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

Wednesday, February 29, 2012

Announcing New APA Member-Initiated Task Force to Reconcile Policies Related to Psychologists’ Involvement in National Security Settings

Dear Colleagues,

Many of you are aware of the petition to annul the 2005 Report of the APA Presidential Task Force on Psychological Ethics and National Security (the PENS report) being circulated on behalf of the Coalition for an Ethical Psychology.  This petition highlights how the PENS report (which is now out of date in important respects) is still being viewed at times as the sole or primary APA policy related to the role of psychologists in national security settings.  Yet, there are five other relevant APA Council resolutions focused on torture, ethics, detainee welfare, and interrogation dating back to 1985, along with the significant membership petition resolution in 2008 and the important changes to Standards 1.02 and 1.03 of the APA Ethics Code in 2010.

A membership-driven initiative has arisen in response to the concerns raised by the coalition.  Several leaders of Division 48 (Peace Psychology) have joined forces with a second group of APA members who represent a broad range of backgrounds and perspectives and who likewise agree that APA needs to address concerns regarding the PENS report.  Together, these two groups have formed the APA Member-Initiated Task Force to Reconcile Policies Related to Psychologists’ Involvement in National Security Settings.  The goal of this task force is to develop a clear, comprehensive policy statement that consolidates existing APA policies into a unified, consistent document.  This consolidated policy will replace the PENS report, along with other Council resolutions focused on national security settings, but will not replace the broader 2006 Council Resolution Against Torture and Other Cruel, Inhuman, and Degrading Treatment or Punishment, the membership petition resolution, or the amendments to the Ethics Code, all of which will remain intact as APA policy.

Among its provisions, the consolidated policy document will include the following principles drawn from existing APA policies: 1) torture is always a violation of human rights and psychologists’ professional ethics; 2) psychologists are always prohibited from engaging in torture or other cruel, inhuman, or degrading treatment or punishment; 3) abusive interrogation techniques, such as waterboarding and sensory deprivation, constitute torture or cruel, inhuman, or degrading treatment or punishment and are always prohibited; 4) the role of psychologists in unlawful detention settings is limited to working on behalf of detainees or providing treatment for military personnel; and 5) there is no defense to a violation of human rights under the APA Ethics Code.

As chair of this new task force, I am pleased to provide you with the attached announcement of our goal, rationale, membership, and work plan.  This statement has also been provided to the APA Board of Directors and Council of Representatives.  We welcome its wide dissemination.


Linda M. Woolf

Policy Task Force Announcement

Tuesday, February 28, 2012

Chronic Pain Fuels Boom in Opioids

By John Fauber
Milwaukee Journal Sentinel/MedPage Today
Originally published on February 19, 2012

Prescriptions for narcotic painkillers soared so much over the last decade that by 2010 enough were being dispensed to medicate every adult in the U.S. around-the-clock for a month.

Fueling that surge was a network of pain organizations, doctors, and researchers that pushed for expanded use of the drugs while taking in millions of dollars from the very companies that made them, a Journal Sentinel/MedPage Today investigation found.

Last year, the Journal Sentinel/MedPage Today found that a University of Wisconsin-Madison-based organization had been a national force in helping liberalize the way opioids are prescribed and viewed. During a decade-long campaign that promoted expanded use of opioids -- an agenda that critics say was not supported by rigorous science -- the UW Pain & Policy Studies Group received $2.5 million from makers of opioid analgesics.

After that article was published last April, the UW Pain group said it had decided to stop taking money from the drug industry.


The Pendulum Swings Back

Several of the pain industry's core beliefs about chronic pain and opioids are not supported by good science and contributed to the growing use of the drugs, a Journal Sentinel/MedPage Today review of records and interviews found.

Among the misconceptions:
  • The risk of addiction is low in patients who obtain their narcotic painkillers legitimately.
  • There is no maximum dose of the drugs that can't be safely prescribed.
  • People who seek more frequent prescriptions or higher doses of the drugs aren't addicts, they are "pseudoaddicts" who just need more pain relief and more opioids.

Underlying those fallacies, critics say, is an even larger one: That the use of narcotic painkillers to treat non-cancer pain lasting many months or years is supported by rigorous science.

Even doctors who have financial relationships with companies that make narcotic painkillers concede that the practice of pain medicine got ahead of the science.
Lynn Webster, MD, a Utah pain specialist who has worked as a consultant and adviser to most of the companies in the opioid analgesic market, said the pain community got some of it wrong.

"We overshot our mark, all well-intended, I believe," Webster, an officer of the American Academy of Pain Medicine, said in an interview. "We certainly have a lot of reverse education that needs to occur."

Some chronic pain sufferers do benefit from the drugs, Webster said.

"The problem is pain is complex," he said. "There is a whole family of opioids and we have not figured out how to best identify the individuals who can benefit long term.

"I don't think industry was trying to harm anyone. I think industry was trying to fill a need that we as physicians saw."

Others say that Webster is too forgiving in his analysis: they claim that the pharmaceutical industry chose profits over patient safety.

Monday, February 27, 2012

Judge: Killer Faked Insanity for Decades

By Elaine Silverstrini
The Tampa Tribune

More than 30 years after Carlos Bello murdered a Tampa police detective and wounded another, a judge concluded he is faking mental illness and is competent to be resentenced.

As soon as Circuit Judge Ronald Ficarrotta announced his ruling Friday, several Tampa police officers in his courtroom took out phones and began sending text messages.

Among those present was Detective Greg Stout, president of the Tampa Police Benevolent Association, who immediately after the hearing said he was sure word had spread through the department. The reaction, he said, was "jubilation."

Bello, 58, was convicted and sentenced to death in 1987 for killing Detective Gerald Rauft and shooting Detective Robert Ulriksen during a drug raid at an Ybor City home in 1981. But his sentence was overturned by the Florida Supreme Court, and Bello began years of evaluations for mental competency.

"This defendant has played the system like no one has ever played the system before," Assistant State Attorney Darrell Dirks told Ficarrotta. "He had one judge tell him in 1987 he is going to be sentenced to death. This defendant has made it his purpose that that is never ever going to happen to him. … He has done a great job. I'll give him kudos. He is a great manipulator."

Prosecutors Allowed Access to Loughner Notes

By Michael Kiefer
The Arizona Republic

The judge in the Tucson mass shooting case has ruled that prosecutors can have access to notes made by Jared Loughner's prison psychologist over the course of her evaluations of his mental health.

The suspected shooter is undergoing restoration to competency at a federal prison hospital in Springfield, Mo., and his lawyer asked that federal prosecutors be denied access to the psychologist's notes because of self-incriminating statements Loughner made during sessions with psychologist Christina Pietz.

Sunday, February 26, 2012

Law OKs Cross-State Counseling Services

By Joe Gould
Army Times

The recent passage of the National Defense Authorization Act in Congress will make it easier for active-duty personnel and veterans to get mental health care wherever they are, officials said.

A provision of the act, aimed at expanding federal exemptions for behavioral telehealth consultations across state lines, removes the requirement for health care providers to be licensed in the state in which their patients are being treated.

Gen. Peter Chiarelli, then-Army vice chief of staff and an advocate for providing behavioral health counseling to soldiers in their homes via telehealth, praised the new law as a “big victory.”

“It’s the biggest step forward we’ve seen in two years,” Chiarelli told Army Times. “For me, it is huge. We have just to take advantage of it.”

Chiarelli retired Jan. 31, and Gen. Lloyd Austin has since assumed the post as Army vice chief.

Nearly 20 percent of military personnel returning from Iraq and Afghanistan showed symptoms of post-traumatic stress disorder, according to a Rand Corp. survey.

Patients are plentiful, but the doctors who are needed to treat them are not. Chiarelli acknowledged a shortage of behavioral health specialists in the Army, as well as the challenge of attracting, hiring and retaining them to the rural areas that surround some posts.

“I find when I get closer to large metropolitan areas, I don’t have as many problems,” Chiarelli said. “But when I go to the Fort Stewarts, when I go to the Fort Braggs, when I go to the Fort Hoods, my ability to attract a shortage population in society is difficult. But we’re working very, very hard to get everything we possibly can to hire those folks.”

The hope is that connecting patients to care by video teleconference skirts this problem, allowing a provider in Seattle, for example, to speak with a patient across state lines in rural Montana.

Saturday, February 25, 2012

UK: Phone and Email Records to be Stored in New Spy Plan

By David Barret
The Telegraph: Technology-Internet

Details of every phone call and text message, email traffic and websites visited online are to be stored in a series of vast databases under new Government anti-terror plans.

Landline and mobile phone companies and broadband providers will be ordered to store the data for a year and make it available to the security services under the scheme. 

The databases would not record the contents of calls, texts or emails but the numbers or email addresses of who they are sent and received by. 

For the first time, the security services will have widespread access to information about who has been communicating with each other on social networking sites such as Facebook. 

Direct messages between subscribers to websites such as Twitter would also be stored, as well as communications between players in online video games. 

The Home Office is understood to have begun negotiations with internet companies in the last two months over the plan, which could be officially announced as early as May. 

It is certain to cause controversy over civil liberties - but also raise concerns over the security of the records. 

Access to such information would be highly prized by hackers and could be exploited to send spam email and texts. Details of which websites people visit could also be exploited for commercial gain. 

The plan has been drawn up on the advice of MI5, the home security service, MI6, which operates abroad, and GCHQ, the Government’s “listening post” responsible for monitoring communications.

Friday, February 24, 2012

mHealth: Remote Patient Monitoring Is On The Rise, With Smartphones Leading The Way

By Rip Empson
Tech Crunch
Originally published February 8, 2012

Last month, we took a look at someof the ways mobile technology is transforming the health industry. While there are many factors affecting this transformation, like artificial intelligence, big data, 3-D printing, social health networks, and remote communications, to name a few (check out Josh’s post on this here), unsurprisingly, change is coming at the hands of the growing ubiquity of cell phones, smartphones, and mobile devices.

Early last year, PEW Researchwas already reporting that 17 percent of mobile phone users were using their devices to look up health and medical information, and Juniperrecently estimated that 44 million health apps were downloaded in 2011.

In turn, the amount and availability of health data is exploding in tandem with the growing adoption of health and medical apps and devices, thanks to the increasingly wearable and user-friendly devices that use smart sensors to capture and transmit a variety biometric data. Electronic medical records (EMRs) are being made available on mobile devices — even KaiserPermanente is getting in on the digital revolution.

The mHealth industry is growing fast. According to Research2guidance‘s calculations, the size of the mHealth app market will nearly double in 2012 to $1.3 billion, up from $718 million in 2011. (I discussed the volatility of these statistics, the still-changing definitions of mHealth and mHealth technology, and conflictingreporting on these numbers here.)

While these numbers can sometimes be misleading, the mHealth sector is not only going to continue to expand, its profitability is going to skyrocket. This is because, in juxtaposition with the $7 trillion global healthcare market, the mHealth market remains incipient. Healthcare companies, startups, and beyond are just beginning to tap into the potential of mobile technology, both in terms of quantified self devices, which bring healthcare in the clinic home, the mobility of data and communication channels. Companies are beginning to spend more and more on research and development, the big kahunas of the medical world are starting to release real, functional mobile apps, and consumer-facing medical devices are just starting to see real market penetration.

Thursday, February 23, 2012

Termination of Supervision Requires Planning

Termination of Supervision Requires Planning

Wednesday, February 22, 2012

Suicidal Ideation and Self-Harm in LGBT Youth

Medical News Today
Originally published February 16, 2012

What protects lesbian, gay, bisexual and transgender (LGBT) youths from considering suicide and, conversely, what makes them most vulnerable to it?

The question is of paramount concern because these youths are at least twice as likely to attempt suicide than heterosexual youths, prompting the national "It Gets Better Project" with encouraging video messages from such public figures as Lady Gaga and President Barack Obama.

Now the first longitudinal study to look at suicide ideation and self-harm in this population shows support from friends and family offers the most protection in preventing youths from thinking about suicide. Adolescents who know they can talk to their parents about problems and know they have friends who care about them are less likely to consider ending their lives, according to new Northwestern Medicine research.

Adolescents most likely to consider killing themselves and engage in self-harm behaviors are those who feel victimized for being gay. About 94 percent of LGBT youths have had at least one experience in which people said cruel things to them, spit on them, destroyed their property and threatened or assaulted them - all related to them being gay, according to prior Northwestern research.

Suicidal thoughts are a key predictor of a suicide attempt. Cutting behaviors also are a risk factor.

Previous studies of LGBT adolescents looked at their risk of making suicide attempts, not predictors that make them vulnerable to it or protect them from it.

"Our research shows how critical it is for these young people to have social support and for schools to have programs to reduce bullying," said Brian Mustanski, associate professor of medical social sciences at Northwestern University Feinberg School of Medicine. "We believe this will help save young lives."

The entire story is here.

The research article is here.

Tuesday, February 21, 2012

The Unintended Consequences of Conflict of Interest Disclosure

By George Loewenstein, PhD, Sunita Sah, MD, PhD, & Daylian M. Cain, PhD.
The Journal of the American Medical Association

Conflicts of interest, both financial and nonfinancial, are ubiquitous in medicine, and the most commonly prescribed remedy is disclosure. The Medicare Payment Advisory Commission and the Accountable Care Act impose a range of disclosure requirements for physicians, and almost all medical journals now require authors to disclose conflicts of interest (although these requirements may be imperfectly heeded). Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Given that some relationships between physicians and industry are fruitful and some conflicts are unavoidable, can disclosure correct the problems that arise when economic interests prevent physicians from putting patients' interests first?

Disclosure has appeal across the political spectrum because it acknowledges the problem of conflicts but involves minimal regulation and is less expensive to implement than more comprehensive remedies.

More importantly, even if disclosure is rarely seen as providing a complete solution to the problem, it is broadly perceived to have beneficial effects.

There are, however, reasons that disclosure can have adverse effects, exacerbating bias and hurting those it is ostensibly intended to help.



Despite its potential pitfalls, disclosure is almost certainly a good thing.

It should be a patient's right to know whether his or her physician is receiving financial benefits from prescribing a particular drug or will personally benefit if the patient accepts recommended tests or procedures.

The question for policy should not be whether to disclose but how to ensure that disclosure has its intended effects.

Research has revealed ways of making disclosure more effective.


Even if disclosure is crafted in a fashion that increases effectiveness and minimizes potentially adverse consequences, it is no panacea.

Disclosure is simply not applicable to many serious conflicts of interest affecting medicine in the United States.

Although payments from pharmaceutical and device companies have received most of the attention in the literature on disclosure, other conflicts, such as financial arrangements that give physicians (and their institutions) incentives for providing high-cost services of dubious value, may be more consequential.

It is difficult to imagine how disclosure could even be applied to, let alone undo, those problems.

However, perhaps the most significant likely pitfall of disclosure is not its effects on the quality of advice received by individual patients or its inapplicability to many serious conflicts of interest, but the likelihood of a kind of moral licensing on the part of the profession as a whole--the rationalization that, with disclosure, the profession has dispensed with its obligation to deal with conflicts of interest.

Conflicts of interest, including fee-for-service arrangements, are at the heart of the astronomical increases in health care costs in the United States, and transparency is no substitute for more substantive reform.

Special thanks to Ken Pope for this information.

Monday, February 20, 2012

Q&A about Patient Abandonment or Wrongful Termination

The following exchange is taken from a national ethics listserv discussion.  We acquired permission from both parties to post this dialogue.

Jeff Younggren asks:

As many of you may know, I have been quite absorbed in the past year or so in the topic of abandonment/wrongful termination.  While I believe that we do owe our clients/patients pre-termination counseling when appropriate and possible, I also believe there conditions that make this unnecessary.

For example, I would argue that when a patient stops paying you, or threatens you or some other situation that compromises therapy or the therapeutic relationship; your obligations to provide pre-termination guidance or counseling are reduced and/or eliminated.  I contend that, emergencies aside, we have no obligation to see people for free if we do not want to (but you can if you want to).  I am puzzled as to how the profession can require someone to work for free when the patient/client violates the professional relationship by acting out, not paying a bill or threatening the professional in some way. 

What would you say about the rights of a licensing board, for example, to punish a psychologist for not providing free, non-emergent services to clients?

Gary Schoener replies:

These issues come up all the time because some clients threaten clinicians with a charge of abandoning them.  I have been involved in a number of cases where this has been litigated.

First of all, I agree that our field has no tradition of treating people without fee as an expectation. Medicine actually did have such a belief.  In fact, I began my career at a neuropsychology clinic and doctors and their families were treated for free by the psychiatrists and neurologists.

They expected us psychologists to do the same as a "courtesy" but we pointed out that:

(a) We did not get free care from any of our physicians; so this was not, with us, a collegial exchange of courtesies;
(b) While we might choose to treat someone for free, when we do it is usually for someone who does not have financial resources (not typical of doctors and their families); and,
(c) People often do not value free services; so this was questionable on that basis too.

BENEFICENCE:  In terms of professional issues, it is our duty to determine who we are capable of treating, to monitor progress and be willing to re-examine our presumption if they are not responding, and to cease treatment that is not working. 

NONMALEFICENCE:  Since all of our treatment techniques can be harmful, and because it is likely harmful in a general sense to provide 'treatment" which is not working, we are again obligated to discontinue treatment that is not working.

AUTONOMY:  The client can choose to leave therapy at any time, but autonomy does not include any "right to treatment." There is no such right.  If a client comes in and asks for  a lobotomy, a psychiatrist would not be expected to do it.  Autonomy in the current world means the right to have information and make informed choices, but it does not bind the practitioner to those choices.

FIDELITY:  The main issue here is that the client knows, going into treatment, that you will be both monitoring progress and that sometimes therapy does not work or does not help, and in that instance a referral should be considered.  In your initial discussion, you should outline your policies on payment for service.

JUSTICE:  Although not critical much of the time, if treatment of the client is harming other clients (e.g. disruption in the waiting room, disruption in group therapy), you can terminate the client.  Resources (e.g. you) are limited and our job is to use them where they can do the most good.  The clients are not "ours" and we are not "theirs" -- nobody has ownership.

Obviously, as a practical reality, practice standard, and consistent with the last revision of our APA code of ethics, we are not bound to provide free service, to continue with people who violate their agreements with us, or to continue in the face of threats by the client or anyone connected with them.

I believe our duty is to provide referrals and be willing to provide information to the new service provider.  It is not our job to find then another service provider -- just to make reasonable suggestions.  If they go into crisis, normally a referral to the local hospital or crisis service discharges ones duty.

In case law, there is that one exceptional case where a psychiatrist about to retire gave all his patients referrals.  However, one patient was very introverted and the psychiatrist himself admitted that a referral alone was probably not enough.  The man was on medications and the psychiatrist never got a records request.  The jury felt, based on the facts including the psychiatrist's own admissions, that he failed in his duty by not working to help this very vulnerable man (who had seen him for many years) make an adequate transition to another practitioner. This was not, of course, an abandonment case -- it was a duty to do more at the end.  I know of no other case, but this has been in the journals so often that it causes people to think that abandonment was the issue.

Jeff Younggren:

What is of great concern to me is that we have clinicians staying in nonproductive and adversarial treatment alliances out of their fear that they will be charged with abandonment if they stop seeing the client.  They fail to see that you can stop seeing anyone, it is how you do it that is key.  In some cases, you have no obligation to do anything other than stop seeing the client, like when your safety is threatened or a patient sues you and in others, like long-term treatment cases, you have a much more extensive obligation that likely includes termination sessions and referral.  We need to make sure that psychologists in practice understand this dynamic.
Gary Schoener:
I agree Jeff.  In addition, as is true for so many things like this, litigiphobia and anxiety are enemies of good decision-making.
Jeff Younggren:
Great point!  
Litigiphobia?  That is a new one for me.

Sunday, February 19, 2012

Data Breaches Put Patients at Risk for Identity Theft

By Robin Erb
Detroit Free Press
Originally published 2/12/12

Walk into a doctor's office and chances are that some of your most private information -- from your Social Security number to the details of your last cervical exam and your family's cancer history -- is stored electronically.

Your doctor might access the information on a cell phone that could slip into the wrong hands. The staff might take it home on a laptop or a flash drive.

As Detroit-area health care providers take multimillion-dollar steps toward electronic records, they're talking about more than efficiency and better care. They're talking security, too.

"It's a great concern," said Dr. Matthew Zimmie, who is heading an $80-million conversion to electronic records at Oakwood Healthcare System.

Oakwood's security measures include passwords and security profiles — allowing a radiology tech, for example, to look only at information for radiology patients.
"We definitely take this seriously," Zimmie said.

They have to. According to a recent report by the Ponemon Institute, a Traverse City, Mich.-based firm that conducts research about privacy and security:
  • Data breaches nationally grew 32% last year, mostly because of employee negligence and lack of oversight.
  • Nearly all of the 72 organizations surveyed reported at least one incident of lost or stolen information in the previous year.•And although four out of five doctors use smartphones, more than half say they are not taking precautions to encrypt information.
  • The top three causes for a data breach were lost or stolen computing devices, unintentional release of information by contractors and unintentional employee action, according to the report.
  • More than half of the respondents reported they had little or no confidence that their organization would be able to detect all breaches.
"It's almost a matter of time before anyone can be a victim. The key is catching it early," said Dennis Doherty, an assistant prosecutor who handles fraud cases for Wayne County, Mich.

Saturday, February 18, 2012

Jury awards $16.5 million in State College suit

By Matt Carroll

A jury awarded $16.5 million Thursday to a woman who said she was drugged with carbon dioxide and manipulated to believe she was raped by family members at the hands of a former State College psychologist.

Her attorney, Bernard Cantorna, asked the jury to hold Julian Metter, 59, accountable for planting a “horror story” in the woman’s mind while she was drugged with carbon dioxide.

The jurors responded after five hours of deliberation, unanimously ordering Metter to pay what Cantorna said is the largest jury verdict in Centre County history.

“They clearly wanted to send a message that Dr. Metter is a danger to the public and anyone he might attempt to treat,” Cantorna said. “They wanted to make sure anybody and everybody could find this case and make sure he can never do this to anyone again.”

Metter, who had been in practice for 20 years, lost his license to practice psychology in June 2009 when he pleaded guilty to fraudulently billing Medicare, according to the National Council Against Health Fraud.

He was sentenced in February 2011 to serve five months in prison followed by two years probation. Cantorna said Metter is free to continue treating people, just not as a psychologist, after his probation.

When contacted Thursday night, Metter said he was saddened and disappointed by the jury’s decision. He said he will appeal the verdict.

“It was very surprising,” Metter said. “Everyone with me who knows (the woman) and the situation really felt we brought forward a very accurate picture.”

Cantorna said his client was made to believe she was raped at the hands of her family and abused in cultlike rituals by prominent members of the community.

Metter was accused in the civil lawsuit of creating those images and suggesting them as reality while the woman was drugged and in her most vulnerable state.

“He took a woman who never had any history of this and made her relive the most horrific things one could imagine,” Cantorna said Thursday during closing arguments in the six-day civil trial. “He made her live it.”

The lawsuit alleged the woman suffered lasting emotional anguish as a result. It also stated she suffered a brain injury due to repeated exposures to a mixture of carbon dioxide and oxygen.

The entire story is here.

Here is the civil complaint.

Here is a copy of the Consent Agreement and Order from the PA State Board of Psychology.

Here is Metter on Autism, with his center's "treatments" that fall outside the scope of a psychologist's practice.

Friday, February 17, 2012

Russians alarmed by rash of teenage suicides

By Mansur Mirovalev
Associated Press
Originally published 2/10/12

MOSCOW (AP) — A rash of teenage suicides in Russia has set off alarm bells and experts are urging the government to take immediate action.

Russia has the world's third-highest rate of suicide among teenagers aged 15-to-19, with about 1,500 taking their own lives every year, according to a recent UNICEF report. The rate is higher only in the neighboring former Soviet republics of Belarus and Kazakhstan.
In recent years, there have been 19-to-20 annual suicides per 100,000 teenagers in Russia — three times the world average, Boris Polozhy of the respected Serbsky psychiatric center in Moscow said Friday.

"Until the highest authorities see suicide as a problem, our joint efforts will be unlikely to yield any results," he said.

In the southwestern Siberian region of Tuva, the rate reaches a staggering 120 suicides per 100,000 teenagers, while the nearby region of Buryatiya has an average rage of 77 per 100,000. Both regions are impoverished and have high crime and alcoholism rates.

Two 14-year-old girls in the Moscow suburb of Lobnya killed themselves this week by jumping off the roof of a 14-story building while holding hands. They had skipped classes for two weeks and were terrified of what their parents would do to them once they found out, Russian media quoted their friends as saying.

Most Teens Who Self-Harm Are Not Evaluated for Mental Health in ER

By Mary Elizabeth Dallas

Most children and teens who deliberately injure themselves are discharged from emergency rooms without an evaluation of their mental health, a new study shows.

The findings are worrisome since risk for suicide is greatest right after an episode of deliberate self-harm, according to researchers at Nationwide Children's Hospital in Columbus, Ohio.

The researchers also found the majority of these kids do not receive any follow-up care with a mental health professional up to one month after their ER visit.

"Emergency department personnel can play a unique role in suicide prevention by assessing the mental health of patients after deliberate self-harm and providing potentially lifesaving referrals for outpatient mental health care," said lead study author Jeff Bridge, principal investigator at the hospital's Center for Innovation in Pediatric Practice, in a news release. "However, the coordination between emergency services for patients who deliberately harm themselves and linkage with outpatient mental health treatment is often inadequate."

The story can be found here.

The study is from Child & Adolescent Psychiatry, Volume 51, Issue 2, pages 213-222.  Here is the conclusion of the study from the abstract.
"A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care."

Thursday, February 16, 2012

Diagnosis of a DSM 5 News Cycle

By John Grohol
World of Psychology

As I was sitting around catching up on some mental health news on Saturday, I inadvertently stumbled upon another manufactured news cycle about the DSM 5. Considering no new significant research findings were released in the past week on the DSM-5 revision efforts, I was a little surprised.

This latest fake news cycle started on Thursday, apparently with the release of a Reuters news story from Kate Kelland. Kelland notes the newest concern comes from “Liverpool University’s Institute of Psychology at a briefing in London about widespread concerns over the manual.” There’s no link to the briefing. And I’m not sure what a “briefing” is — a press conference? (And since when is a press conference a news item? It’s not really equivalent to a new research study, is it?)

Kelland fails to note that Europe and the U.K. don’t actually use the DSM to diagnose mental disorders — it’s a U.S. reference manual for mental disorders diagnosis. So while it’s nice that some Europeans are expressing concern about this reference text, their concern isn’t exactly much relevant. Context is everything, and Reuters failed to provide any useful context in that article.

Sadly, Reuters is a brand name. And once you write an article under that brand name, it cascades down an entire news cycle. Let’s follow it for fun!

New Mental Health Manual is "dangerous" say Experts

By Kate Kelland
Health and Science Correspondence

Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were at best "silly" and at worst "worrying and dangerous."

"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill," said Peter Kinderman, head of Liverpool University's Institute of Psychology at a briefing in London about widespread concerns over the manual.

"It's not humane, it's not scientific, and it won't help decide what help a person needs."

The DSM is published by the American Psychiatric Association (APA) and has symptoms and other criteria for diagnosing mental disorders. It is used internationally and seen as the diagnostic "bible" for mental health medicine.
No one from the APA was immediately available for comment.

More than 11,000 health professionals have already signed a petition (at dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.
Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medical zing behaviors most people would consider normal or just mildly eccentric, the experts said.

At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.

The entire story is here.

Critics attack DSM-5 for overmedicalising normal human behaviour

By Geoff Watts
British Journal of Medicine
Originally published on February 10, 2012

Although not due to be published until May 2013, the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is already provoking dissent among psychiatrists and psychologists in Britain.

Critics claim it will make an already problematic diagnostic system worse and result in more people being labelled mentally ill.


"The new categories are based on lists of symptoms that don't necessarily map well on to the underlying biological and psychological processes involved in emotion, behaviour, and cognition," said Nick Craddock, professor of psychiatry at Cardiff University.

Speaking at a critical briefing on the current plans for the DSM-5 he claimed that more aspects of emotion, behaviour, and cognition are going to be labelled as diagnoses.

This will medicalise more of what most people view as normal human behaviour.

He offered the example of someone having an episode of severe low mood that met the accepted diagnostic criteria of depression.

"Currently, if this follows bereavement, it would be excluded. It would be regarded as normal. But in DSM-5 the plan is to remove the bereavement exclusion. What most would view as a normal reaction to the death of a loved one would be labelled as a depressive illness," said Professor Craddock.

Peter Kinderman, professor of clinical psychology at the University of Liverpool and also speaking at the briefing said, "DSM-5 is making the process of describing and explaining situations worse."

 He gave as an example the diagnosis of gambling disorder.

"For individuals and for society gambling is a problem.  I think it's unhelpful to regard it as an illness," he said.

"The proposed revision will include a vast number of social, psychological, and behaviour problems in the category of mental disorder, so pathologising mild eccentricity, loneliness, shyness, sadness, and much else.  One worries about what this will mean for the person who receives the label."

To be categorised as mentally ill has all sorts of consequences, he added.

Professor Kinderman suggested that "the American Psychiatric Association call a halt and convene a representative international expert panel to discuss the proposals."

The article can be found here.
Thanks to Ken Pope for this information.

Wednesday, February 15, 2012

8 Breach Prevention Tips: Action Items Based on Lessons Learned

By Howard Anderson
Originally published February 8, 2012

What can be learned from the more than 390 major breaches affecting more than 19 million individuals that have been reported as a result of the federal HIPAA breach notification rule? Plenty, breach prevention experts say.

Here are eight key breach-prevention insights from information security thought-leaders:

1. Don't Forget Risk Assessments
The details of the biggest breaches last year "make it painfully clear that inadequate, if any, HIPAA security risk analysis took place prior to the breaches," says Dan Berger, CEO at Redspin.
2. Encrypt Mobile Devices, Media
"Even though encryption is what's referred to as an addressable standard in the HIPAA security rule - which means it's not actually mandated in all cases - I don't see any reason why information shouldn't be encrypted in all cases on portable media and devices," says Robert Belfort, partner at the law firm Manatt, Phelps & Phillips LLP. "That's one step that organizations can take that can address a very significant share of the types of breaches that are occurring."
3. Beef Up Training
"People have to be trained to understand the policies of the organization, and they have to be trained about common-sense safeguards that they can follow to avoid breaches or the misuse of information," Szabo stresses.
4. Conduct Internal Audits
In addition to training, an important step toward addressing internal breach threats is to conduct audits of records access, Belfort says.
5. Monitor Business Associates
About 22 percent of major breaches, including many of the largest incidents, have involved business associates. As a result, it's essential to work with vendor partners to ensure they're taking adequate breach prevention steps.

In the Resources section of this blog, there is a White Paper on Preventing a Data Breach and Protecting Health Records – One Year Later: Are You Vulnerable to a Breach? by Kaufman, Rossin & Co. to augment these security issues.

Preventing a Data Breach and Protecting Health Records

Preventing a Data Breach and Protecting Health Records
Found in the public domain.

Tuesday, February 14, 2012

Patient Communication Study Shows Doctors Regularly Withhold Truth

Catherine Pearson
The Huffington Post - Healthy Living
Originally published February 9, 2012

If you think your doctor is hiding something from you, you might be right.

According to a new study, published Wednesday in the journal Health Affairs, some physicians are not always forthright when it comes to patient communication, withholding information about medical errors, relationships with drug companies and severity of a person's prognosis.

"It should be a source of caution," said Dr. Lisa Lezzioni, a professor of medicine at Harvard Medical School and the study's author. "The caution requires patients to think about and discuss what they want in terms of communication with their doctors."

Researchers surveyed more than 1,800 physicians from around the country, working in a variety of specialties, to ask about how they perceive and handle patient communications.

Nearly 35 percent of respondents said they did not "completely agree" that they should disclose serious medical errors to their patients, and approximately 20 percent said they had not revealed a mistake to a patient in the last year because they feared being sued.

Additionally, 35 percent of the doctors said they did not "completely agree" that they should disclose their financial relationships with drug and medical device companies, and 11 percent admitted that they had told a patient something untrue in the past year.

The entire story is here.

Here is a portion of the abstract from the original article in Health Affairs.

Overall, approximately one-third of physicians did not completely agree with disclosing serious medical errors to patients, almost one-fifth did not completely agree that physicians should never tell a patient something untrue, and nearly two-fifths did not completely agree that they should disclose their financial relationships with drug and device companies to patients. Just over one-tenth said they had told patients something untrue in the previous year. Our findings raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible without more widespread physician endorsement of the core communication principles of openness and honesty with patients.

Monday, February 13, 2012

The New Synthesis in Moral Psychology

The New Synthesis in Moral Psychology

Sunday, February 12, 2012

For Mentally Ill Inmates, Health Care Behind Bars is Often Out of Reach

By Elizabeth Chuck, msnbc.com

A man who was declared suicidal by a New Mexico jail and alleges he was then left to rot in solitary confinement for nearly two years is just one of many former inmates who say they were denied essential mental health services while incarcerated at that detention center, which like others across the country has struggled with how to treat the mentally ill.

Stephen Slevin, 57, made headlineslast week when a jury awarded him $22 million after he alleged inhumane treatment in the Dona Ana County Detention Center following his arrest in August 2005 on charges of driving while under the influence and possession of a stolen vehicle.

But a search of Dona Ana County court records reveals the detention center was also hit with a class-action lawsuit six months prior to Slevins', in which 13 former inmates alleged their constitutional rights to mental health care had been "continually and persistently ignored."

The lawsuit was settled in 2010, with a judgment of $400,000 for the plaintiffs and a commitment from the county to change its practices.

According to criminal justice experts, many other jails and prisons have struggled to adequately handle mentally ill inmates. Few areas of the country, they say, have the money and resources and staff to handle such a challenging population.

"The Supreme Court has established that you have a constitutional right to a basic level of adequate health care, which now includes mental health care," Thomas Hafemeister, an associate professor at the University of Virginia School of Law, told msnbc.com. "They've recognized that there tends to be limited resources in this setting. As long as a qualified professional has examined the inmate and exercised his or her judgment as to what needs to be done, that's all that is required."

'Cruel and unusual'

But Hafemeister, who has written about alternatives to the traditional criminal justice system for the mentally ill, explained that the definition of a "qualified professional" is a loose one.

"Some would argue for inmates, all that is required is medication," he said, meaning anyone with a medical degree, from a physician to a psychiatrist, could be considered qualified.

"Often it's very expensive. They're only willing to come in for an hour a week, and they zoom through very quickly. It can be a very cursory examination," Hafemeister said.

Slevin was detained for 22 months, released in June of 2007 without ever having been given a trial. By the time he was freed, he was deemed mentally incompetent, and his charges were dropped.

The rest of the story is here.