Reports of Mental Health Disability Increase in US

ScienceDaily — The prevalence of self-reported mental health disabilities increased in the U.S. among non-elderly adults during the last decade, according to a study by Ramin Mojtabai, MD, PhD, of the Johns Hopkins Bloomberg School of Public Health. At the same time, the study found the prevalence of disability attributed to other chronic conditions decreased, while the prevalence of significant mental distress remained unchanged.

The findings will appear in the November edition of the American Journal of Public Health.

The entire story can be found here.

Dilemma 6: Referral and Treatment Boundaries

A psychologist receives a phone call from a well-known internist in her area.  The psychologist is involved in a busy practice, specializes in treating eating disorders, and receives only occasional referrals from this physician.  The physician wants the psychologist to treat his 17-year-old daughter, who suffers with what he describes to be an eating disorder and perhaps some Borderline Personality Disorder traits. 

The physician explains that he has been medicating her for about four months with Prozac and Klonopin, once he became aware of her eating disordered behavior.  Because of his status as a well-known internist, he does not want to refer his daughter to a psychiatrist because he believes that he can handle the medication piece of her treatment.  He will also pay for all treatment in cash, as he wants as few people and organizations to know about his daughter’s issues.

Feeling somewhat uncomfortable with the medication management issue, the psychologist indicates that she will have to call him back after looking at her schedule.  The psychologist then phones you for an informal consultation.  The psychologist expresses her concerns about working with a patient whose father is prescribing medication.

Are there any ethical considerations in this dilemma?

What are the potential pitfalls in the scenario?

What are potential advantages in this scenario?

What are some of the suggestions that you may have for the psychologist about accepting or declining the referral?

What concrete steps might be important before calling the physician back?

 Are there additional considerations for how to approach the referring physician when calling back?

A third of troop suicides told someone of plans

By Dan Elliott

The Associated Press

DENVER — A third of military personnel who committed suicide last year had told at least one person they planned to take their own lives, a newly released Defense Department report says.

Nearly half went to see medical personnel, behavioral health specialists, chaplains or other service providers sometime in the 90 days before they died, according to the 2010 Department of Defense Suicide Event Report.

That doesn’t necessarily reflect a failure in the Defense Department suicide prevention program, said Richard McKeon, chief of the Suicide Prevention Branch at the federal Substance Abuse and Mental Health Services Administration.

“It’s not that some person blew it,” McKeon said Thursday. But physical and behavior health care personnel, counselors and other providers need to monitor their programs and look for improvements, he said.

“(Providers) need to be aware of what those opportunities are, and need to be regularly evaluating their efforts on what is working or what is not,” McKeon said.

The 250-page report released late Wednesday analyzes 295 confirmed or “strongly suspected” suicides that were reported last year, down from 309 the year before. Caucasian service members under age 25 and in the lower ranks were at the highest risk, the same as the year before.

The 2010 total includes active-duty, reserve and National Guard personnel. It reflects a slight downward revision from the 301 suicides the Defense Department reported in January, which included about 70 that were still under investigation.

The Defense Department has been coping with rising suicide numbers during its protracted wars in Afghanistan and Iraq. Individual service branches have tracked suicides for years, and in 2008, the Defense Department began using a standard form for collecting information called the Department of Defense Suicide Event Report or DoDSER.

The entire story can be found here.

Prevalence and Risk Factors Associated With Suicides of Army Soldiers 2001-2009

By Sandra A. Black, M. S. Gallaway, M. R. Bell & E. C. Ritchie
Military Psychology (vol. 23, #4), pp. 433-451

Contemporary research on suicide in the general population has shown that biological, psychosocial, and environmental factors interact to influence suicide-related deaths each year (Brown, 2006; Ellis, 2007; Leenaars, 2008; Lester, 2004; Lester, 2008; Schneidman, 1996). Research on biological risk factors suggests that genetic vulnerability to mental disorders, serotonin insufficiency, and serious physical illness or injury are particularly linked to suicide-related deaths (Heeringen, 2001; Mann, 2002; Mann, 2003; Moscicki, 2001; Roy, Rylander, & Sarchiapone, 1997). Similarly, research on psychological risk factors has also linked mood, anxiety, and personality-related disorders, as well as alcohol and substance disorders, with suicide-related deaths (Conner, Duberstein, Conwell, Seidlitz, & Caine, 2001; Harris & Barraclough, 1997; Nock et al., 2009; Simon, 2006), while other research has linked suicidal behavior with hopelessness, impulsivity, aggression, a history of trauma or abuse, and any previous suicide attempt (Beck, Brown, Berchick, & Stewart, 1990; Brown, 2006; Brown, Jeglic, Henriques, & Beck, 2006; Linehan, 1993; Martin, Ghahramanlou-Holloway, Lou, & Tucciarone; 2009; Schneidman, 1996).

Research on sociocultural risk factors suggests that race/ethnicity, marital status, lack of social support, a sense of isolation or not belonging, social losses, financial difficulties, stigma associated with help-seeking, and suicide as a noble or acceptable resolution of a personal dilemma associated with cultural or religious beliefs are correlated with suicide-related deaths (Clarke, Bannon, & Denihan, 2003; Kerkhof & Arensman, 2001; Kolves, Ide, & De Leo, 2010; Kposowa, 2000; Leenaars, 2008; Lester, 2008; Mann et al., 2005; Sartorius, 2007). Moreover, research on environmental risk factors indicates that access to lethal weapons and barriers to health care contribute to suicide-related deaths (Martin et al., 2009; Simon, 2006). Studies on the prevalence and risk factors associated with suicide-related deaths in military personnel have reported similar results. Specifically, mental disorders, substance abuse, physical illness, stigma, family separation, occupational difficulties, and relationship losses have been linked to suicide-related deaths among military personnel (Cox, Edison, Stewart, Dorson, & Ritchie, 2006; Ritchie, Keppler, & Rothberg, 2003).

This research has advanced our understanding of the prevalence and correlates of suicide-related deaths among military personnel. However, it is worth noting that little of this research has examined specific risk factors in relation to trends in Army suicides, particularly over the past decade, that is, 2001-2009. Examining the prevalence and risk factors associated with suicide-related deaths among Army personnel is particularly important given increasing operational demands associated with ongoing operations in Afghanistan and Iraq. In fact, research indicates that stress associated with deployment, combat intensity, and the potential shame of failure or weakness--all of which are known to increase the risk for mood disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and substance-related disorders--have been linked to suicide-related deaths among military personnel (Allen, Cross, & Swanner, 2005; Bodner, Ben-Artzi, & Kaplan, 2006; Hill, Johnson, & Barton, 2006; Hoge et al., 2008; Rand Center for Military Health Policy Research, 2008). Moreover, it is worth noting that many of these risk factors may be accompanied by increased availability of firearms within the military as compared to civilian society (Marzuk et al., 1992).

Additionally, certain risk factors may differentially impact military personnel. For example, the loss of friends, particularly those assigned to the same unit, can have a deep impact, whether in combat or not (Kang & Bullman, 2008). Stress may be greater in the Army population because of increased dependence on social support provided by friends and coworkers in the military environment (Mahon, Tobin, Cusack, Kelleher, & Malone, 2005). Externalized psychopathology (drug and particularly alcohol abuse or dependence) may be more evident in the military due to greater cultural acceptability of these behaviors (Hills, Afifi, Cox, Bienvenu, & Sareen, 2009). Stigma associated with help-seeking behavior or treatment may also be more prevalent in the military, because mental illness is often viewed as a manifestation of weakness or malingering, as well as a threat to one's career (Hoge et al., 2008; Rand Center, 2008).

This is only the beginning of the article.

Thanks to Ken Pope for this information.

HIPAA Summit West: 1 in 4 Organizations Report Data Breaches

Dom Nicastro, for HealthLeaders Media, September 27, 2011

Ali Pabrai said it best at last week's fifth national HIPAA Summit West at the Grand Hyatt in San Francisco. Pabrai, a data security expert, noted that 97% of chief information officers are concerned about data security.

"My question is, 'Who are these other three percent?'" Pabrai asked the hundreds of laughing attendees.

Pabrai, MSEE, CISSP (ISSMP, ISSAP), of ecfirst's HIPAA Academy in Newport Beach, CA, delivered a message that resonates with HIPAA privacy and security officers: Everyone, especially those charged with protecting the privacy of patient information, needs to be concerned about data security.

Numbers game

The numbers at the HIPAA Summit told the story:

• 1 in 4: Organizations reporting a data breach (source: Pabrai)
• 250,000 to 500,000: Medical identity thefts (source: Pabrai)
•  330: Organizations reporting a breach of unsecured protected health information affecting 500 or more individuals since September 2009 (source: Office for Civil Rights, or OCR)
• 34,000: Number of reports of breaches submitted to OCR affecting fewer than 500 individuals (source: OCR)

From how and from where the 500-or-more breaches are coming:

How:

• Theft: 50%
• Unauthorized access disclosure: 20%
•  Loss: 16%
• Hacking/IT: 7%

Where:

• Paper records: 24%
• Laptop: 23%
• Desktop computer: 17%
• Portable electronic device: 16%
• Network server: 10%

In August, McAfee reported that hackers broke into the United Nations data system and hid there for two years unnoticed, Pabrai said.

"How do we know that someone isn't hiding in our systems, and how long have they been there?" Pabrai asked the audience. "Do we have appropriate controls? What is the state of our information security?" Do you have intrusion protection and intrusion prevention in place?

"This is not just a compliance issue," Pabrai said. "This will have significant risk to the organization and will impact your facility in the seven figures."

The entire story can be read here.

Health industry lacks patient data safeguards: poll

by Alina Selyukh

(Reuters) - New technologies are flooding into the healthcare world, but the industry is not adequately prepared to protect patients from data breaches, according to a report published on Thursday.

A vast majority of hospitals, doctors, pharmacies and insurers are eager to adapt to increasingly digital patient data. However, less than half are addressing implications for privacy and security, a survey of healthcare industry executives by PricewaterhouseCoopers LLP found.

The original article is here.

Calling the Nurse ‘Doctor,’ a Title Physicians Oppose

By Gardiner Harris

The New York Times

Originally published October 2, 2011

With pain in her right ear, Sue Cassidy went to a clinic. The doctor, wearing a white lab coat with a stethoscope in one pocket, introduced herself.

“Hi. I’m Dr. Patti McCarver, and I’m your nurse,” she said. And with that, Dr. McCarver stuck a scope in Ms. Cassidy’s ear, noticed a buildup of fluid and prescribed an allergy medicine.

It was something that will become increasingly routine for patients: a someone who is not a physician using the title of doctor.

Dr. McCarver calls herself a doctor because she returned to school to earn a doctorate last year, one of thousands of nurses doing the same recently. Doctorates are popping up all over the health professions, and the result is a quiet battle over not only the title “doctor,” but also the money, power and prestige that often comes with it.

As more nurses, pharmacists and physical therapists claim this honorific, physicians are fighting back. For nurses, getting doctorates can help them land a top administrative job at a hospital, improve their standing at a university and win them more respect from colleagues and patients. But so far, the new degrees have not brought higher fees from insurers for seeing patients or greater authority from states to prescribe medicines.

Nursing leaders say that their push to have more nurses earn doctorates has nothing to do with their fight of several decades in state legislatures to give nurses more autonomy, money and prescriptive power.

But many physicians are suspicious and say that once tens of thousands of nurses have doctorates, they will invariably seek more prescribing authority and more money. Otherwise, they ask, what is the point?

Dr. Roland Goertz, the board chairman of the American Academy of Family Physicians, says that physicians are worried that losing control over “doctor,” a word that has defined their profession for centuries, will be followed by the loss of control over the profession itself. He said that patients could be confused about the roles of various health professionals who all call themselves doctors.

“There is real concern that the use of the word ‘doctor’ will not be clear to patients,” he said.

So physicians and their allies are pushing legislative efforts to restrict who gets to use the title of doctor. A bill proposed in the New York State Senate would bar nurses from advertising themselves as doctors, no matter their degree. A law proposed in Congress would bar people from misrepresenting their education or license to practice. And laws already in effect in Arizona, Delaware and other states forbid nurses, pharmacists and others to use the title “doctor” unless they immediately identify their profession.

The entire story can be read 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.

Bartering For Health Care: Yardwork For Treatment

By Eric Molinsky

NPR

Deb Barth is raking leaves for Lesley Jones. But Barth isn't earning money for her yardwork, at least not in physical currency. She's earning "time dollars" — for every two hours she spends doing odd jobs, she'll earn a free visit with her doctor.

As a struggling artist, Barth's income qualifies her for the program at True North, a nonprofit health care clinic in Falmouth, Maine. She's one of 33 patients who pay with time dollars there.

"I do things like deep cleaning, organizing," Barth says. "I also offer caregiver support for people who may be caring for an older parent."

So how does her doctor cash in these time credits? By getting free services from any of the other hundreds of people who belong to The Portland Hour Exchange Program.

Tom Dahlborg, the executive director of True North, used to work in Medicaid, where he thought the patients weren't getting enough from their health care.

"People would come in for care and they would be like, 'OK, give me what you can, that's fine,' and they really weren't engaged in it," Dahlborg says. "It was almost like a guilt, like, 'Oh, it's free care, so I don't really deserve that much anyways.' "

But he says patients at True North who pay with time dollars are fully engaged.

"We'll hear from a landscaper [who] will say, 'I mowed five lawns in the last month so I could bring my children in to see your pediatric nurse practitioner. This darn well better be a good visit,' " Dahlborg says.

They certainly get a lengthy visit. Patients are allowed to spend up to an hour or more with their doctors.

The entire story can be read here.