenges. These include:

• Cultivating meaning and purpose in young people, including by engaging them in caring for
• others and service;
• Supporting young people in developing gratifying and durable relationships; and
• Helping young people experience their lives as more than the sum of their achievements.

“We need to do much more to support young adults’ mental health and devote more resources to prevention,” said Kiran Bhai, MCC’s Schools & Parenting Programs Director and a co-author of the

report. “This includes reducing the stressors that young people are facing and helping them develop

the skills they need to thrive.”

The Plunging Number of Primary Care Physicians Reaches a Tipping Point.

Elisabeth Rosenthal

KFF Health News

Originally posted 8 September 23

Here are two excerpts:

The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all.

Already, more than 100 million Americans don’t have usual access to primary care, a number that has nearly doubled since 2014. One reason our coronavirus vaccination rates were low compared with those in countries such as China, France, and Japan could be because so many of us no longer regularly see a familiar doctor we trust.

Another telling statistic: In 1980, 62% of doctor’s visits for adults 65 and older were for primary care and 38% were for specialists, according to Michael L. Barnett, a health systems researcher and primary care doctor in the Harvard Medical School system. By 2013, that ratio had exactly flipped and has likely “only gotten worse,” he said, noting sadly: “We have a specialty-driven system. Primary care is seen as a thankless, undesirable backwater.” That’s “tragic,” in his words — studies show that a strong foundation of primary care yields better health outcomes overall, greater equity in health care access, and lower per capita health costs.

One explanation for the disappearing primary care doctor is financial. The payment structure in the U.S. health system has long rewarded surgeries and procedures while shortchanging the diagnostic, prescriptive, and preventive work that is the province of primary care. Furthermore, the traditionally independent doctors in this field have little power to negotiate sustainable payments with the mammoth insurers in the U.S. market.

Faced with this situation, many independent primary care doctors have sold their practices to health systems or commercial management chains (some private equity-owned) so that, today, three-quarters of doctors are now employees of those outfits.

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Some relatively simple solutions are available, if we care enough about supporting this foundational part of a good medical system. Hospitals and commercial groups could invest some of the money they earn by replacing hips and knees to support primary care staffing; giving these doctors more face time with their patients would be good for their customers’ health and loyalty if not (always) the bottom line.

Reimbursement for primary care visits could be increased to reflect their value — perhaps by enacting a national primary care fee schedule, so these doctors won’t have to butt heads with insurers. And policymakers could consider forgiving the medical school debt of doctors who choose primary care as a profession.

They deserve support that allows them to do what they were trained to do: diagnosing, treating, and getting to know their patients.

The info is here.

Here is my warning:

The number of primary care physicians in the US is declining, and this trend is reaching a tipping point. More than 100 million Americans don't have usual access to primary care, and this number has nearly doubled since 2014. This shortage of primary care physicians could have a negative impact on public health, as people without access to primary care are more likely to delay or forgo needed care.

Burnout Is About Your Workplace, Not Your People

Jennifer Moss

Harvard Business Review

Originally posted 11 December 2019

We tend to think of burnout as an individual problem, solvable by “learning to say no,” more yoga, better breathing techniques, practicing resilience — the self-help list goes on. But evidence is mounting that applying personal, band-aid solutions to an epic and rapidly evolving workplace phenomenon may be harming, not helping, the battle. With “burnout” now officially recognized by the World Health Organization (WHO), the responsibility for managing it has shifted away from the individual and towards the organization. Leaders take note: It’s now on you to build a burnout strategy.

The Non-Classification Classification

The term “burnout” originated in the 1970s, and for the past 50 years, the medical community has argued about how to define it. As the debate grows increasingly contentious, the most recent WHO announcement may have caused more confusion than clarity. In May, the WHO included burnout in its International Classification of Diseases (ICD-11) and immediately the public assumed that burnout would now be considered a medical condition. The WHO then put out an urgent clarification stating, “Burn-out is included in the 11th Revision of the International Classification of Diseases (ICD-11) as an occupational phenomenon, not a medical condition… reasons for which people contact health services but that are not classed as illnesses or health conditions.”

Although the WHO is now working on guidelines to help organizations with prevention strategies, most still have no idea what to do about burnout. Since it was explicitly not classified as a medical condition, the case is less about liability for employers and more about the impact on employee well-being and the massive associated costs.

The Emotional and Financial Toll

When Stanford researchers looked into how workplace stress affects health costs and mortality in the United States (pdf), they found that it led to spending of nearly $190 billion — roughly 8% of national  healthcare outlays — and nearly 120,000 deaths each year. Worldwide, 615 million suffer from depression and anxiety and, according to a recent WHO study, which costs the global workforce an estimated $1 trillion in lost productivity each year. Passion-driven and caregiving roles such as doctors and nurses  are some of the most susceptible to burnout, and the consequences can mean life or death; suicide rates among caregivers are dramatically higher than that of the general public — 40% higher for men and 130% higher for women.

The info is here.

Summary: Burnout is a serious problem that can have a significant impact on individuals and organizations. It is important to understand that burnout is not just about the individual, but also about the workplace environment. There are a number of factors that can contribute to burnout, including unfair treatment, unmanageable workload, lack of role clarity, lack of communication and support from managers, and unreasonable time pressure.

Ethical considerations for precision psychiatry: A roadmap for research and clinical practice

Fusar-Poli, P., Manchia, M., et al. (2022, October). 

European Neuropsychopharmacology, 63, 17–34.

https://doi.org/10.1016/j.euroneuro.2022.08.001

Abstract

Precision psychiatry is an emerging field with transformative opportunities for mental health. However, the use of clinical prediction models carries unprecedented ethical challenges, which must be addressed before accessing the potential benefits of precision psychiatry. This critical review covers multidisciplinary areas, including psychiatry, ethics, statistics and machine-learning, healthcare and academia, as well as input from people with lived experience of mental disorders, their family, and carers. We aimed to identify core ethical considerations for precision psychiatry and mitigate concerns by designing a roadmap for research and clinical practice. We identified priorities: learning from somatic medicine; identifying precision psychiatry use cases; enhancing transparency and generalizability; fostering implementation; promoting mental health literacy; communicating risk estimates; data protection and privacy; and fostering the equitable distribution of mental health care. We hope this blueprint will advance research and practice and enable people with mental health problems to benefit from precision psychiatry.

From the Results section

3.1. Ethics of precision psychiatry: Key concepts

Broadly speaking, ethical issues concern the development of ‘practical ought claims’ (Sheehan and Dunn, 2013) (i.e. normative claims that are practical in nature), which arise when we face ethical uncertainty in precision psychiatry. These practical claims come schematically like this: how should somebody or a group of people act in relation to a particular issue when they face certain circumstances? For example, how should researchers inform patients about their individualised risk estimates after running a novel clinical prediction model? To address these questions, four overarching ethical principles have been suggested (by Beauchamp and Childress) (Beauchamp and Childress, 2019), which include autonomy, beneficence, non-maleficence and justice. These can be applied to precision psychiatry, complemented by an extra principle of “explainability/interpretability” (Panel 1) which has been specifically introduced for artificial intelligence (Floridi et al., 2018) (for a more detailed discussion of ethical platforms for big data analytics see eSupplementary 1).

Although these four principles have become the cornerstones of biomedical ethics in healthcare practice, they have been criticised as they are often conflicting with no clear hierarchy and are not very specific (i.e. these principles are somewhat implicit, representing general moral values), leading to “imprecise ethics” that may not fit the needs of precision psychiatry (Table 1). Rather we should ask ourselves “why” a certain act may be harmful or beneficial. For example, let's imagine having a risk assessment; what would that mean for the individual, their family planning, workplace, choosing their studies, or their period of life? Alternatively, let's imagine that the risk assessment is not performed; what would be the results in a few years’ time? To address these sorts of questions, this study will consider ethical values in a broader sense, for example, by taking into account some of the different principles present in the charter of fundamental rights of the European Union – starting from dignity, freedom, equality, solidarity, citizens’ rights and justice (Table 1) (European Union, 2012; Hallinan, 2021). In particular, human dignity and human flourishing are the most crucial elements from an ethical point of view that are tightly linked to autonomy and self-determination (which is modulated by several factors such as physical health, psychological state, sociocultural environment, as well as values and beliefs). The loss of insight associated with some psychiatric disorders may incapacitate the individual to make autonomous decisions. For example, autonomy emerged as the driving decision component for undergoing risk prediction testing among young populations (Mantell et al., 2021a), regardless of whether a person would decide for or against risk profiling. Finally, it is important to highlight that unique ethical considerations may be associated with the historically complex socio-political perceptions and attitudes towards severe mental disorders and psychiatry (Ball et al., 2020a; Manchia et al., 2020a).

The info is here.

Downloading COVID-19 contact tracing apps is a moral obligation

G. Owen Schaefer and Angela Ballantyne
BMJ Blogs
Originally posted 4 May 20

Should you download an app that could notify you if you had been in contact with someone who contracted COVID-19? Such apps are already available in countries such as Israel, Singapore, and Australia, with other countries like the UK and US soon to follow. Here, we explain why you might have an ethical obligation to use a tracing app during the COVID-19 pandemic, even in the face of privacy concerns.

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Vulnerability and unequal distribution of risk

Marginalized populations are both hardest hit by pandemics and often have the greatest reason to be sceptical of supposedly benign State surveillance. COVID-19 is a jarring reminder of global inequality, structural racism, gender inequity, entrenched ableism, and many other social divisions. During the SARS outbreak, Toronto struggled to adequately respond to the distinctive vulnerabilities of people who were homeless. In America, people of colour are at greatest risk in several dimensions – less able to act on public health advice such as social distancing, more likely to contract the virus, and more likely to die from severe COVID if they do get infected. When public health advice switched to recommending (or in some cases requiring) masks, some African Americans argued it was unsafe for them to cover their faces in public. People of colour in the US are at increased risk of state surveillance and police violence, in part because they are perceived to be threatening and violent. In New York City, black and Latino patients are dying from COVID-19 at twice the rate of non-Hispanic white people.

Marginalized populations have historically been harmed by State health surveillance. For example, indigenous populations have been the victims of State data collection to inform and implement segregation, dispossession of land, forced migration, as well as removal and ‘re‐education’ of their children. Stigma and discrimination have impeded the public health response to HIV/AIDS, as many countries still have HIV-specific laws that prosecute people living with HIV for a range of offences.  Surveillance is an important tool for implementing these laws. Marginalized populations therefore have good reasons to be sceptical of health related surveillance.

Human Trafficking Survivor Settles Lawsuit Against Motel Where She Was Held Captive

Todd Bookman
npr.org
Originally posted 20 Feb 20

Here is an excerpt:

Legal experts and anti-trafficking groups say her 2015 case was the first filed against a hotel or motel for its role in a trafficking crime.

"It is not that any hotel is liable just because trafficking occurred on their premises," explains Cindy Vreeland, a partner at the firm WilmerHale, which handled Ricchio's case pro bono. "The question is whether the company that's been sued knew or should have known about the trafficking."

After a number of appeals and delays, the case finally settled in December 2019 with Ricchio receiving an undisclosed monetary award. Owners of the Shangri-La Motel didn't respond to a request for comment.

"I never thought it would be, like, an eight-year process," Ricchio says. "Anything in the court system seems to take forever."

That slow process isn't deterring other survivors of trafficking from bringing their own suits.

According to the Human Trafficking Institute, there were at least 25 new cases filed nationwide against hotels and motels last year under the TVPA.

Some of the named defendants include major chains such as Hilton, Marriott and Red Roof Inn.

"You can't just let anything happen on your property, turn a blind eye and say, 'Too bad, so sad, I didn't do it, so I'm not responsible,' " says Paul Pennock with the firm Weitz & Luxenberg.

The info is here.

Why parents are struggling to find mental health care for their children

Bernard Wolfson
Kaiser Health News/PBS.org
Originally posted May 7, 2019

Here is an excerpt:

Think about how perverse this is. Mental health professionals say that with children, early intervention is crucial to avoid more severe and costly problems later on. Yet even parents with good insurance struggle to find care for their children.

The U.S. faces a growing shortage of mental health professionals trained to work with young people — at a time when depression and anxiety are on the rise. Suicide was the No. 2 cause of death for children and young adults from age 10 to 24 in 2017, after accidents.

There is only one practicing child and adolescent psychiatrist in the U.S. for about every 1,800 children who need one, according to data from the American Academy of Child & Adolescent Psychiatry.

Not only is it hard to get appointments with psychiatrists and therapists, but the ones who are available often don’t accept insurance.

“This country currently lacks the capacity to provide the mental health support that young people need,” says Dr. Steven Adelsheim, director of the Stanford University psychiatry department’s Center for Youth Mental Health and Wellbeing.

The info is here.

Beyond safety questions, gene editing will force us to deal with a moral quandary

Josephine Johnston
STAT News
Originally published November 29, 2018

Here is an excerpt:

The majority of this criticism is motivated by major concerns about safety — we simply do not yet know enough about the impact of CRISPR-Cas9, the powerful new gene-editing tool, to use it create children. But there’s a second, equally pressing concern mixed into many of these condemnations: that gene-editing human eggs, sperm, or embryos is morally wrong.

That moral claim may prove more difficult to resolve than the safety questions, because altering the genomes of future persons — especially in ways that can be passed on generation after generation — goes against international declarations and conventions, national laws, and the ethics codes of many scientific organizations. It also just feels wrong to many people, akin to playing God.

As a bioethicist and a lawyer, I am in no position to say whether CRISPR will at some point prove safe and effective enough to justify its use in human reproductive cells or embryos. But I am willing to predict that blanket prohibitions on permanent changes to the human genome will not stand. When those prohibitions fall — as today’s announcement from the Second International Summit on Human Genome Editing suggests they will — what ethical guideposts or moral norms should replace them?

The info is here.

Silicon Valley Writes a Playbook to Help Avert Ethical Disasters

Arielle Pardes
www.wired.com
Originally posted August 7, 2018

Here is an excerpt:

The first section outlines 14 near-future scenarios, based on contemporary anxieties in the tech world that could threaten companies in the future. What happens, for example, if a company like Facebook purchases a major bank and becomes a social credit provider? What happens if facial-recognition technology becomes a mainstream tool, spawning a new category of apps that integrates the tech into activities like dating and shopping? Teams are encouraged to talk through each scenario, connect them back to the platforms or products they're developing, and discuss strategies to prepare for these possible futures.

Each of these scenarios came from contemporary "signals" identified by the Institute of the Future—the rise of "deep fakes," tools for "predictive justice," and growing concerns about technology addiction.

"We collect things like this that spark our imagination and then we look for patterns, relationships. Then we interview people who are making these technologies, and we start to develop our own theories about where the risks will emerge," says Jane McGonigal, the director of game research at the Institute of the Future and the research lead for the Ethical OS. "The ethical dilemmas are around issues further out than just the next release or next growth cycle, so we felt helping companies develop the imagination and foresight to think a decade out would allow more ethical action today."

The info is here.

How AI is transforming the NHS

Ian Sample
The Guardian
Originally posted July 4, 2018

Here is an excerpt:

With artificial intelligence (AI), the painstaking task can be completed in minutes. For the past six months, Jena has used a Microsoft system called InnerEye to mark up scans automatically for prostate cancer patients. Men make up a third of the 2,500 cancer patients his department treats every year. When a scan is done, the images are anonymised, encrypted and sent to the InnerEye program. It outlines the prostate on each image, creates a 3D model, and sends the information back. For prostate cancer, the entire organ is irradiated.

The software learned how to mark up organs and tumours by training on scores of images from past patients that had been seen by experienced consultants. It already saves time for prostate cancer treatment. Brain tumours are next on the list.

Automating the process does more than save time. Because InnerEye trains on images marked up by leading experts, it should perform as well as a top consultant every time. The upshot is that treatment is delivered faster and more precisely. “We know that how well we do the contouring has an impact on the quality of the treatment,” Jena says. “The difference between good and less good treatment is how well we hit the tumour and how well we avoid the healthy tissues.”

The article is here.

Building A More Ethical Workplace Culture

PYMNTS
PYMNTS.com
Originally posted March 20, 2018

Here is an excerpt:

The Worst News

Among the positive findings in the report was the fact that reporting is on the rise by a whole 19 percent, with 69 percent of employees stating they had reported misconduct in the last two years.

But that number, Harned said, comes with a bitter side note. Retaliation has also spiked during the same time period, with 44 percent reporting it – up from 22 percent two years ago.

The rate of retaliation going up faster than the rate of reporting, Harned noted, is disturbing.

“That is a very real problem for employees, and I think over the last year, we’ve seen what a huge problem it has become for employers.”

The door-to-door on retaliation for reporting is short – about three weeks on average. That is just about the time it takes for firms – even those serious about doing a good job with improving compliance – to get any investigation up and organized.

“By then, the damage is already done,” said Harned. “We are better at seeing misconduct, but we aren’t doing enough to prevent it from happening – especially because retaliation is such a big problem.”

There are not easy solutions, Harned noted, but the good news – even in the face of the worst news – is that improvement is possible, and is even being logged in some segments. Employees, she stated, mostly come in the door with a moral compass to call their own, and want to work in environments that are healthy, not vicious.

“The answer is culture is everything: Companies need to constantly communicate to employees that conduct is the expectation for all levels of the organization, and that breaking those rules will always have consequences.”

The post is here.

Should Governments Invest More in Nudging?

Shlomo Benartzi, John Beshears, Katherine L. Milkman, and others
Psychological Science 
Vol 28, Issue 8, pp. 1041 - 1055
First Published June 5, 2017

Abstract

Governments are increasingly adopting behavioral science techniques for changing individual behavior in pursuit of policy objectives. The types of “nudge” interventions that governments are now adopting alter people’s decisions without coercion or significant changes to economic incentives. We calculated ratios of impact to cost for nudge interventions and for traditional policy tools, such as tax incentives and other financial inducements, and we found that nudge interventions often compare favorably with traditional interventions. We conclude that nudging is a valuable approach that should be used more often in conjunction with traditional policies, but more calculations are needed to
determine the relative effectiveness of nudging.

The article is here.

Companies should treat cybersecurity as a matter of ethics

Thomas Lee
The San Francisco Chronicle
Originally posted September 2, 2017

Here is an excerpt:

An ethical code will force companies to rethink how they approach research and development. Instead of making stuff first and then worrying about data security later, companies will start from the premise that they need to protect consumer privacy before they start designing new products and services, Harkins said.

There is precedent for this. Many professional organizations like the American Medical Association and American Bar Association require members to follow a code of ethics. For example, doctors must pledge above all else not to harm a patient.

A code of ethics for cybersecurity will no doubt slow the pace of innovation, said Maurice Schweitzer, a professor of operations, information and decisions at the University of Pennsylvania’s Wharton School.

Ultimately, though, following such a code could boost companies’ reputations, Schweitzer said. Given the increasing number and severity of hacks, consumers will pay a premium for companies dedicated to security and privacy from the get-go, he said.

In any case, what’s wrong with taking a pause so we can catch our breath? The ethical quandaries technology poses to mankind are only going to get more complex as we increasingly outsource our lives to thinking machines.

That’s why a code of ethics is so important. Technology may come and go, but right and wrong never changes.

The article is here.

Google has created a tool that tests for clinical depression

Katherine Ellen Foley
Quartz
Originally posted August 24, 2017

People often delay seeking treatment for mental health conditions like depression. The longer they wait to see their doctors, the worse the condition becomes, making it harder to treat in the future.

In an effort to encourage more patients to seek treatment sooner, Google announced Aug. 23 that it has teamed up with National Alliance on Mental Illness (NAMI), an advocacy group, to create a simple tool for users to assess if they may be depressed. Now, when people in the US search for “clinical depression” on their phones, the typical “knowledge panel”—a container that displays company-vetted information on Google’s search results page—will come with an option to take a quiz that can assess the severity of symptoms. (Google says the quiz results will not be seen by anyone but the quiz-taker.)

Google’s quiz isn’t new. It’s a reskinned version of the 18-year-old PQH-9 (pdf), used by physicians to help diagnose patients with mental illnesses like depression and anxiety. It asks about general interest in activities, eating and sleeping habits, and overall mood. Alone, the PQH-9 won’t give a definitive diagnosis. Doctors use it in conjunction with physical exams to rule out other causes for patients’ symptoms, like a thyroid problem. Google says its incorporation of the PQH-9 test in its search results is not meant as a final diagnosis, but as a tool to inspire people to have conversations with their healthcare providers if they were hesitant before.

The article is here.

Childhood Firearm Injuries in the United States

Katherine A. Fowler, Linda L. Dahlberg, Tadesse Haileyesus, Carmen Gutierrez, Sarah Bacon
Pediatrics
July 2017, VOLUME 140 / ISSUE 1

RESULTS: Nearly 1300 children die and 5790 are treated for gunshot wounds each year. Boys, older children, and minorities are disproportionately affected. Although unintentional firearm deaths among children declined from 2002 to 2014 and firearm homicides declined from 2007 to 2014, firearm suicides decreased between 2002 and 2007 and then showed a significant upward trend from 2007 to 2014. Rates of firearm homicide among children are higher in many Southern states and parts of the Midwest relative to other parts of the country. Firearm suicides are more dispersed across the United States with some of the highest rates occurring in Western states. Firearm homicides of younger children often occurred in multivictim events and involved intimate partner or family conflict; older children more often died in the context of crime and violence. Firearm suicides were often precipitated by situational and relationship problems. The shooter playing with a gun was the most common circumstance surrounding unintentional firearm deaths of both younger and older children.


CONCLUSIONS: Firearm injuries are an important public health problem, contributing substantially to premature death and disability of children. Understanding their nature and impact is a first step toward prevention.

The article is here.

How could they?

By Tage Rai
Aeon Magazine
Originally published June 18, 2015

Here is an excerpt:

It would be easier to live in a world where perpetrators believe that violence is wrong and engage in it anyway. That is not the world we live in. While our refusal to acknowledge this basic fact may have helped to orient our own moral compass, it has also stood in the way of interventions that might actually reduce harm. Let’s put aside the philosophical questions that arise once we accept that there is moral disagreement about violence. How does the message that violence is morally motivated aid our efforts to reduce it?

For years, we have been trying to reduce crime by enacting mass incarceration, by placing restrictions on the mentally ill, and by teaching potential perpetrators how to exercise more self-control. On the face of it, these all sound like plausible strategies. But all of them miss their target.

One of the most robust findings in criminology is that increasing the severity of punishment has little deterrent effect. People simply aren’t as sensitive to the potential costs of crime as the rational-choice model predicts they should be, and so efforts to reduce it by cracking down have failed to justify the immense fiscal and social costs of mass incarceration. Meanwhile, because most violent crimes are committed by psychologically healthy individuals, legislation that focuses on the mentally ill – for example, by stopping them from buying guns – would lead to only a small reduction.

The entire article is here.

Social media, big data and the next generation of e-health interventions

By Professor Helen Christensen
MAPS, Executive Director
Black Dog Institute and Professor of Mental Health, University of New South Wales

The Internet is a place where we, as psychologists, can quickly learn about new developments in our area, source research papers, publish research, connect with our colleagues and clients, undertake online training, manage accounts, and keep records. For those who use our services, we can also learn about useful apps or websites that offer online assessments, psychoeducation, self-help and supplementary therapies. However, as ordinary people in everyday life, we use the Internet far more frequently. We make social connections, keep in touch with our families, pay bills, upload our exercise data from our Jawbones and Fitbits, send out invitations, make appointments, read the news, text our family members, look at television programs we missed over the past week and even check the rain radar before we walk to work. Internet enabled activities are ubiquitous in Australia, as they are in almost all countries, and we can’t get enough of them.

The entire article is here.

Treatment of Mental Illness Lowers Arrest Rates, Saves Money

Science Daily
Originally published June 10, 2013

Research from North Carolina State University, the Research Triangle Institute (RTI) and the University of South Florida shows that outpatient treatment of mental illness significantly reduces arrest rates for people with mental health problems and saves taxpayers money.

"This study shows that providing mental health care is not only in the best interest of people with mental illness, but in the best interests of society," says Dr. Sarah Desmarais, an assistant professor of psychology at NC State and co-author of a paper describing the research.

The researchers wanted to determine the extent to which treating mental illness can keep people with mental health problems out of trouble with the law. It is well established that people with mental health problems, such as schizophrenia or bipolar disorder, make up a disproportionate percentage of defendants, inmates and others who come into contact with the criminal justice system.

The entire story is here.

California Senate leader proposes mental health program expansions

By Patrick McGreevy
The Los Angeles Times
Originally posted May 7, 2013

State Senate leader Darrell Steinberg (D-Sacramento) on Tuesday proposed a plan to significantly increase mental health services in California with the goal of reducing the number of people ending up in prison, jail and emergency rooms.

Steinberg said the plan is in response to the Newtown, Conn., school massacre, in which a gunman killed 20 students and six adults, as well as a scandal involving a Nevada hospital dumping patients in other states, and the recent order by a federal court to further cut the number of inmates in California prisons

“It’s time for action,” he told reporters at the Capitol. Steinberg proposed expanding a program providing mental health services to prison parolees with mental illness from 1,500 to 5,000 people. Those in the program have a recidivism rate of 24%, nearly a third of the rate for those not in the program.

“While the governor appeals a federal court order to release thousands of state prison inmates, we also need to be smarter about crime by putting more resources into ensuring people who leave incarceration don’t commit new crimes and go back in,’’ Steinberg said.

The entire story is here.