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

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

Sunday, March 24, 2024

From a Psych Hospital to Harvard Law: One Black Woman’s Journey With Bipolar Disorder

Krista L. R. Cezair
Ms. Magazine
Originally posted 22 Feb 24

Here is an excerpt:

In the spring of 2018, I was so sick that I simply couldn’t consider my future performance on the bar exam. I desperately needed help. I had very little insight into my condition and had to be involuntarily hospitalized twice. I also had to make the decision of which law school to attend between trips to the psych ward while ragingly manic. I relied on my mother and a former professor who essentially told me I would be attending Harvard. Knowing my reduced capacity for decision‐making while manic, I did not put up a fight and informed Harvard that I would be attending. The next question was: When? Everyone in my community supported me in my decision to defer law school for a year to give myself time to recover—but would Harvard do the same?

Luckily, the answer was yes, and that fall, the fall of 2018, as my admitted class began school, I was admitted to the hospital again, for bipolar depression this time.

While there, I roomed with a sweet young woman of color who was diagnosed with schizophrenia, bipolar disorder and PTSD and was pregnant with her second child. She was unhoused and had nowhere to go should she be discharged from the hospital, which the hospital threatened to do because she refused medication. She worried that the drugs would harm her unborn child. She was out of options, and the hospital was firm. She was released before me. I wondered where she would go. She had expressed to me multiple times that she had nowhere to go, not her parents’ house, not the child’s father’s house, nowhere.

It was then that I decided I had to fight—for her and for myself. I had access to resources she couldn’t dream of, least of all shelter and a support system. I had to use these resources to get better and embark on a career that would make life better for people like her, like us.

After getting out of the hospital, I started to improve, and I could tell the depression was lifting. Unfortunately, a rockier rock bottom lay ahead of me as I started to feel too good, and the depression lifted too high. Recovery is not linear, and it seemed I was manic again.

Here are some thoughts:

In this powerful piece, Krista L. R. Cezair candidly shares her journey navigating bipolar disorder while achieving remarkable academic and professional success. She begins by describing her history of depression and suicidal thoughts, highlighting the pivotal moment of diagnosis and the challenges within mental health care facilities, particularly for marginalized groups. Cezair eloquently connects her personal experience with broader issues of systemic bias and lack of understanding around mental health, especially within prestigious institutions like Harvard Law School. Her article advocates for destigmatizing mental health struggles and recognizing the resilience and contributions of those living with mental illness.

Thursday, March 7, 2024

Canada Postpones Plan to Allow Euthanasia for Mentally Ill

Craig McCulloh
Voice of America News
Originally posted 8 Feb 24

The Canadian government is delaying access to medically assisted death for people with mental illness.

Those suffering from mental illness were supposed to be able to access Medical Assistance in Dying — also known as MAID — starting March 17. The recent announcement by the government of Canadian Prime Minister Justin Trudeau was the second delay after original legislation authorizing the practice passed in 2021.

The delay came in response to a recommendation by a majority of the members of a committee made up of senators and members of Parliament.

One of the most high-profile proponents of MAID is British Columbia-based lawyer Chris Considine. In the mid-1990s, he represented Sue Rodriguez, who was dying from amyotrophic lateral sclerosis, commonly known as ALS.

Their bid for approval of a medically assisted death was rejected at the time by the Supreme Court of Canada. But a law passed in 2016 legalized euthanasia for individuals with terminal conditions. From then until 2022, more than 45,000 people chose to die.


Canada originally planned to expand its Medical Assistance in Dying (MAiD) program to include individuals with mental illnesses in March 2024.
  • This plan has been postponed until 2027 due to concerns about the healthcare system's readiness and potential ethical issues.
  • The original legislation passed in 2021, but concerns about safeguards and mental health support led to delays.
  • This issue is complex and ethically charged, with advocates arguing for individual autonomy and opponents raising concerns about coercion and vulnerability.
I would be concerned about the following issues:
  • Vulnerability: Mental illness can impair judgement, raising concerns about informed consent and potential coercion.
  • Safeguards: Concerns exist about insufficient safeguards to prevent abuse or exploitation.
  • Mental health access: Limited access to adequate mental health treatment could contribute to undue pressure towards MAiD.
  • Social inequalities: Concerns exist about disproportionate access to MAiD based on socioeconomic background.

Monday, February 26, 2024

Hope for Suicide Prevention

Ellen Barry
The New York Times
Originally published 21 Feb 24

Here is an excerpt:

Research has demonstrated that suicide is most often an impulsive act, with a period of acute risk that passes in hours, or even minutes. Contrary to what many assume, people who survive suicide attempts often go on to do well: Nine out of 10 of them do not die by suicide.

Policymakers, it seems, are paying attention. I have been reporting on mental health for The New York Times for two years, and in today’s newsletter I will look at promising, evidence-based efforts to prevent suicide.

A single element

For generations, psychiatrists believed that, in the words of the British researcher Norman Kreitman, “anyone bent on self-destruction must eventually succeed.”

Then something strange and wonderful happened: Midway through the 1960s, the annual number of suicides in Britain began dropping — by 35 percent in the following years — even as tolls crept up in other parts of Europe.

No one could say why. Had medicine improved, so that more people survived poisoning? Were antidepressant medications bringing down levels of despair? Had life in Britain just gotten better?

The real explanation, Kreitman discovered, was none of these. The drop in suicides had come about almost by accident: As the United Kingdom phased out coal gas from its supply to household stoves, levels of carbon monoxide decreased. Suicide by gas accounted for almost half of the suicides in 1960.

It turns out that blocking access to a single lethal means — if it is the right one — can make a huge difference.

The strategy that arose from this realization is known as “means restriction” or “means safety,” and vast natural experiments have borne it out. When Sri Lanka restricted the import of toxic pesticides, which people had ingested in moments of crisis, its suicide rate dropped by half over the next decade.

Here is my summary

The article discusses new suicide prevention measures in the U.S., where suicide rates have risen 35% in recent decades. This contrasts with global trends of declining suicide rates.
  • It highlights how installing barriers on bridges, buildings, and other high structures can deter impulsive suicide attempts. Many communities are now considering such barriers.
  • Research shows most who survive a suicide attempt go on to live their lives and not die by suicide later. This suggests preventing access to lethal means in moments of crisis can save lives.
  • Restricting access to highly lethal means like guns and toxic pesticides has significantly reduced suicide rates when implemented in other countries.
  • In the U.S., red flag laws that temporarily remove guns from high-risk individuals have been associated with drops in firearm suicides.
  • Educating gun owners on safe storage habits is another promising approach, as is providing incentives for measures like locking devices or gun safes.
  • Even brief counseling for gun owners has proven effective in getting people to voluntarily store guns securely and prevent access during periods of risk.
In summary, the text highlights several evidence-based strategies for reducing access to lethal means during periods of acute suicide risk, thereby giving people a chance to recover and survive their suicidal crises.

Thursday, February 22, 2024

Rising Suicide Rate Among Hispanics Worries Community Leaders

A. Miller and M. C. Work
KFF Health News
Originally posted 22 Jan 24

Here is an excerpt:

The suicide rate for Hispanic people in the United States has increased significantly over the past decade. The trend has community leaders worried: Even elementary school-aged Hispanic children have tried to harm themselves or expressed suicidal thoughts.

Community leaders and mental health researchers say the pandemic hit young Hispanics especially hard. Immigrant children are often expected to take more responsibility when their parents don’t speak English ― even if they themselves aren’t fluent. Many live in poorer households with some or all family members without legal residency. And cultural barriers and language may prevent many from seeking care in a mental health system that already has spotty access to services.

“Being able to talk about painful things in a language that you are comfortable with is a really specific type of healing,” said Alejandra Vargas, a bilingual Spanish program coordinator for the Suicide Prevention Center at Didi Hirsch Mental Health Services in Los Angeles.

“When we answer the calls in Spanish, you can hear that relief on the other end,” she said. “That, ‘Yes, they’re going to understand me.’”

The Centers for Disease Control and Prevention’s provisional data for 2022 shows a record high of nearly 50,000 suicide deaths for all racial and ethnic groups.

Grim statistics from KFF show that the rise in the suicide death rate has been more pronounced among communities of color: From 2011 to 2021, the suicide rate among Hispanics jumped from 5.7 per 100,000 people to 7.9 per 100,000, according to the data.

For Hispanic children 12 and younger, the rate increased 92.3% from 2010 to 2019, according to a study published in the Journal of Community Health.

Sunday, December 31, 2023

Problems with the interjurisdictional regulation of psychological practice

Taube, D. O., Shapiro, D. L., et al. (2023).
Professional Psychology: Research and Practice,
54(6), 389–402.


The U.S. Constitutional structure creates ethical conflicts for the cross-jurisdictional practice of professional psychology. The profession has chosen to seek interstate agreements to overcome such barriers, and such agreements now include almost 80% of American jurisdictions. Although an improvement over a patchwork of state laws regarding practice, the structure of this agreement and the exclusion of the remaining states continue to pose barriers to the principles of beneficence and nonmaleficence. It creates a system that is extraordinarily difficult to change and places an unrealistic burden on professionals to know, address, and act under complex legal mandates. As psychological services have moved increasingly to remote platforms, cross-jurisdictional business models, and a nationwide mental health crisis emerged alongside the pandemic, it is time to consider a national professional licensing system more seriously, both to further reduce barriers to care and complexity and permit the best interests of patients to prevail.

Impact Statement

Access to and the ability to continue receiving mental health care across jurisdictions and nations has become increasingly urgent in the wake of the COVID-19 pandemic This Ethics in Motion section highlights legal barriers to providing ethical care across jurisdictions, how those challenges developed, and strengths and limitations of current approaches and potential solutions.

My summary: 

The current system of interjurisdictional regulation of psychological practice in the United States is problematic because it creates ethical conflicts for psychologists and places an unrealistic burden on them to comply with complex legal mandates. The system is also extraordinarily difficult to change, and it excludes psychologists in states that have not joined the interstate agreement. As a result, the current system does not adequately protect the interests of patients.

A national professional licensing system would be a more effective way to regulate the practice of psychology across state lines. Such a system would eliminate the need for psychologists to comply with multiple state laws, and it would make it easier for them to provide care to patients who live in different states. A national system would also be more equitable, as it would ensure that all psychologists are held to the same standards.

Tuesday, January 31, 2023

Why VIP Services Are Ethically Indefensible in Health Care

Denisse Rojas Marquez and Hazel Lever
AMA J Ethics. 2023;25(1):E66-71.
doi: 10.1001/amajethics.2023.66.


Many health care centers make so-called VIP services available to “very important persons” who have the ability to pay. This article discusses common services (eg, concierge primary care, boutique hotel-style hospital stays) offered to VIPs in health care centers and interrogates “trickle down” economic effects, including the exacerbation of inequity in access to health services and the maldistribution of resources in vulnerable communities. This article also illuminates how VIP care contributes to multitiered health service delivery streams that constitute de facto racial segregation and influence clinicians’ conceptions of what patients deserve from them in health care settings.

Insurance and Influence

It is common practice for health care centers to make “very important person” (VIP) services available to patients because of their status, wealth, or influence. Some delivery models justify the practice of VIP health care as a means to help offset the cost of less profitable sectors of care, which often involve patients who have low income, are uninsured, and are from historically marginalized communities.1 In this article, we explore the justification of VIP health care as helping finance services for patients with low income and consider if this “trickle down” rationale is valid and whether it should be regarded as acceptable. We then discuss clinicians’ ethical responsibilities when taking part in this system of care.

We use the term VIP health care to refer to services that exceed those offered or available to a general patient population through typical health insurance. These services can include concierge primary care (also called boutique or retainer-based medicine) available to those who pay out of pocket, stays on exclusive hospital floors with luxury accommodations, or other premium-level health care services.1 Take the example of a patient who receives treatment on the “VIP floor” of a hospital, where she receives a private room, chef-prepared food, and attending physician-only services. In the outpatient setting, the hallmarks of VIP service are short waiting times, prompt referrals, and round-the-clock staffing.

While this model of “paying for more” is well accepted in other industries, health care is a unique commodity, with different distributional consequences than markets for other goods (eg, accessing it can be a matter of life or death and it is deemed a human right under the Alma-Ata Declaration2). The existence of VIP health care creates several dilemmas: (1) the reinforcement of existing social inequities, particularly racism and classism, through unequal tiers of care; (2) the maldistribution of resources in a resource-limited setting; (3) the fallacy of financing care of the underserved with care of the overserved in a profit-motivated system.



VIP health care, while potentially more profitable than traditional health care delivery, has not been shown to produce better health outcomes and may distribute resources away from patients with low incomes and patients of color. A system in which wealthy patients are perceived to be the financial engine for the care of patients with low incomes can fuel distorted ideas of who deserves care, who will provide care, and how expeditiously care will be provided. To allow VIP health care to exist condones the notion that some people—namely, wealthy White people—deserve more care sooner and that their well-being matters more. When health institutions allow VIP care to flourish, they go against the ideal of providing equitable care to all, a value often named in organizational mission statements.22 At a time when pervasive distrust in the medical system has fueled negative consequences for communities of color, it is our responsibility as practitioners to restore and build trust with the most vulnerable in our health care system. When evaluating how VIP care fits into our health care system, we should let health equity be a moral compass for creating a more ethical system.

Sunday, November 20, 2022

Telehealth is here to stay. Psychologists should equip themselves to offer it.

Hannah Calkins
The Monitor On Psychology
Vol. 53 No. 7, Print version: page 30

Telehealth continues to play a significant role in the health care industry. However, psychologists who offer both in-person and virtual services are poised to meet increased demand for flexible, accessible mental health care.

In 2020, psychologists responded to the onset of the COVID-19 pandemic by making a nearly universal pivot to telehealth. This rapid and widespread adoption was largely enabled by the federal government’s declaration of a public health emergency (PHE), which prompted several significant policy changes that made telehealth more feasible for both patients and providers.

Yet in the following year, an APA survey found that 50% of psychologists had moved to offering both in-person and virtual services to their patients, up from 30% in 2020. Additionally, Pew Research Center data showed that 25% of adults with ­low incomes do not own smartphones, and 40% of this group do not have broadband internet or computers at home, signaling significant concerns about telehealth equity.

This means that psychologists should prepare for a hybrid future in which they deliver services via both modalities.

“Telehealth is here to stay. In-person isn’t going away,” said Robin McLeod, PhD, a licensed psychologist and president and chief business development officer at Natalis Psychology in St. Paul, Minnesota. “I believe it is vital for most psychologists to be able and willing to provide both options for patients. It just makes good business sense.”

Meeting demand for telehealth

Like many other providers, those at McLeod’s large practice made a quick pivot to virtual care during the pandemic and now offer hybrid options.

“[Our] providers have returned to providing in-person care, which many of our patients welcomed,” said McLeod. “However, most every provider in our organization continues to provide telehealth services for those clients who prefer that.”

Similarly, Zixuan Wang, PsyD, of Encounter Psychotherapy in Gaithersburg, Maryland, also has a robust hybrid practice. However, prior to spring 2020, she had never seriously considered offering telehealth.

“I am so appreciative that technology has enabled us to provide telehealth services, as they have been proven to be effective and beneficial for so many people who need care,” she said.

Wang and McLeod’s stories are scaled-down versions of the broader narrative of telehealth during the pandemic: Rapid and sustained implementation out of necessity has led to a permanent change.

Wednesday, November 16, 2022

‘What if Yale finds out?’

William Wan
The Washington Post
Originally posted November 11, 2022

Suicidal students are pressured to withdraw from Yale, then have to apply to get back into the university

Here are two excerpt:

‘Getting rid of me’

Five years before the pandemic derailed so many college students’ lives, a 20-year-old math major named Luchang Wang posted this message on Facebook:

“Dear Yale, I loved being here. I only wish I could’ve had some time. I needed time to work things out and to wait for new medication to kick in, but I couldn’t do it in school, and I couldn’t bear the thought of having to leave for a full year, or of leaving and never being readmitted. Love, Luchang.”

Wang had withdrawn from Yale once before and feared that under Yale’s policies, a second readmission could be denied.
Instead, she flew to San Francisco, and, according to authorities, climbed over the railing at the Golden Gate Bridge and jumped to her death.

Her 2015 suicide sparked demands for change at Yale. Administrators convened a committee to evaluate readmission policies, but critics said the reforms they adopted were minor.

They renamed the process “reinstatement” instead of “readmission,” eliminated a $50 reapplication fee and gave students a few more days at the beginning of each semester to take a leave of absence without having to reapply.

Students who withdrew still needed to write an essay, secure letters of recommendation, interview with Yale officials and prove their academic worth by taking two courses at another four-year university. Those who left for mental health reasons also had to demonstrate to Yale that they’d addressed their problems.

In April — nearly 10 months after S. had been pressured to withdraw — Yale officials announced another round of changes to the reinstatement process. 

They eliminated the requirement that students pass two courses at another university and got rid of a mandatory interview with the reinstatement committee.

The reforms have not satisfied student activists at Yale, where the mental health problems playing out on many American campuses has been especially prominent.


In recent years, Yale has also faced an “explosion” in demand for mental health counseling, university officials said. Last year, roughly 5,000 Yale students sought treatment — a 90 percent increase compared with 2015.

“It’s like nothing we’ve ever seen before,” said Hoffman, the director of Yale Mental Health and Counseling. Roughly 34 percent of the 14,500 students at 

Yale seek mental health help from college counselors, compared with a national average of 11 percent at other universities.

Meeting that need has been challenging, even at a school with a $41.4 billion endowment.

Bluebelle Carroll, 20, a Yale sophomore who sought help in September 2021, said she waited six months to be assigned a therapist. She secured her first appointment only after emailing the counseling staff repeatedly.

“The appointment was 20 minutes long,” she said, “and we spent the last five minutes figuring out when he could see me again.”

Because of staffing constraints, students are often asked to choose between weekly therapy that lasts 30 minutes or 45-minute sessions every two weeks.

Tuesday, July 26, 2022

U.S. drug overdose deaths reached all-time high in 2021, CDC says

Berkeley Lovelace Jr.
Originally posted 11 MAY 22

More than 107,600 Americans died from drug overdoses last year, the highest annual death toll on record, the Centers for Disease Control and Prevention said Wednesday.

Overdose deaths increased 15 percent in 2021, up from an estimated 93,655 fatalities the year prior, according to a report from the CDC’s National Center for Health Statistics (NCHS), which collects data on a range of health topics, including drug use.

While the total number of deaths reached record highs, the increase appeared to slow compared to the change seen from 2019 to 2020, when overdose deaths rose 30 percent, according to the report.

It's still too early to say whether that slowdown will hold, said Farida Ahmad, a scientist at the health statistics center. The agency's latest report is considered provisional, meaning the data is incomplete and subject to change.

Even if the increase in overdose deaths is smaller compared to last year, the 2021 total is still a huge number, Ahmad said.

The data helps illustrate one of the consequences of the pandemic, which has seen an uptick in substance abuse amid widespread unemployment and more Americans reporting mental health issues.

Overdose-related deaths were already increasing before the pandemic, but there was "clearly a very sharp uptick during the pandemic," said Joseph Friedman, an addiction researcher at the University of California, Los Angeles. He published research in April that found drug overdose deaths among teenagers rose sharply over the last two years.

According to the NCHS report, fentanyl, a powerful synthetic opioid, was involved in the most overdose deaths in 2021: 71,238.

Wednesday, March 9, 2022

As Suicide Attempts Rise in America, Mental Health Care Remains Stagnant

Kara Grant
Originally posted 19 JAN 22

Despite the substantial increase in suicide attempts among U.S. adults over the last decade, use of mental health services by these individuals didn't match that growth, data from the National Surveys on Drug Use and Health (NSDUH) revealed.

From 2008 to 2019, suicide attempts among adults increased from 481.2 to 563.9 per 100,000 (adjusted odds ratio [aOR] 1.23, 95% CI 1.05-1.44, P=0.01), reported Greg Rhee, PhD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

And according to their study in JAMA Psychiatry, there was a significant uptick in the number of individuals that attempted suicide within the past year who said they felt they needed mental health services but failed to receive it (34.8% in 2010-2011 vs 45.5% in 2018-2019).

Overall, the researchers found no significant changes in the likelihood of receiving past-year outpatient, inpatient, or medication services for mental health reasons, nor any change in substance use treatment services. An increase in the number of visits to mental health centers was detected, but even this change was no longer significant after correcting for different sources of mental health care.

"One would hope that as suicide attempts increase, the percentage of individuals who receive treatment in proximity to their attempt would also increase," Rhee and colleagues wrote. "Current suicide prevention interventions largely focus on individuals connected to treatment and high-risk individuals who have contact with the health care system."

"However, our finding that less than half of suicide attempters had clinical contact around the time of their attempt suggest[s] that it is not only important to expand initiatives for high-risk individuals with clinical contact, but also to implement public health-oriented strategies outside the formal treatment system," they suggested.

Thursday, November 4, 2021

The AMA needs to declare a national mental health emergency

Susan Hata and Thalia Krakower
Originally published 6 OCT 21

As the pandemic continues to disrupt life across the U.S., a staggering number of Americans are reaching out to their primary care doctors for help with sometimes overwhelming mental health struggles. Yet primary care doctors like us have nowhere to turn when it comes to finding mental health providers for them, and our patients often suffer without the specialty care they need.

It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.

More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are flooded with patients in psychiatric crises. Untreated, these issues can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives to suicide; among children ages 10 to 14, suicide is the second leading cause of death.

Finding mental health providers for patients is an uphill climb, in part because there is no centralized process for it. Timely mental health services are astonishingly difficult to obtain even in Massachusetts, where we live and work, which has the most psychologists per capita. Waitlists for therapists can be longer than six months for adults, and even longer for children.


By declaring a mental health emergency, the AMA could galvanize health administrators and drive the innovation needed to improve the existing mental health system. When Covid-19 was named a pandemic, the U.S. health care infrastructure adapted quickly to manage the deluge of infections. Leaders nimbly and creatively mobilized resources. They redeployed staff, built field hospitals and overflow ICUs, and deferred surgeries and routine care to preserve resources and minimize hospital-based transmission of Covid-19. With proper framing and a sense of urgency, similar things can happen for the mental health care system.

To be clear, all of this is the AMA’s lane: In addition to the devastating toll of suicides and overdoses, untreated mental illness worsens cardiac outcomes, increases mortality from Covid-19, and shortens life spans. Adult mental illness also directly affects the health of children, leading to poor health outcomes across generations.

Monday, June 21, 2021

Drug Overdose Deaths Up 30% in Pandemic Year, Government Data Show

Joyce Frieden
MedPage Today 
Originally published 1 June 2021

Mortality from all types of drug overdoses increased by a whopping 30% over a 1-year period, Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), reported at the FDA Science Forum.

Data from the National Center for Health Statistics from October 2019 to October 2020 shows that mortality from overdoses from all types of drugs increased 30%, from 70,669 deaths in October 2019 to 91,862 deaths in October 2020, "and I think that that is a number that is very, very chilling," Volkow said at the forum. Among those overdose deaths in both years, more than half came from synthetic opiates -- "the most notable presence is fentanyl," she said. There was also a 46% increase in overdose deaths from other psychostimulants, mainly methamphetamine, and a 38% increase in deaths from cocaine overdoses.

Having any kind of substance use disorder (SUD) also affects the risk of getting COVID-19, she continued. According to a study done by Volkow and colleagues, "Regardless of the specific type of substance use disorder -- legal or illegal -- there was a significant increase in the likelihood of people that have a substance use disorder to become infected," she said. Their study, which included electronic health records from 7.5 million patients with an SUD diagnosis, found that patients with a recent SUD diagnosis -- within the past year -- were nearly nine times more likely to contract COVID-19 than patients without that diagnosis; for those with opioid use disorder in particular, their odds of contracting COVID were 10 times higher.

Wednesday, July 22, 2020

FCC Approves 988 as Suicide Hotline Number

Jennifer Weaver
Originally posted 16 July 20

A three-digit number to connect to suicide prevention and mental health crisis counselors has been approved.

The Federal Communications Commission voted unanimously Thursday to make 988 the number people can call to be connected directly to the National Suicide Prevention Hotline.

Phone service providers have until July 2022 to implement the new number. The 10-digit number is currently 1-800-273-8255 (TALK).

Saturday, July 4, 2020

In the face of Covid-19, the U.S. needs to change how it deals with mental illness

Jeffrey Geller
Originally posted 29 May 20

Here are two excerpts:

Frontline physicians, nurses, and other health care workers are looking death in the face every day. Shift workers in economically treacherous situations are forced to risk their health for a paycheck. Millions of Americans have lost their jobs. Still more are separated from the people they love, their daily routines have been disrupted, and they are making anxious choices every day that affect their physical and mental health.


Second, Covid-19 has laid bare the severe doctor shortage across the United States, and that shortage includes psychiatrists. While every kind of mental health professional is necessary and indeed critical to responding to the crisis, psychiatrists bring unique expertise in serving some of the most severely compromised patients in psychiatric units and hospitals, long-term care facilities, homeless shelters, and jails and prisons. Forgiving some of the debt that students amass during medical school would incentivize more individuals to serve in these capacities, as would lifting caps on federal funding for new residency slots.

Third, we needed more psychiatric beds in hospitals before Covid-19, and need even more now as physical distancing continues — yet some hospitals have decreased the number of psychiatric beds by converting them to beds for individuals with Covid-19. Patients in psychiatric units who contract Covid-19 need to be separated from other patients. We currently do not have enough beds to treat everyone for the length of time they need. Without federal funding for psychiatric beds, we will have an increase in deaths from the mental health sequelae of Covid-19.

The info is here.

Wednesday, March 4, 2020

Stressed Out at the Office? Therapy Can Come to You

Rachel Feintzeig
The Wall Street Journal
Originally published 31 Jan 20

Here is an excerpt:

In the past, discussion of mental-health issues at the office was uncommon. Workers were largely expected to leave their personal struggles at home. Crying was confined to the bathroom stall.

Today, that’s changing. One reason is a broadening of the popular understanding of “mental health” to encompass anxiety, stress and other widespread issues.

It’s also a reflection of a changing workplace. Younger workers are more comfortable talking about their struggles and expect their employers to take emotional distress seriously, says Jeffrey Pfeffer, a professor of organizational behavior at the Stanford Graduate School of Business.

Senior leaders are responding, rolling out mental-health services and sometimes speaking about their own experiences. Lloyds Banking Group Plc chief executive António Horta-Osório has said publicly in recent years that the pressure he felt around the bank’s financial situation in 2011 dominated his thoughts, leaving him unable to sleep and exhausted. He took eight weeks off from the company to recover, working with a psychiatrist. The psychiatrist later helped him devise a mental-health program for Lloyds employees.

Brynn Brichet, a lead product manager at Cerner Corp., a maker of electronic medical-records systems, said she sometimes returns from her counseling appointments with an on-site therapist red-faced from crying. (The therapist sits a few floors down.) If colleagues ask, she tells them that she just got out of an intense therapy session. Some are taken aback when she mentions her therapy, she said. But she thinks it’s important to be open.

“We all are terrified. We all are struggling,” she said. “If we don’t talk about it, it can run our lives.”

The info is here.

Thursday, January 23, 2020

Colleges want freshmen to use mental health apps. But are they risking students’ privacy?

 (iStock)Deanna Paul
The New York Times
Originally posted 2 Jan 20

Here are two excepts:

TAO Connect is just one of dozens of mental health apps permeating college campuses in recent years. In addition to increasing the bandwidth of college counseling centers, the apps offer information and resources on mental health issues and wellness. But as student demand for mental health services grows, and more colleges turn to digital platforms, experts say universities must begin to consider their role as stewards of sensitive student information and the consequences of encouraging or mandating these technologies.

The rise in student wellness applications arrives as mental health problems among college students have dramatically increased. Three out of 5 U.S. college students experience overwhelming anxiety, and 2 in 5 students reported debilitating depression, according to a 2018 survey from the American College Health Association.

Even so, only about 15 percent of undergraduates seek help at a university counseling center. These apps have begun to fill students’ needs by providing ongoing access to traditional mental health services without barriers such as counselor availability or stigma.


“If someone wants help, they don’t care how they get that help,” said Lynn E. Linde, chief knowledge and learning officer for the American Counseling Association. “They aren’t looking at whether this person is adequately credentialed and are they protecting my rights. They just want help immediately.”

Yet she worried that students may be giving up more information than they realize and about the level of coercion a school can exert by requiring students to accept terms of service they otherwise wouldn’t agree to.

“Millennials understand that with the use of their apps they’re giving up privacy rights. They don’t think to question it,” Linde said.

The info is here.

Friday, December 27, 2019

Affordable treatment for mental illness and substance abuse gets harder to find

Image result for mental health parityJenny Gold
The Washington Post
Originally published 1 Dec 19

Here is an excerpt:

A report published by Milliman, a risk management and health-care consulting company, found that patients were dramatically more likely to resort to out-of-network providers for mental health and substance abuse treatment than for other conditions. The disparities have grown since Milliman published a similarly grim study two years ago.

The latest study examined the claims data of 37 million individuals with commercial preferred provider organization’s health insurance plans in all 50 states from 2013 to 2017.

Among the findings:

●People seeking inpatient care for behavioral health issues were 5.2 times more likely to be relegated to an out-of-network provider than for medical or surgical care in 2017, up from 2.8 times in 2013.

●For substance abuse treatment, the numbers were even worse: Treatment at an inpatient facility was 10 times more likely to be provided out-of-network — up from 4.7 times in 2013.

●In 2017, a child was 10 times more likely to go out-of-network for a behavioral health office visit than for a primary care office visit.

●Spending for all types of substance abuse treatment was just 0.9 percent of total health-care spending in 2017. Mental health treatment accounted for 2.4 percent of total spending.

In 2017, 70,237 Americans died of drug overdoses, and 47,173 from suicide, according to the Centers for Disease Control and Prevention. In 2018, nearly 20 percent of adults — more than 47 million people — experienced a mental illness, according to the National Alliance on Mental Illness.

“I thought maybe we would have seen some progress here. It’s very depressing to see that it’s actually gotten worse,” said Henry Harbin, former chief executive of Magellan Health, a managed behavioral health-care company, and adviser to the Bowman Family Foundation, which commissioned the report. “Employers and insurance plans need to quadruple their efforts.”

The info is here.

Monday, December 16, 2019

Courts Strike Down Trump’s ‘Refusal of Care’ Conscience Rule

Alicia Gallegos
Originally posted 7 Nov 19

A federal court has struck down a Trump administration rule that would have allowed clinicians to refuse to provide medical care to patients for religious or moral reasons.

In a Nov. 6 decision, the U.S. District Court for the Southern District of New York vacated President Trump’s rule in its entirety, concluding that the rule had no justification and that its provisions were arbitrary and capricious. In his 147-page opinion, District Judge Paul Engelmayer wrote that the U.S. Department of Health & Human Services did not have the authority to enact such an expansive rule and that the measure conflicts with the Administrative Procedure Act, Title VII of the Civil Rights Act, and the Emergency Medical Treatment & Labor Act, among other laws.

“Had the court found only narrow parts of the rule infirm, a remedy tailoring the vacatur to only the problematic provision might well have been viable,” Judge Engelmayer wrote. “The [Administrative Procedure Act] violations that the court has found, however, are numerous, fundamental, and far reaching ... In these circumstances, a decision to leave standing isolated shards of the rule that have not been found specifically infirm would ignore the big picture: that the rulemaking exercise here was sufficiently shot through with glaring legal defects as to not justify a search for survivors [and] leaving stray nonsubstantive provisions intact would not serve a useful purpose.”

At press time, the Trump administration had not indicated whether they plan to file an appeal.

The info is here.

Monday, November 25, 2019

Racial bias in a medical algorithm favors white patients over sicker black patients

Carolyn Johnson
Scientists discovered racial bias in a widely used medical algorithm that predicts which patients will have complex health needs.  (iStock)The Washington Post
Originally posted October 24, 2019

A widely used algorithm that predicts which patients will benefit from extra medical care dramatically underestimates the health needs of the sickest black patients, amplifying long-standing racial disparities in medicine, researchers have found.

The problem was caught in an algorithm sold by a leading health services company, called Optum, to guide care decision-making for millions of people. But the same issue almost certainly exists in other tools used by other private companies, nonprofit health systems and government agencies to manage the health care of about 200 million people in the United States each year, the scientists reported in the journal Science.

Correcting the bias would more than double the number of black patients flagged as at risk of complicated medical needs within the health system the researchers studied, and they are already working with Optum on a fix. When the company replicated the analysis on a national data set of 3.7 million patients, they found that black patients who were ranked by the algorithm as equally as in need of extra care as white patients were much sicker: They collectively suffered from 48,772 additional chronic diseases.

The info is here.

Wednesday, September 18, 2019

California Requires Suicide Prevention Phone Number On Student IDs

Mark Kreider
Kaiser Health News
Originally posted August 30, 2019

Here is an excerpt:

A California law that has greeted students returning to school statewide over the past few weeks bears a striking resemblance to that Palo Alto policy from four years ago. Beginning with the 2019-20 school year, all IDs for California students in grades seven through 12, and in college, must bear the telephone number of the National Suicide Prevention Lifeline. That number is 800-273-TALK (8255).

“I am extremely proud that this strategy has gone statewide,” said Herrmann, who is now superintendent of the Roseville Joint Union High School District near Sacramento.

The new student ID law marks a statewide response to what educators, administrators and students themselves know is a growing need.

The numbers support that idea — and they are as jarring as they are clarifying.

Suicide was the second-leading cause of death in the United States among people ages 10 to 24 in 2017, according to the U.S. Centers for Disease Control and Prevention.  The suicide rate among teenagers has risen dramatically over the past two decades, according to data from the CDC.

The info is here.