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

Monday, April 22, 2024

Union accuses Kaiser of violations months after state fine on mental health care

Emily Alpert Reyes
Los Angeles Times
Originally posted 9 April 24

Months after Kaiser Permanente reached a sweeping agreement with state regulators to improve its mental health services, the healthcare giant is facing union allegations that patients could be improperly losing such care.

The National Union of Healthcare Workers, which represents thousands of Kaiser mental health professionals, complained earlier this year to state regulators that Kaiser appeared to be inappropriately handing off decisions about whether therapy is still medically necessary.

The union alleged that Rula Health, a contracted network of therapists that Kaiser uses to provide virtual care to its members, had been directed by Kaiser to use “illegal criteria” to make those decisions during regular reviews.

Here is my thoughts:

Kaiser Permanente is facing accusations from the National Union of Healthcare Workers (NUHW) that it is still violating mental health care laws, even after a recent $200 million settlement with the California Department of Managed Health Care (DMHC) over its mismanagement of behavioral health benefits.

The union alleges that Kaiser is inappropriately delegating decisions about the medical necessity of therapy during regular reviews to a contracted network of therapists, Rula Health, who are using "illegal criteria" to make these decisions instead of professional group criteria as required by California law.

The union claims this is resulting in patients with psychological disorders being unfairly denied continued access to necessary treatment.  Furthermore, the union argues that the frequent clinical care reviews Kaiser is subjecting mental health patients to violate laws prohibiting insurers from erecting more barriers to mental healthcare than for other health conditions.  Importantly, Kaiser does not subject other outpatient care to such reviews.

The DMHC has confirmed it is examining the issues raised by the union under the recent $200 million settlement agreement, which required Kaiser to pay a $50 million fine and invest $150 million over five years to improve its mental healthcare.  The settlement came after the DMHC's investigation found several deficiencies in Kaiser's provision of behavioral health services, including long delays for patients trying to schedule appointments and a failure to contract enough high-level behavioral care facilities.

Kaiser has stated that it does not limit the number of therapy sessions and that decisions on the level and frequency of therapy are made by providers in consultation with patients based on clinical needs.  However, the union maintains that Kaiser's actions are still violating mental health parity laws.

Thursday, February 16, 2023

Telehealth Providers Prepare for the Future

Phoebe Kolbert & Charlotte Engrav
Originally posted 9 FEB 23

Here is an excerpt:

Telehealth Abortion Care

The Guttmacher Institute reports that, in 2017, medication abortions accounted for 39 percent of all abortions performed. By 2020, medication abortion usage accounted for 53 percent.

Coplon attributes the rise in telehealth medication abortions to COVID, but the continued use of it, she says, “is due to people’s understanding and acceptance, and also providers being more comfortable with providing pills without having the testing that we prior thought we needed.” 

She would know. Since 2016, Coplon has been part of a coalition of researchers, lawyers and other clinicians looking at telehealth medication abortion and ways to increase access to telehealth services. She now serves as the director of clinical operations at Abortion on Demand. 

In 2018, state policies enacted to support reproductive health were almost triple the number restricting reproductive healthcare. It was the first year in at least two decades where protections outpaced restrictions. 

Restrictions were eased even more when the COVID-19 pandemic made social distancing necessary, and lawmakers loosened restrictions, allowing more healthcare to be practiced online via telehealth. However, the landscape completely changed again in June of this year when the Supreme Court overturned the longstanding precedent of Roe in their Dobbs decision. Now, 18 states have abortion bans, 14 of which are total or near total. Eight other states have abortion bans on the books that are currently blocked, and there has been a push from anti-abortion groups to rescind access to telehealth medication abortions altogether. 

Telemedicine abortion has many benefits beyond preventing the spread of COVID-19—which may be why anti-abortion groups have been so quick to target it. Telehealth can make abortions more accessible for those who want and need them, and they tend to be cheaper and easier to schedule quickly. Even before Roe’s fall, patients would sometimes have to travel out of state or drive hours to the only abortion clinic in their state. Now, people living in states with bans must travel an average of 276 miles each way. States without bans have seen a swell of out-of-state patients seeking legal abortions. Bloomberg News estimated Illinois could face an 8,000 percent increase in abortion seekers. Planned Parenthood of Illinois estimated an increase of 20,000-30,000 out-of-state patients. Some clinics are struggling to keep up. For these clinics and patients, Coplon notes, telehealth can make a huge difference in the post-Roe era.

Not only can telehealth provide appointments within just a day or two of scheduling, as opposed to the potentially weeks-long waits at clinics in some overburdened states, it can also help reduce the overall burden on those in-person clinics—freeing up space for their own clients. 

Saturday, October 15, 2022

Boundary Issues of Concern

Charles Dike
Psychiatric News
Originally posted 25 AUG 22

Here is an excerpt:

There are, of course, less prominent but equally serious boundary violations other than sexual relations with patients or a patients’ relatives. The case of Dr. Jerome Oremland, a prominent California psychiatrist, is one example. According to a report by KQED on October 3, 2016, John Pierce, a patient, alleged that his psychiatrist, Dr. Oremland, induced Mr. Pierce to give him at least 12 works of highly valued art. The psychiatrist argued that the patient had consented to their business dealings and that the art he had received from the patient was given willingly as payment for psychiatric treatment. The patient further alleged that Dr. Oremland used many of their sessions to solicit art, propose financial schemes (including investments), and discuss other subjects unrelated to treatment. Furthermore, the patient allegedly made repairs in Dr. Oremland’s home, offices, and rental units; helped clear out the home of Dr. Oremland’s deceased brother; and cleaned his pool. Mr. Pierce began therapy with Dr. Oremland in 1984 but brought a lawsuit against him in 2015. The court trial began shortly after Dr. Oremland’s death in 2016, and Dr. Oremland’s estate eventually settled with Mr. Pierce. In addition to being a private practitioner, Dr. Oremland had been chief of psychiatry at the Children’s Hospital in San Francisco and a clinical professor of psychiatry at UCSF. He also wrote books on the intersection of art and psychology.


There are less dramatic but still problematic boundary crossings such as when a psychiatrist in private practice agrees that a patient may pay off treatment costs by doing some work for the psychiatrist. Other examples include a psychiatrist hiring a patient, for example, a skilled plumber, to work in the psychiatrist’s office or home at the patient’s going rate or obtaining investment tips from a successful investment banker patient. In these situations, questions arise about the physician-patient relationship. Even when the psychiatrist believes he or she is treating the patient fairly—such as paying the going rate for work done for the psychiatrist—the psychiatrist is clueless regarding how the patient is interpreting the arrangement: Does the patient experience it as exploitative? What are the patient’s unspoken expectations? What if the patient’s work in the psychiatrist’s office is inferior or the investment advice results in a loss? Would these outcomes influence the physician-patient relationship? Even compassionate acts such as writing off the bill of patients who are unable to pay or paying for an indigent patient’s medications should make the psychiatrist pause for thought. To avoid potential misinterpretation of the psychiatrist’s intentions or complaints of inequitable practices or favoritism, the psychiatrist should be ready to do the same for other indigent patients. It would be better to establish neutral policies for all indigent patients than to appear to favor some over others.

Wednesday, May 11, 2022

Bias in mental health diagnosis gets in the way of treatment

Howard N. Garb
Originally posted 2 MAR 22

Here is an excerpt:

What about race-related bias? 

Research conducted in the US indicates that race bias is a serious problem for the diagnosis of adult mental disorders – including for the diagnosis of PTSD, depression and schizophrenia. Preliminary data also suggest that eating disorders are underdiagnosed in Black teens compared with white and Hispanic teens.

The misdiagnosis of PTSD can have significant economic consequences, in addition to its implications for treatment. In order for a US military veteran to receive disability compensation for PTSD from the Veterans Benefits Administration, a clinician has to diagnose the veteran. To learn if race bias is present in this process, a research team compared its own systematic diagnoses of veterans with diagnoses made by clinicians during disability exams. Though most clinicians will make accurate diagnoses, the research diagnoses can be considered more accurate, as the mental health professionals who made them were trained to adhere to diagnostic criteria and use extensive information. When veterans received a research diagnosis of PTSD, they should have also gotten a clinician’s diagnosis of PTSD – but this occurred only about 70 per cent of the time.

More troubling is that, in cases where research diagnoses of PTSD were made, Black veterans were less likely than white veterans to receive a clinician’s diagnosis of PTSD during their disability exams. There was one set of cases where bias was not evident, however. In roughly 25 per cent of the evaluations, clinicians administered a formal PTSD symptom checklist or a psychological test to help them make a diagnosis – and if this additional information was collected, race bias was not observed. This is an important finding. Clinicians will sometimes form a first impression of a patient’s condition and then ask questions that can confirm – but not refute – their subjective impression. By obtaining good-quality objective information, clinicians might be less inclined to depend on their subjective impressions alone.

Race bias has also been found for other forms of mental illness. Historically, research indicated that Black patients and sometimes Hispanic patients were more likely than white patients to be given incorrect diagnoses of schizophrenia, while white patients were more often given correct diagnoses of major depression and bipolar disorder. During the past 20 years, this appears to have changed somewhat, with the most accurate diagnoses being made for Latino patients, the least accurate for Black patients, and the results for white patients somewhere in between.

Tuesday, May 3, 2022

The Mystifying Rise of Child Suicide

Andrew Solomon
The New Yorker
Originally posted 4 APR 22

Here are two excerpts:

Every suicide creates a vacuum. Those left behind fill it with stories that aspire to rationalize their ultimately unfathomable plight. People may blame themselves or others, cling to small crumbs of comfort, or engage in pitiless self-laceration; many do all this and more. In a year of interviewing the people closest to Trevor, I saw all of these reactions and experienced some of them myself. I came to feel a love for Trevor, which I hadn’t felt when he was alive. The more I understood the depths of his vulnerability, the more I wished that I had encouraged my son, whose relationship with Trevor was often antagonistic, to befriend him. As I interviewed Trevor’s parents, my relationship with them changed. The need to write objectively without increasing their suffering made it more fraught—but it also became deeper and more loving. As the April 6th anniversary of Trevor’s death approached, I started to share their hope that this article would be a kind of memorial to him.

Angela was right that a larger issue is at stake. The average age of suicides has been falling for a long time while the rate of youth suicide has been rising. Between 1950 and 1988, the proportion of adolescents aged between fifteen and nineteen who killed themselves quadrupled. Between 2007 and 2017, the number of children aged ten to fourteen who did so more than doubled. It is extremely difficult to generalize about youth suicide, because the available data are so much sparser and more fragmentary than for adult mental illness, let alone in the broader field of developmental psychology. What studies there are have such varied parameters—of age range, sample size, and a host of demographic factors—as to make collating the information all but impossible. The blizzard of conflicting statistics points to our collective ignorance about an area in which more and better studies are urgently needed. Still, in 2020, according to the Centers for Disease Control and Prevention, in the United States suicide claimed the lives of more than five hundred children between the ages of ten and fourteen, and of six thousand young adults between fifteen and twenty-four. In the former group, it was the second leading cause of death (behind unintentional injury). This makes it as common a cause of death as car crashes.


Perhaps the most unsettling aspect of child suicide is its unpredictability. A recent study published in the Journal of Affective Disorders found that about a third of child suicides occur seemingly without warning and without any predictive signs, such as a mental-health diagnosis, though sometimes a retrospective analysis points to signs that were simply missed. Jimmy Potash, the chair of the psychiatry department at Johns Hopkins, told me that a boy who survived a suicide attempt described the suddenness of the impulse: seeing a knife in the kitchen, he thought, I could stab myself with that, and had done so before he had time to think about it. When I spoke to Christine Yu Moutier, who is the chief medical officer at the American Foundation for Suicide Prevention, she told me that, in children, “the moment of acute suicidal urge is very short-lived. It’s almost like the brain can’t keep up that rigid state of narrowed cognition for long.” This may explain why access to means is so important; children living in homes with guns have suicide rates more than four times higher than those of other children.

Thursday, November 12, 2020

Deinstitutionalization of People with Mental Illness: Causes and Consequences

Daniel Yohanna, MD
Virtual Mentor. 2013;15(10):886-891.

Here is an excerpt:

State hospitals must return to their traditional role of the hospital of last resort. They must function as entry points to the mental health system for most people with severe mental illness who otherwise will wind up in a jail or prison. State hospitals are also necessary for involuntary commitment. As a nation, we are working through a series of tragedies involving weapons in the hands of people with severe mental illness—in Colorado, where James Holmes killed or wounded 70 people, Arizona, where Jared Loughner killed or wounded 19 people, and Connecticut, where Adam Lanza killed 28 including children as young as 6 years old. All are thought to have had severe mental illness at the time of their crimes. After we finish the debate about the availability of guns, particularly to those with mental illness, we will certainly have to address the mental health system and lack of services, especially for those in need of treatment but unwilling or unable to seek it. With proper services, including involuntary commitment, many who have the potential for violence can be treated. Just where will those services be initiated, and what will be needed?

Nearly 30 years ago, Gudeman and Shore published an estimate of the number of people who would need long-term care—defined as secure, supportive, indefinite care in specialized facilities—in Massachusetts. Although a rather small study, it is still instructive today. They estimated that 15 persons out of 100,000 in the general population would need long-term care. Trudel and colleagues confirmed this approximation with a study of the long-term need for care among people with the most severe and persistent mental illness in a semi-rural area in Canada, where they estimated a need of 12.4 beds per 100,000. A consensus of other experts estimates that the total number of state beds required for acute and long-term care would be more like 50 beds per 100,000 in the population. At the peak of availability in 1955, there were 340 beds per 100,000. In 2010, the number of state beds was 43,318 or 14.1 beds per 100,000.

Saturday, April 4, 2020

Suicide attempt survivors’ recommendations for improving mental health treatment for attempt survivors.

Melanie A. Hom and others
Psychological Services. 
Advance online publication.


Research indicates that connection to mental health care services and treatment engagement remain challenges among suicide attempt survivors. One way to improve suicide attempt survivors’ experiences with mental health care services is to elicit suggestions directly from attempt survivors regarding how to do so. This study aimed to identify and synthesize suicide attempt survivors’ recommendations for how to enhance mental health treatment experiences for attempt survivors. A sample of 329 suicide attempt survivors (81.5% female, 86.0% White/Caucasian, mean age = 35.07 ± 12.18 years) provided responses to an open-ended self-report survey question probing how treatment might be improved for suicide attempt survivors. Responses were analyzed utilizing both qualitative and quantitative techniques. Analyses identified four broad areas in which mental health treatment experiences might be improved for attempt survivors: (a) provider interactions (e.g., by reducing stigma of suicidality, expressing empathy, and using active listening), (b) intake and treatment planning (e.g., by providing a range of treatment options, including nonmedication treatments, and conducting a thorough assessment), (c) treatment delivery (e.g., by addressing root problems, bolstering coping skills, and using trauma-informed care), and (d) structural issues (e.g., by improving access to care and continuity of care). Findings highlight numerous avenues by which health providers might be able to facilitate more positive mental health treatment experiences for suicide attempt survivors. Research is needed to test whether implementing the recommendations offered by attempt survivors in this study might lead to enhanced treatment engagement, retention, and outcomes among suicide attempt survivors at large.

Here is an excerpt from the Discussion:

On this point, this study revealed numerous recommendations for how providers might be able to improve their interactions with attempt survivors. Suggestions in this domain aligned with prior studies on treatment experiences among suicide attempt survivors. For instance, recommendations that providers not stigmatize attempt survivors and, instead, empathize with them, actively listen to them, and humanize them, are consistent with aforementioned studies (Berglund et al., 2016; Frey et al., 2016; Shand et al., 2018; Sheehan et al., 2017; Taylor et al., 2009). This study’s findings regarding the importance of a collaborative therapeutic relationship are also consistent with previous work (Shand et al., 2018). Though each of these factors has been identified as salient to treatment engagement efforts broadly (see Barrett et al., 2008, for review), several suggestions that emerged in this study were more specific to attempt survivors. For example, ensuring that patients feel comfortable openly discussing suicidal thoughts and behaviors and taking disclosures of suicidality seriously are suggestions specifically applicable to the care of at-risk individuals. These recommendations not only support research indicating that asking about suicidality is not iatrogenic (see DeCou & Schumann, 2018, for review), but they also underscore the importance of considering the unique needs of attempt survivors. Indeed, given that most participants provided a recommendation in this area, the impact of provider-related factors should not be overlooked in the provision of care to this group.

Friday, April 3, 2020

Treating “Moral” Injuries

Anna Harwood-Gross
Scientific American
Originally posted 24 March 20

Here is an excerpt:

Though PTSD symptoms such as avoidance of reminders of the traumatic event and intrusive thought patterns may also be present in moral injury, they appear to serve different purposes, with PTSD sufferers avoiding fear and moral injury sufferers avoiding shame triggers. Few comparison studies of PTSD and moral injury exist, yet there has been research that indirectly compares the two conditions by differentiating between fear-based and non-fear-based (i.e., moral injury) forms of PTSD, which have been demonstrated to have different neurobiological markers. In the context of the military, there are countless examples of potentially morally injurious events (PMIEs), which can include killing or wounding others, engaging in retribution or disproportionate violence, or failing to save the life of a comrade, child or civilian. The experience of PMIEs has been demonstrated to lead to a larger range of psychological distress symptoms, including higher levels of guilt, anger, shame, depression and social isolation, than those seen in traditional PTSD profiles.

Guilt is difficult to address in therapy and often lingers following standardized PTSD treatment (that is, if the sufferer is able to access therapy). It may, in fact, be a factor in the more than 49 percent of veterans who drop out of evidence-based PTSD treatment or in why, at times, up to 72% of sufferers, despite meaningful improvement in their symptoms, do not actually recover enough after such treatment for their PTSD diagnosis to be removed. Most often, moral injury symptoms that are present in the clinic are addressed through traditional PTSD treatments, with thoughts of guilt and shame treated similarly to other distorted cognitions. When guilt and the events it relates to are treated as “a feeling and not a fact,” as psychologist Lisa Finlay put it in a 2015 paper, there is an attempt to lessen or relieve such emotions while taking a shortcut to avoid experiencing those that are legitimate and reasonable after-wartime activities. Continuing, Finlay stated that “the idea that we might get good, as a profession, at talking people out of guilt following their involvement in traumatic incidents is frighteningly short-sighted in more ways than one.”

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.

Monday, January 6, 2020

Pa. prison psychologist loses license after 3 ‘preventable and foreseeable’ suicides

Samantha Melamed
Originally posted 4 Dec 19

Nearly a decade after a 1½-year stretch during which three prisoners at State Correctional Institution Cresson died by suicide and 17 others attempted it, the Pennsylvania Board of Psychology has revoked the license of the psychologist then in charge at the now-shuttered prison in Cambria County and imposed $17,233 in investigation costs.

An order filed Tuesday said the suicides were foreseeable and preventable and castigated the psychologist, James Harrington, for abdicating his ethical responsibility to intervene when mentally ill prisoners were kept in inhumane conditions — including solitary confinement — and were prevented from leaving their cells for treatment.

Harrington still holds an administrative position with the Department of Corrections, with an annual salary of $107,052.

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.

Thursday, December 12, 2019

State Supreme Court upholds decision in Beckley psychiatrist case

Jessica Farrish
The Register-Herald
Originally posted 8 Nov 19

West Virginia Supreme Court of Appeals on Friday upheld a decision by the West Virginia Board of Medicine that imposed disciplinary actions on Dr. Omar Hasan, a Beckley psychiatrist.

The original case was decided in Kanawha County Circuit Court in July 2018 after Hasan appealed a decision by the West Virginia Board of Medicine to discipline him for an improper relationship with a patient. Hasan alleged the board had erred by failing to adopt recommended finding of facts by its own hearing examiner, had improperly considered content of text messages and had misstated various facts in its final order.

Court documents state that Hasan began providing psychiatric medication in 2011 to a female patient. In September 2014, the patient reported to WVBOM that she and Hasan had had an improper relationship that included texts, phone calls, gifts and “sexual encounters on numerous occasions at various locations.”

She said that when Hasan ended the relationship, she tried to kill herself.

WVBOM investigated the patient’s claim and found probable cause to issue disciplinary actions against Hasan for entering a relationship with a patient for sexual satisfaction and for failing to cut off the patient-provider relationship once the texts had become sexual in nature, according to court filings.

Both are in violation of state law.

The info is here.

Friday, November 22, 2019

What School Shooters Have in Common

Jillian Peterson & James Densley
Originally posted October 8, 2019

Here is an excerpt:

However, school shooters are almost always a student at the school, and they typically have four things in common:

They suffered early-childhood trauma and exposure to violence at a young age. They were angry or despondent over a recent event, resulting in feelings of suicidality. They studied other school shootings, notably Columbine, often online, and found inspiration. And they possessed the means to carry out an attack.

By understanding the traits that school shooters share, schools can do more than just upgrade security or have students rehearse for their near-deaths. They can instead plan to prevent the violence.

To mitigate childhood trauma, for example, school-based mental-health services such as counselors and social workers are needed. Schools can also adopt curriculum focused on teaching positive coping skills, resilience, and social-emotional learning, especially to young boys (According to our data, 98 percent of mass shooters are men.)

A crisis is a moment, an inflection point, when things will either become very bad or begin to get better. In 80 percent of cases, school shooters communicated to others that they were in crisis, whether through a marked change in behavior, an expression of suicidal thoughts or plans, or specific threats of violence. For this reason, all adults in schools, from the principal to the custodian, need high-quality training in crisis intervention and suicide prevention and the time and space to connect with a student. At the same time, schools need formal systems in place for students and staff to (anonymously) report a student in crisis.

The info is here.

Saturday, October 26, 2019

Treatments for the Prevention and Management of Suicide: A Systematic Review.

D'Anci KE, Uhl S, Giradi G, et al.
Ann Intern Med. 
doi: 10.7326/M19-0869


Suicide is a growing public health problem, with the national rate in the United States increasing by 30% from 2000 to 2016.

To assess the benefits and harms of nonpharmacologic and pharmacologic interventions to prevent suicide and reduce suicide behaviors in at-risk adults.

Both CBT and DBT showed modest benefit in reducing suicidal ideation compared with TAU or wait-list control, and CBT also reduced suicide attempts compared with TAU. Ketamine and lithium reduced the rate of suicide compared with placebo, but there was limited information on harms. Limited data are available to support the efficacy of other nonpharmacologic or pharmacologic interventions.


In this SR, we reviewed and synthesized evidence from 8 SRs and 15 RCTs of nonpharmacologic and pharmacologic interventions intended to prevent suicide in at-risk persons. These interventions are a subset of topics included in the updated VA/DoD 2019 CPG for assessment and management of patients at risk for suicide. The full final guideline is available from the VA Web site (www.healthquality.va.gov).

Nonpharmacologic interventions encompassed a range of approaches delivered either face-to-face or via the Internet or other technology. We found moderate-strength evidence supporting the use of face-to-face or Internet-delivered CBT in reducing suicide attempts, suicidal ideation, and hopelessness compared with TAU. We found low-strength evidence suggesting that CBT was not effective in reducing suicides. However, rates of suicide were generally low in the included studies, which limits our ability to draw firm conclusions about this outcome. Data from small studies provide low-strength evidence supporting the use of DBT over client-oriented therapy or control for reducing suicidal ideation. For other outcomes and other comparisons, we found no benefit of DBT. There was low-strength evidence supporting use of WHO-BIC to reduce suicide, CRP to reduce suicide attempts, and Window to Hope to reduce suicidal ideation and hopelessness.

Wednesday, July 24, 2019

Campuses Are Short on Mental-Health Counselors. But They’ve Got Plenty of Antidepressants.

Lily Jackson
The Chronicle of Higher Education
Originally posted June 28, 2019

Here is an excerpt:

A Potential for Lopsided Treatment

It is generally accepted that the most effective treatment for medium-to-severe depression is a mix of therapy and medication. But on most college campuses, it’s easier to get the latter than the former.

A student experiencing symptoms of depression who wants to see a counselor may have to wait weeks. The average wait for a first-time appointment among all college counseling centers is about seven business days, according to a report by the Association for University and College Counseling Center Directors. And nearly two-thirds of counseling directors whose centers offer psychiatric services say they need “more hours of psychiatric services than they currently have to meet student needs,” according to the same report.

On many campuses, the path to a prescription is simpler. A student can walk into a campus clinic where a medical employee can administer an evaluation called the PHQ-9, a nine-question rubric, commonly used across medicine, that assesses the patient's well-being with questions like, “Have you been feeling blue for the last two weeks?” and “Have you experienced thoughts of suicide?”

Based on the student’s evaluation score, psychologists can direct them toward medication or therapy, or both, based on the severity of their symptoms. Some students are seeking mental health resources with a driving force of “instant relief,” said Gregory Eells, executive director of Counseling and Psychological Services at the University of Pennsylvania and the president-elect of Aucccd.

So they tell their physician what they want, Eells said, rather than inquiring about what they need.

It’s common, experts say, for a patient to leave the first visit with a prescription for an antidepressant.

“Most students come in knowing one thing: They want help,” said William E. Neighbor, clinical professor of family medicine at the University of Washington Hall Health Center. “They are interested in medications because most have friends who have been on them.”

The info is here.

Thursday, April 11, 2019

6 women sexually abused by counselor at women's rehab center Timberline Knolls, prosecutors say

David Jackson
The Chicago Tribune
Originally posted March 7, 2019

Here is an excerpt:

Cook County prosecutors allege that a Timberline Knolls counselor, Mike Jacksa, sexually assaulted or abused six patients last year at the leafy 43-acre rehab center in suburban Lemont. Former patients told police that Jacksa subjected them to rape, forced oral sex, digital penetration and fondling beneath their clothes. He faces 62 felony charges.

The abuse allegations began to surface last summer, but Timberline officials waited at least three weeks to contact law enforcement, police reports show. In the meantime, Timberline staff conducted internal investigations, twice suspending and reinstating Jacksa, police records show.

In early July, when Timberline staff discovered journal entries by a patient that described her sexual encounters with Jacksa, they confronted the woman in his presence, police reports show. Afterward, the woman “went back to her lodge and broke a mirror, intending to hurt herself or commit suicide over the embarrassment and emotional distress the whole situation with Jacksa had caused,” a Lemont police report said. “She was transported to a hospital.”

Widely accepted treatment standards say people who report sex crimes should not be forced to give their accounts in front of their alleged attackers.

Timberline Knolls suspended Jacksa a third time in early August, after the police got involved, then fired him Aug. 10. His alleged sexual attacks on patients were “an isolated incident,” said Timberline spokesman Gary Mack. “Facility administrators were greatly saddened by this whole situation and believed they acted swiftly and certainly to take Jacksa off the street.”

The info is here.

Saturday, April 6, 2019

Wit et al. vs. United Behavioral Health and Alexander et al. vs. United Behavioral Health

U.S. Federal Court Finds United Healthcare Affiliate Illegally Denied Mental Health and Substance Use Coverage in Nationwide Class Action

  • Landmark Case Challenges the Nation’s Largest Mental Health Insurance Company for Unlawful, Systematic Claims Denials – and Wins
  • Groundbreaking Ruling Affects Certified Classes of Tens of Thousands of Patients, Including Thousands of Children and Teenagers 
  • Judge Rules, “At every level of care that is at issue in this case, there is an excessive emphasis on addressing acute symptoms and stabilizing crises while ignoring the effective treatment of members’ underlying conditions.”

In a landmark mental health ruling, a federal court held today that health insurance giant United Behavioral Health (UBH), which serves over 60 million members and is owned by UnitedHealth Group, used flawed internal guidelines to unlawfully deny mental health and substance use treatment for its insureds across the United States. The historic class action was filed by Psych-Appeal, Inc. and Zuckerman Spaeder LLP, and litigated in the U.S. District Court for the Northern District of California.

The federal court found that, to promote its own bottom line, UBH denied claims based on internally developed medical necessity criteria that were far more restrictive than generally accepted standards for behavioral health care. Specifically, the court found that UBH’s criteria were skewed to cover “acute” treatment, which is short-term or crisis-focused, and disregarded chronic or complex mental health conditions that often require ongoing care.

The court was particularly troubled by UBH’s lack of coverage criteria for children and adolescents, estimated to number in the thousands in the certified classes.

“For far too long, patients and their families have been stretched to the breaking point, both financially and emotionally, as they battle with insurers for the mental health coverage promised by their health plans,” said Meiram Bendat of Psych-Appeal, Inc. and co-counsel for the plaintiffs who uncovered the guideline flaws. “Now a court has ruled that denying coverage based on defective medical necessity criteria is illegal.”

In its decision, the court also held that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must use in Connecticut, Illinois and Rhode Island. Additionally, the court found that UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.

The legal opinion is here.

Thursday, March 7, 2019

Prominent psychiatrist accused of sexually exploiting patients

Michael Rezendes
The Boston Globe
Originally posted February 21, 2019

A prominent North Shore psychiatrist is facing lawsuits from three female patients who say he lured them into degrading sexual relationships, including beatings, conversations about bondage, and, in one case, getting a tattoo of the doctor’s initials to show his “ownership” of her, according to court documents.

The women allege that Dr. Keith Ablow, an author who was a contributor to Fox News network until 2017, abused his position while treating them for acute depression, leaving them unable to trust authority figures and plagued with feelings of shame and self-recrimination.

“He began to hit me when we engaged in sexual activities,” wrote one plaintiff, a New York woman, in a sworn affidavit filed with her lawsuit. “He would have me on my knees and begin to beat me with his hands on my breasts,” she wrote, “occasionally saying, ‘I own you,’ or ‘You are my slave.’”

The malpractice lawsuits, two of them filed on Thursday in Essex Superior Court and a third filed last year, paint a picture of a therapist who encouraged women to trust and rely on him, then coaxed them into humiliating sexual activities, often during treatment sessions for which they were charged.

When the New York woman had trouble paying her therapy bills, she said, Ablow advised her to work as an escort or stripper because the work was lucrative.

Although the women used their real names in their lawsuits, the Globe is withholding their identities at their request.  The Globe does not identify alleged victims of sexual abuse without their consent.

The info is here.

Wednesday, February 13, 2019

Former San Diego psychiatrist won't see jail time after admitting to sexual contact with patients

Mark Saunders
Originally posted January 18, 2019

A former San Diego County psychiatrist who admitted to having sexual contact with seven female patients during office visits and sexual battery will not see any jail time.

Leon Fajerman, 75, was not sentenced to any jail time during his sentencing hearing Friday. Instead, the judge ordered Fajerman to serve house arrest for a year, pay an undetermined amount of restitution, and he must register as a sex offender.

He is eligible to have an ankle bracelet removed after six months of house arrest, pending good behavior.

Friday, victim impact statement's were read in court by the victims' attorney, who called the sentencing of no jail time absurd. Jessica Pride, an attorney representing two victims said they suffered from, “post-traumatic stress disorder, they are also suffering from anxiety, night terrors, insomnia, suicidal ideations.”

The info is here.

Monday, October 15, 2018

ICP Ethics Code

Institute of Contemporary Psychoanalysis

Psychoanalysts strive to reduce suffering and promote self-understanding, while respecting human dignity. Above all, we take care to do no harm. Working in the uncertain realm of unconscious emotions and feelings, our exclusive focus must be on safeguarding and benefitting our patients as we try to help them understand their unconscious mental life. Our mandate requires us to err on the side of ethical caution. As clinicians who help people understand the meaning of their dreams and unconscious longings, we are aware of our power and sway. We acknowledge a special obligation to protect people from unintended harm resulting from our own human foibles.

In recognition of our professional mandate and our authority—and the private, subjective and influential nature of our work—we commit to upholding the highest ethical standards. These standards take the guesswork out of how best to create a safe container for psychoanalysis. These ethical principles inspire tolerant and respectful behaviors, which in turn facilitate the health and safety of our candidates, members and, most especially, our patients. Ultimately, ethical behavior protects us from ourselves, while preserving the integrity of our institute and profession.

Professional misconduct is not permitted, including, but not limited to dishonesty, discrimination and boundary violations. Members are asked to keep firmly in mind our core values of personal integrity, tolerance and respect for others. These values are critical to fulfilling our mission as practitioners and educators of psychoanalytic therapy. Prejudice is never tolerated whether on the basis of age, disability, ethnicity, gender, gender identity, race, religion, sexual orientation or social class. Institute decisions (candidate advancement, professional opportunities, etc.) are to be made exclusively on the basis of merit or seniority. Boundary violations, including, but not limited to sexual misconduct, undue influence, exploitation, harassment and the illegal breaking of confidentiality, are not permitted. Members are encouraged to seek consultation readily when grappling with any ethical or clinical concerns. Participatory democracy is a primary value of ICP. All members and candidates have the responsibility for knowing these guidelines, adhering to them and helping other members comply with them.

The ethics code is here.