Women Carry An Undue Mental Health Burden. They Shouldn’t Have To

Rawan Hamadeh

Ms. Magazine

Originally posted 12 June 21

Here is an excerpt:

In developing countries, there is a huge gap in the availability and accessibility of specialized mental health services. Rather than visiting mental health specialists, women are more likely to seek mental health support in primary health care settings while accompanying their children or while attending consultations for other health issues. This leads to many mental health conditions going unidentified and therefore not treated. Often, women do not feel fully comfortable disclosing certain psychological and emotional distress because they fear stigmatization, confidentiality breaches or not being taken seriously.

COVID-19 has put the mental well-being of the entire world at risk. More adults are reporting struggles with mental health and substance use and are experiencing more symptoms of anxiety and depressive disorders. The stressors caused by the pandemic have affected the entire population; however, the effect on women and mothers specifically has been greater.

Women, the unsung heroes of the pandemic, face mounting pressures amid this global health crisis. Reports suggest that the long-term repercussions of COVID-19 could undo decades of progress for women and impose considerable additional burdens on them, threatening the difficult journey toward gender equality.

Unemployment, parenting responsibilities, homeschooling or caring for sick relatives are all additional burdens on women’s daily lives during the pandemic. It’s also important that we acknowledge the exponential need for mental health support for health care workers, and particularly health care mothers, who are juggling both their professional duties and their parenting responsibilities. They are the heroes on the front lines of the fight against the virus, and it’s crucial to prioritize their physical as well as their mental health.

The article is here.

Updated Physician-Aid-in-Dying Law Sparks Controversy in Canada

Richard Karel

Psychiatric News

Originally posted 27 May 21

Here is an excerpt:

Addressing the changes for people who may be weighing MAID for severe mental illness, the government stated the following:

“If you have a mental illness as your only medical condition, you are not eligible to seek medical assistance in dying. … This temporary exclusion allows the Government of Canada more time to consider how MAID can safely be provided to those whose only medical condition is mental illness.

“To support this work, the government will initiate an expert review to consider protocols, guidance, and safeguards for those with a mental illness seeking MAID and will make recommendations within a year (by March 17, 2022).

“After March 17, 2023, people with a mental illness as their sole underlying medical condition will have access to MAID if they are eligible and the practitioners fulfill the safeguards that are put in place for this group of people. …”

While many physicians and others have long been sympathetic to allowing medical professionals to help those with terminal illness die peacefully, the fear has been that medically assisted death could become a substitute for adequate—and more costly—medical care. Those concerns are growing with the expansion of MAID in Canada.

The info is here.

How ecstasy and psilocybin are shaking up psychiatry

Paul Tullis

Nature.com

Originally posted 27 Jan 21

Here is an excerpt:

Psychedelic-assisted psychotherapy could provide needed options for debilitating mental-health disorders including PTSD, major depressive disorder, alcohol-use disorder, anorexia nervosa and more that kill thousands every year in the United States, and cost billions worldwide in lost productivity.

But the strategies represent a new frontier for regulators. “This is unexplored ground as far as a formally evaluated intervention for a psychiatric disorder,” says Walter Dunn, a psychiatrist at the University of California, Los Angeles, who sometimes advises the US Food and Drug Administration (FDA) on psychiatric drugs. Most drugs that treat depression and anxiety can be picked up at a neighbourhood pharmacy. These new approaches, by contrast, use a powerful substance in a therapeutic setting under the close watch of a trained psychotherapist, and regulators and treatment providers will need to grapple with how to implement that safely.

“The clinical trials that have been reported on depression have been done under highly circumscribed and controlled conditions,” says Bertha Madras, a psychobiologist at Harvard Medical School who is based at McLean Hospital in Belmont, Massachusetts. That will make interpreting results difficult. A treatment might show benefits in a trial because the experience is carefully coordinated, and everyone is well trained. Placebo controls pose another challenge because the drugs have such powerful effects.

And there are risks. In extremely rare instances, psychedelics such as psilocybin and LSD can evoke a lasting psychotic reaction, more often in people with a family history of psychosis. Those with schizophrenia, for example, are excluded from trials involving psychedelics as a result. MDMA, moreover, is an amphetamine derivative, so could come with risks for abuse.

But many researchers are excited. Several trials show dramatic results: in a study published in November 2020, for example, 71% of people who took psilocybin for major depressive disorder showed a greater than 50% reduction in symptoms after four weeks, and half of the participants entered remission1. Some follow-up studies after therapy, although small, have shown lasting benefits2,3.

The info is here.

Association of Physician Burnout With Suicidal Ideation and Medical Errors

Menon NK, Shanafelt TD, Sinsky CA, et al. 

JAMA Netw Open. 2020;3(12):e2028780. 

doi:10.1001/jamanetworkopen.2020.28780

Key Points

Question  Is burnout associated with increased suicidal ideation and self-reported medical errors among physicians after accounting for depression?

Findings  In this cross-sectional study of 1354 US physicians, burnout was significantly associated with increased odds of suicidal ideation before but not after adjusting for depression and with increased odds of self-reported medical errors before and after adjusting for depression. In adjusted models, depression was significantly associated with increased odds of suicidal ideation but not self-reported medical errors.

Meaning  The findings suggest that depression but not burnout is directly associated with suicidal ideation among physicians.

Conclusions and Relevance  The results of this cross-sectional study suggest that depression but not physician burnout is directly associated with suicidal ideation. Burnout was associated with self-reported medical errors. Future investigation might examine whether burnout represents an upstream intervention target to prevent suicidal ideation by preventing depression.

The research is here.

Do criminals freely decide to commit offences? How the courts decide?

J. Kennett & A. McCay

The Conversation

Originally published 15 OCT 20

Here is an excerpt:

Expert witnesses were reportedly divided on whether Gargasoulas had the capacity to properly participate in his trial, despite suffering from paranoid schizophrenia and delusions.

A psychiatrist for the defence said Gargasoulas’ delusional belief system “overwhelms him”; the psychiatrist expressed concern Gargasoulas was using the court process as a platform to voice his belief he is the messiah.

A second forensic psychiatrist agreed Gargasoulas was “not able to rationally enter a plea”.

However, a psychologist for the prosecution assessed him as fit and the prosecution argued there was evidence from recorded phone calls that he was capable of rational thought.

Notwithstanding the opinion of the majority of expert witnesses, the jury found Gargasoulas was fit to stand trial, and later he was convicted and sentenced to life imprisonment.

Working from media reports, it is difficult to be sure precisely what happened in court, and we cannot know why the jury favoured the evidence suggesting he was fit to stand trial. However, it is interesting to consider whether research into the psychology of blame and punishment can shed any light on their decision.

Questions of consequence

Some psychologists argue judgements of blame are not always based on a balanced assessment of free will or rational control, as the law presumes. Sometimes we decide how much control or freedom a person possessed based upon our automatic negative responses to harmful consequences.

As the psychologist Mark Alicke says:

we simply don’t want to excuse people who do horrible things, regardless of how disordered their cognitive states may be.

When a person has done something very bad, we are motivated to look for evidence that supports blaming them and to downplay evidence that might excuse them by showing that they lacked free will.

The info is here.

In Japan, more people died from suicide last month than from Covid in all of 2020

S. Wang, R. Wright, & Y. Wakatsuki

CNN.com

Originally posted 29 Nov 20

Here is an excerpt:

In Japan, government statistics show suicide claimed more lives in October than Covid-19 has over the entire year to date. The monthly number of Japanese suicides rose to 2,153 in October, according to Japan's National Police Agency. As of Friday, Japan's total Covid-19 toll was 2,087, the health ministry said.

Japan is one of the few major economies to disclose timely suicide data -- the most recent national data for the US, for example, is from 2018. The Japanese data could give other countries insights into the impact of pandemic measures on mental health, and which groups are the most vulnerable.

"We didn't even have a lockdown, and the impact of Covid is very minimal compared to other countries ... but still we see this big increase in the number of suicides," said Michiko Ueda, an associate professor at Waseda University in Tokyo, and an expert on suicides.

"That suggests other countries might see a similar or even bigger increase in the number of suicides in the future."

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Compounding those worries about income, women have been dealing with skyrocketing unpaid care burdens, according to the study. For those who keep their jobs, when children are sent home from school or childcare centers, it often falls to mothers to take on those responsibilities, as well as their normal work duties.

Increased anxiety about the health and well-being of children has also put an extra burden on mothers during the pandemic.

The info is here.

Trump's Strangest Lie: A Plague of Suicides Under His Watch

Gilad Edelman

wired.com

Originally published 23 Oct 2020

IN LAST NIGHT’S presidential debate, Donald Trump repeated one of his more unorthodox reelection pitches. “People are losing their jobs,” he said. “They’re committing suicide. There’s depression, alcohol, drugs at a level that nobody’s ever seen before.”

It’s strange to hear an incumbent president declare, as an argument in his own favor, that a wave of suicides is occurring under his watch. It’s even stranger given that it’s not true. While Trump has been warning since March that any pandemic lockdowns would lead to “suicides by the thousands,” several studies from abroad have found that when governments imposed such restrictions in the early waves of the pandemic, there was no corresponding increase in these deaths. In fact, suicide rates may even have declined. A preprint study released earlier this week found that the suicide rate in Massachusetts didn’t budge even as that state imposed a strong stay-at-home order in March, April, and May.

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Add this to the list of tragic ironies of the Trump era: The president is using the nonexistent link between lockdowns and suicide to justify an agenda that really could cause more people to take their own lives.

The info is here.

Beliefs have a social purpose. Does this explain delusions?

Anna Greenburgh

psyche.co

Originally published 

Here is an excerpt:

Of course, just because a delusion has logical roots doesn’t mean it’s helpful for the person once it takes hold. Indeed, this is why delusions are an important clinical issue. Delusions are often conceptualised as sitting at the extreme end of a continuum of belief, but how can they be distinguished from other beliefs? If not irrationality, then what demarcates a delusion?

Delusions are fixed, unchanging in the face of contrary evidence, and not shared by the person’s peers. In light of the social function of beliefs, these preconditions have added significance. The coalitional model underlines that beliefs arising from adaptive cognitive processes should show some sensitivity to social context and enable successful social coordination. Delusions lack this social function and adaptability. Clinical psychologists have documented the fixity of delusional beliefs: they are more resistant to change than other types of belief, and are intensely preoccupying, regardless of the social context or interpersonal consequences. In both ‘The Yellow Wallpaper’ and the novel Don Quixote (1605-15) by Miguel de Cervantes, the protagonists’ beliefs about their surroundings are unchangeable and, if anything, become increasingly intense and disruptive. It is this inflexibility to social context, once they take hold, that sets delusions apart from other beliefs.

Across the field of mental health, research showing the importance of the social environment has spurred a great shift in the way that clinicians interact with patients. For example, research exposing the link between trauma and psychosis has resulted in more compassionate, person-centred approaches. The coalitional model of delusions can now contribute to this movement. It opens up promising new avenues of research, which integrate our fundamental social nature and the social function of belief formation. It can also deepen how people experiencing delusions are understood – instead of contributing to stigma by dismissing delusions as irrational, it considers the social conditions that gave rise to such intensely distressing beliefs.

The info is here.

Rethink Crisis Response—People Who Call 911 Shouldn't Get an Ill-Trained Police Officer, Especially When They're Dealing With a Mental Health Emergency

Sally Satel
reason.com
October 2020

Here is an excerpt:

Miami-Dade is a large county that was able to follow the tripartite strategy. Shootings by police have declined by 90 percent since CIT training was implemented in 2010, but the program accomplished something more: It shined a light on the high incidence among police of depression and suicide. According to Judge Steven Leifman, who established the Miami-Dade program, officers who go through the training "have been more willing to recognize their own stress [and] reach out to the program's coordinator for mental-health advice and treatment for their own traumas."

Other cities deploy crisis teams that are solely mental health–based; police are not part of the first line at all. One of the nation's longest-running examples of this is CAHOOTS (Crisis Assistance Helping Out On The Streets). It was created 31 years ago as part of an outreach program of the White Bird Clinic in Eugene, Oregon—once a countercultural medical clinic founded in 1970 as a refuge for hippies on LSD trips and other drug-taking youth. Calls for help are routed to staff 24/7 by the local 911 dispatcher. A medic and a mental health professional respond as a team to incidents such as altercations, overdoses, and welfare checks. They wear jeans and hoodies and arrive in a white van stocked with supplies like socks, soap, water, and gloves. Should a situation spin out of control, they call for CIT-trained police back-up, though last year only 150 out of 24,000 field calls required back-up. People who need further attention are taken to a crisis care facility operated by the mental health department—no trips to jail or to overflowing emergency rooms.

Mental health teams can bring some much-needed relief to municipal budgets. According to TAC, police officers across 355 law enforcement agencies spent slightly over one-fifth of their time responding to people with mental illness or transporting them to jail or psychiatric emergency rooms, at a cost of $918 million in 2017. The CAHOOTS flagship program in Eugene operated on a $2 million budget in 2019 and saved the locale about $14 million in ambulance transport and emergency room care. Within the year, a number of cities (including San Francisco, Los Angeles, New York, and Durham, North Carolina) will be launching programs similar to CAHOOTS.

The best crisis intervention programs help reduce the toll of police involvement gone awry, but the only way to take encounters out of the hands of police in all but the most dangerous instances is to repair the mental health system itself, which is a notoriously tattered network of therapists, psychiatrists, hospitals, residential settings, and support services, and work to prevent ill people from lapsing into crisis in the first place.

The info is here.

Well-Being, Burnout, and Depression Among North American Psychiatrists: The State of Our Profession

R. F. Summers

American Journal of Psychiatry
Published 14 July 2020

Objective:

The authors examined the prevalence of burnout and depressive symptoms among North American psychiatrists, determined demographic and practice characteristics that increase the risk for these symptoms, and assessed the correlation between burnout and depression.

Methods:

A total of 2,084 North American psychiatrists participated in an online survey, completed the Oldenburg Burnout Inventory (OLBI) and the Patient Health Questionnaire–9 (PHQ-9), and provided demographic data and practice information. Linear regression analysis was used to determine factors associated with higher burnout and depression scores.

Results:

Participants’ mean OLBI score was 40.4 (SD=7.9) and mean PHQ-9 score was 5.1 (SD=4.9). A total of 78% (N=1,625) of participants had an OLBI score ≥35, suggestive of high levels of burnout, and 16.1% (N=336) of participants had PHQ-9 scores ≥10, suggesting a diagnosis of major depression. Presence of depressive symptoms, female gender, inability to control one’s schedule, and work setting were significantly associated with higher OLBI scores. Burnout, female gender, resident or early-career stage, and nonacademic setting practice were significantly associated with higher PHQ-9 scores. A total of 98% of psychiatrists who had PHQ-9 scores ≥10 also had OLBI scores >35. Suicidal ideation was not significantly associated with burnout in a partially adjusted linear regression model.

Conclusions:

Psychiatrists experience burnout and depression at a substantial rate. This study advances the understanding of factors that increase the risk for burnout and depression among psychiatrists and has implications for the development of targeted interventions to reduce the high rates of burnout and depression among psychiatrists. These findings have significance for future work aimed at workforce retention and improving quality of care for psychiatric patients.

The info is here.

Mental Health and Clinical Psychological Science in the Time of COVID-19: Challenges, Opportunities, and a Call to Action

June Gruber et al.
American Psychologist. 
Advance online publication.
http://dx.doi.org/10.1037/amp0000707

Abstract

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond.

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Concluding Comments

Clinical psychological science is needed more than ever in response to both the acute and enduring psychological effects of COVID-19 (Adhanom Ghebreyesus, 2020). This article is intended to inspire dialogue surrounding the challenges the field faces and how it must adapt to meet the mental health demands of a rapidly evolving psychological landscape. Of course, sustained change will require strong advocacy to ensure that mental health research funding is available to understand and address mental health challenges following COVID-19. To secure a leadership role, clinical psychological scientists must be prepared to raise their voices not only within scientific outlets, but also in public discussions on the airwaves (radio, cable news), alongside colleagues in other scientific fields. Sustained effort, collaboration with other disciplines, and unity within psychology will be necessary to address the multifaceted impacts of COVID-19 on humanity.

Antipsychotics for Children With ADHD Should Be a Last Resort

Jeannette Y. Wick
pharmacytimes.com
Originally published 20 Feb 20

Here is an excerpt:

ANTIPSYCHOTICS: NOT FIRST LINE

A freestanding diagnosis of ADHD is not an indication for antipsychotic medications. Although no studies have determined which children who get an ADHD diagnosis are most likely to receive antipsychotic medications, mental health comorbidity is a possible factor.

ADHD often occurs in conjunction with other mental health conditions. Common comorbidities include conduct disorder (depression, or oppositional defiant disorder), and prescribers may use antipsychotic drugs to augment other approaches. The evidence does not support using antipsychotic medication for depression in youths, but some data support a risperidone trial for conduct disorder or oppositional defiant disorder in stimulant-resistant youths with ADHD.

A second concern is aggression. Aggression that stems from poor impulse control is common in youths who have ADHD, and it frequently occurs in children who have comorbidities. This behavior is often associated with a need for assessment, hospitalization, or urgent care and requires careful follow-up and cautious risk assessment. ADHD may not respond to stimulant medications, so prescribers may use antipsychotic drugs off-label in an effort to reduce aggressive outbursts. Research shows that antipsychotic-treated youths with ADHD often have clinical characteristics associated with aggression. However, few youths with ADHD who were treated with antipsychotics received the evidence-indicated trial doses of 2 stimulants before an antipsychotic.

The info is here.

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

Jeffrey Geller
STAT NEWS
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.

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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.

American Psychiatric Association Presidential Task Force to Address Structural Racism Throughout Psychiatry

Press Release
American Psychiatric Association
2 July 2020

The American Psychiatric Association today announced the members and charge of its Presidential Task Force to Address Structural Racism Throughout Psychiatry. The
Task Force was initially described at an APA Town Hall on June 15 amidst rising calls from psychiatrists for action on racism. It held its first meeting on June 27, and efforts, including the planning of future town halls, surveys and the establishment of related committees, are underway.

Focusing on organized psychiatry, psychiatrists, psychiatric trainees, psychiatric patients, and others who work to serve psychiatric patients, the Task Force is initially charged with:

1. Providing education and resources on APA’s and psychiatry’s history regarding structural racism;
2. Explaining the current impact of structural racism on the mental health of our patients and colleagues;
3. Developing achievable and actionable recommendations for change to eliminate structural racism in the APA and psychiatry now and in the future;
4. Providing reports with specific recommendations for achievable actions to the APA Board of Trustees at each of its meetings through May 2021; and
5. Monitoring the implementation of tasks 1-4.

The info is here.

Want To See Your Therapist In-Person Mid-Pandemic? Think Again

Todd Essig
Forbes.com
Originally posted 27 June 20

Here is an excerpt:

Psychotherapy is built on a promise; you bring your suffering to this private place and I will work with you to keep you safe and help you heal. That promise is changed by necessary viral precautions. First, the possibility of contact tracing weakens the promise of confidentiality. I promise to keep this private changes to a promise to keep it private unless someone gets sick and I need to contact the local health department.

Even more powerful is the fact that a mid-pandemic in-person psychotherapy promise has to include all the ways we will protect each other from very real dangers, hardly the experience of psychological safety. There will even be a promise to pretend we are safe together even when we are doing so many things to remind us we are each the source of a potentially life-altering infection.

When I imagine how my caseload would react were I to begin mid-pandemic in-person work, like I did for a recent webinar for the NYS Psychological Association, I anticipate as many people welcoming the chance to work together on a shared project of viral safety as I do imagining those who would feel devastated or burdened. But even for the first group of willing co-participants, it is important to see that such a joint project of mutual safety is not psychotherapy. No anticipated reaction included the experience of psychological safety on which effective psychotherapy rests.

Rather than feeling safe enough to address the private and dark, patients/clients will each in their own way labor under the burden of keeping themselves, their families, their therapist, other patients, and office staff safe. The vigilance required to remain safe will inevitably reduce the therapeutic benefits one might hope would develop from being back in the office.

The article is here.

Universal basic income seems to improve employment and well-being

Donna Lu
New Scientist
Originally post 6 May 20

The world’s most robust study of universal basic income has concluded that it boosts recipients’ mental and financial well-being, as well as modestly improving employment.

Finland ran a two-year universal basic income study in 2017 and 2018, during which the government gave 2000 unemployed people aged between 25 and 58 monthly payments with no strings attached.

The payments of €560 per month weren’t means tested and were unconditional, so they weren’t reduced if an individual got a job or later had a pay rise. The study was nationwide and selected recipients weren’t able to opt out, because the test was written into legislation.

Minna Ylikännö at the Social Insurance Institution of Finland announced the findings in Helsinki today via livestream.

The study compared the employment and well-being of basic income recipients against a control group of 173,000 people who were on unemployment benefits.

Between November 2017 and October 2018, people on basic income worked an average of 78 days, which was six days more than those on unemployment benefits.

There was a greater increase in employment for people in families with children, as well as those whose first language wasn’t Finnish or Swedish – but the researchers aren’t yet sure why.

When surveyed, people who received universal basic income instead of regular unemployment benefits reported better financial well-being, mental health and cognitive functioning, as well as higher levels of confidence in the future.

The info is here.

Hospitals prepare for wave of mental health disorders among their workers

Del Quentin Wilber
The Los Angeles Times
Originally posted May 6, 2020

Here is an excerpt:

Mental health practitioners pointed to the suicide late last month of Dr. Lorna Breen as a warning flare. Colleagues said the 49-year-old Breen, an emergency room physician at NewYork-Presbyterian Allen Hospital in Manhattan, took her life after becoming overwhelmed by the volume of coronavirus patients who died on her watch.

“People at these elite medical institutions are talented, disciplined, strong and resilient,” said Dr. Jeffrey Lieberman, the chair of psychiatry at Columbia University Medical Center, where Breen was an assistant professor of emergency medicine. “But everyone has a breaking point. Tragically, in her case, her dedication pushed her past the breaking point.”

Healthcare professionals said the potential for trouble is particularly acute in New York, which has emerged as ground zero in the U.S. for COVID-19, the disease caused by the coronavirus.

Its hospitals have been crushed by an onslaught of severely ill patients. With no proven treatments or cures, physicians and nurses say they have often felt powerless to prevent the sickest from dying. Nearly 14,000 people have perished from the disease in the city, health officials say. During the height of the outbreak a month ago, doctors at Mt. Sinai Hospital were reporting at least 20 deaths a day. Typically, the hospital has one or two.

“The mortality that even veteran clinicians are witnessing has been massive and devastating to healthcare workers,” Lieberman said.

The info is here.

America's Mental Health Crisis Hidden Behind Bars

Eric Westervelt & Liz Baker
npr.org
Originally posted 25 Feb 20

Here is an excerpt:

It's a culmination of decades of policies affecting those with a mental illness. Many of the nation's asylums and hospitals were closed over the past 60-plus years — some horrific places that needed to be shuttered, others emptied to cut costs.

The idea was that they'd be replaced with community-based mental health care and supportive services. That didn't happen. Ensuing decades saw tougher sentencing under aggressive "war on drugs and crime" policies as well as cuts to subsidized housing and mental health. It all created a perfect storm of failed policies driving more of the mentally ill into the nation's jails and prisons.

Many were left to fend for themselves. Substance abuse and homelessness sometimes followed, as did encounters with police, who often are called first to help deal with the effects of or related to mental crises.

It has put the jails in an awkward position. Today the three biggest mental health centers in America are jails: LA County, Cook County, Ill. (Chicago) and New York City's Rikers Island jail. Without the support needed, conditions have created new asylums, advocates say, that can resemble the very places they vowed to shut down.

"Local jails and prisons have become the de facto mental health institutions," says Elizabeth Hancq, director of research at the Treatment Advocacy Center, a national nonprofit that works to eliminate barriers to treatment for people with severe mental illness. "It's really a humanitarian crisis that if you suffer from a severe mental illness in this country, you almost need to commit a crime in order to get into the system."

The info is here.

US 'Deaths of Despair' From COVID-19 Could Top 75,000, Experts Warn

Megan Brooks
MedScape.com
Originally posted 8 May 20

An additional 75,000 Americans could die by suicide, drugs, or alcohol abuse because of the COVID-19 pandemic, projections from a new national report released today suggest.

The number of "deaths of despair" could be even higher if the country fails to take bold action to address the mental health toll of unemployment, isolation, and uncertainty, according to the report from the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

"If nothing happens and nothing improves ― ie, the worst-case scenario ― we could be looking at an additional 150,000 people who died who didn't have to," Benjamin Miller, PsyD, WBT chief strategy officer, told Medscape Medical News.

"We can prevent these deaths. We know how and have a bevy of evidence-based solutions. We lack the resources to really stand this up in a way that can most positively impact communities," Miller added.

Slow Recovery, Quick Recovery Scenarios

For the analysis, Miller and colleagues combined information on the number of deaths from suicide, alcohol, and drugs from 2018 as a baseline (n = 181,686). They projected levels of unemployment from 2020 to 2029 and then used economic modeling to estimate the additional annual number of deaths.

Across nine different scenarios, the number of additional deaths of despair range from 27,644 (quick recovery, smallest impact of unemployment on suicide, alcohol-, and drug-related deaths) to 154,037 (slow recovery, greatest impact of unemployment on these deaths), with 75,000 being the most likely.

The info is here.

Restoring the Economy Is the Last Thing We Should Want

Douglas Rushkoff
medium.com
Originally published 27 April 20

Everyone wants to know when we’re going to get the economy started up again, and just how many lives we’re willing to surrender before we do. We’ve all been made to understand the dilemma: The sooner we “open up” American and get back to our jobs, the more likely we spread Covid-19, further overwhelming hospitals and killing more people. Yet the longer we wait, the more people will suffer and die in other ways.

I think this is a false choice. Yes, it may be true that every 1% rise in unemployment leads to a corresponding 1% rise in suicides. And it’s true that an extended freeze of the economy could shorten the lifespan of 6.4 million Americans entering the job market by an average of about two years. But such metrics say less about the human cost of the downturn than they do about the dangerously absolute dependence of workers on traditional employment for basic sustenance — an artifact of an economy that has been intentionally rigged to favor big banks and passive shareholders over small and local businesses that actually provide goods and services in a sustainable way.

In reality, the sooner and more completely we restore the old economy, the faster we simply recreate the conditions that got us sick in the first place and rendered us incapable of mounting an effective response. The economy we’re committed to restoring is no more the victim of the Covid-19 crisis than it is the cause. We have to stop asking when will things get back to normal. They won’t. There is no going back. And that’s actually good news.

The info is here.