Yale Changes Mental Health Policies for Students in Crisis

William Wan

The Washington Post

Originally posted 18 JAN 23

Here are some excerpts:

In interviews with The Post, several students — who relied on Yale’s health insurance — described losing access to therapy and health care at the moment they needed it most.

The policy changes announced Wednesday reversed many of those practices.

By allowing students in mental crisis to take a leave of absence rather than withdraw, they will continue to have access to health insurance through Yale, university officials said. They can continue to work as a student employee, meet with career advisers, have access to campus and use library resources.

Finding a way to allow students to retain health insurance required overcoming significant logistical and financial hurdles, Lewis said, since New Haven and Connecticut are where most health providers in Yale’s system are located. But under the new policies, students on leave can switch to “affiliate coverage,” which would cover out-of-network care in other states.

In recent weeks, students and mental advocates questioned why Yale would not allow students struggling with mental health issues to take fewer classes. The new policies will now allow students to drop their course load to as low as two classes under special circumstances. But students can do so only if they require significant time for treatment and if their petition is approved.

In the past, withdrawn students had to submit an application for reinstatement, which included letters of recommendation, and proof they had remained “constructively occupied” during their time away. Under new policies, students returning from a medical leave of absence will submit a “simplified reinstatement request” that includes a letter from their clinician and a personal statement explaining why they left, the treatment they received and why they feel ready to return.

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In their updated online policies, the university made clear it still retained the right to impose an involuntary medical leave on students in cases of “a significant risk to the student’s health or safety, or to the health or safety of others.”

The changes were announced one day before Yale officials were scheduled to meet for settlement talks with the group of current and former students who filed a proposed class-action lawsuit against the university, demanding policy changes. 

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In a statement, one of the plaintiffs — a nonprofit group called Elis for Rachael, led by former Yale students — said they are still pushing for more to be done: “We remain in negotiations. We thank Yale for this first step. But if Yale were to receive a grade for its work on mental health, it would be an incomplete at best.”

But after decades of mental health advocacy with little change at the university, some students said they were surprised at the changes Yale has made already.

“I really didn’t think it would happen during my time here,” said Akweley Mazarae Lartey, a senior at Yale who has advocated for mental rights throughout his time at the school. 

“I started thinking of all the situations that I and people I care for have ended up in and how much we could have used these policies sooner.”

The info is here.

Countering cognitive biases on experts’ objectivity in court

Kathryn A. LaFortune

Monitor on Psychology

Vol. 53 No. 6

Print version: page 47

Mental health professionals’ opinions can be extremely influential in legal proceedings. Yet, current research is inconclusive about the effects of various cognitive biases on experts’ objectivity when making forensic mental health judgments and which biases most influence these decisions, according to a 2022 study in Law and Human Behavior by psychologists Tess Neal, Pascal Lienert, Emily Denne, and Jay Singh (Vol. 46, No. 2, 2022). The study also pointed to the need for more research on which debiasing strategies effectively counter bias in forensic mental health decisions and whether there should be specific policies and procedures to address these unique aspects of forensic work in mental health.

In the study, researchers conducted a systematic review of the relevant literature in forensic mental health decision-making. “Bias” was not generally defined in most of the available studies reviewed in the context of researching forensic mental health judgments. Their study noted that only a few forms of bias have been explored as they pertain specifically to forensic mental health professionals’ opinions. Adversarial allegiance, confirmation bias, hindsight bias, and bias blind spot have not been rigorously studied for potential negative effects on forensic mental health expert opinions across different contexts.

The importance of addressing these concerns is heightened when considering APA’s Ethics Code provisions that require psychologists to decline a professional role if bias may diminish their objectivity (See, Ethical Principles of Psychologists and Code of Conduct, Section 3.06). Similarly, the Specialty Guidelines for Forensic Psychologists advises forensic practitioners to decline participation in cases when potential biases may impact their impartiality or to take steps to correct or limit the effects of the bias (Section 2.07). That said, unlike in other professions where tasks are often repetitive, decision-making in the field of forensic psychology is impacted by the unique nature of the various referrals that forensic psychologists receive, making it even more difficult to expect them to consider and correct how their culture, attitudes, values, beliefs, and biases might affect their work. They engage in greater subjectivity in selecting assessment tools from a large array of available tests, none of which are uniformly adopted in cases, in part because of the wide range of questions experts often must answer to assist the court and the current lack of standardized methods. Neither do experts typically receive immediate feedback on their opinions. This study also noted that the only debiasing strategy shown to be effective for forensic psychologists was to “consider the opposite,” in which experts ask themselves why their opinions might be wrong and what alternatives they may have considered.

The info is here.

What is behind the rise in girls questioning their gender identity?

Amelia Gentleman

The Guardian

Originally posted 24 Nov 22

Here is an excerpt:

The trend was confirmed by clinicians who spoke to the Guardian.

“In the past few years it has become an explosion. Many of us feel confused by what has happened, and it’s often hard to talk about it to colleagues,” said a London-based psychiatrist working in a child and adolescent mental health unit, who has been a consultant for the past 17 years.

Like all NHS employees interviewed, she asked for anonymity due to the sensitivity of the subject.

“I might have seen one child with gender dysphoria once every two years when I started practising. It was very niche and rare.” Now, somewhere between 10% and 20% of her caseload is made up of adolescents registered as female at birth who identify as non-binary or trans, with just an occasional male-registered teenager who identifies as trans.

Another senior child psychiatrist said girls who wanted to transition made up about 5% of her caseload.

“In the last five to 10 years we’ve seen a huge surge in young women who, at the age of around 12 or 13, want to become boys. They’ve changed their name and they are pressing … to have hormones or puberty blockers”

The psychiatrist added: “Often those girls are children who are going through the normal identity and developmental problems of adolescence and finding a solution for themselves in this way.”

Greater awareness of trans issues is likely to be one common-sense explanation for the rise in requests for referrals.

“Left-handedness increased over time after we stopped punishing left-handed children in schools, because some children are naturally left-handed and were now able to express it,” said Cleo Madeleine, a spokesperson for the trans support group Gendered Intelligence.

“In the same way, increased visibility and acceptance of trans people has led to a gradual increase in young people who feel comfortable expressing their trans identity. The most important thing is to recognise that this is not a problem to be solved or a bad outcome to be avoided.”

The mother of a 17-year-old A-level student (who came out as trans at 13, leaving a handwritten letter for his parents on his bed) agreed: “It’s discussed so much more – on Facebook and on social media. It’s no longer a taboo.”

She is confident this was the right decision for her child. “I think I wondered if this was a phase, but I didn’t look to dissuade him. As he began to socially transition he was a different person. It has made him happier,” she said.

The info is here.

‘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.

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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.

The info is here.

Psychiatry wars: the lawsuit that put psychoanalysis on trial

Rachel Aviv

The Guardian

Originally posted 11 OCT 22

Here is an excerpt:

In the lawsuit, the 20th century’s two dominant explanations for mental distress collided. No psychiatric malpractice lawsuit has attracted more prominent expert witnesses than Ray’s, according to Alan Stone, the former president of the APA. The case became “the organising nidus” around which leading biological psychiatrists “pushed their agenda”, he told me.

At a hearing before an arbitration panel, which would determine whether the case could proceed to trial, the Lodge presented Ray’s attempt to medicalise his depression as an abdication of responsibility. In a written report, one of the Lodge’s expert witnesses, Thomas Gutheil, a professor of psychiatry at Harvard, observed that the language of the lawsuit, much of which Ray had drafted himself, exemplified Ray’s struggle with “‘externalisation’ – that is, the tendency to blame one’s problems on others”. Gutheil concluded that Ray’s “insistence on the biological nature of his problem is not only disproportionate but seems to me to be yet another attempt to move the problem away from himself: it is not I, it’s my biology.”

The Lodge’s experts attributed Ray’s recovery at Silver Hill at least in part to his romantic entanglement with a female patient, which gave him a jolt of self-esteem.

“It’s a demeaning comment,” Ray responded when he testified. “And it just speaks to the whole total disbelief in the legitimacy of the symptomatology and the disease.”

The Lodge lawyers tried to chip away at Ray’s description of depression, arguing that he had shown moments of pleasure at the Lodge, such as when he had played piano.

“The sheer mechanical banging of ragtime rhythms on that dilapidated old piano on the ward was almost an act of agitation rather than a creative pleasurable act,” Ray responded. “Just because I played ping-pong, or had a piece of pizza, or smiled, or may have made a joke, or made googly eyes at a good-looking girl, it did not mean that I was capable of truly sustaining pleasurable feelings.” He went on, “I would say to myself: ‘I am living, but I am not alive.’”

Manuel Ross, Ray’s analyst from the Lodge, testified for more than eight hours. He had read a draft of Ray’s memoir and he rejected the possibility that Ray had been cured by antidepressants. He was not a recovered man, because he was still holding on to the past. (“That’s what I call melancholia as used in the 1917 article,” he said, referring to Freud’s essay Mourning and Melancholia.)

Ross said that he had hoped Ray would develop insight at the Lodge. “That’s the true support,” he said, “if one understands what is going on in one’s life.” He wanted Ray to let go of his need to be a star doctor, the richest and most powerful in his field, and to accept a life in which he was one of the “ordinary mortals who labour in the medical vineyard”.

Ray’s lawyer, Philip Hirschkop, one of the most prominent civil rights attorneys in the country, asked Ross: “As an analyst, do you have to sometimes look inside yourself to make sure you’re not reacting to your own feelings about someone?”

“Oh yes,” Ross said. “Oh yes.”

“You who’ve locked yourself into one position for 19 years with no advancement in position other than salary, might you be a little resentful of this man who makes so much more money, and now he’s here as your patient?” Hirschkop asked.

The article is here.

Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations

Ogbu-Nwobodo, L., Shim, R.S., et al.

October 27, 2022

N Engl J Med 2022; 387:1613-1617

DOI: 10.1056/NEJMms2211124

Here is an excerpt:

Abortion and Mental Health

To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.

There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.

In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.

The Role of Structural Racism

Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.

The information is here.

Longest Strike Ends: California Mental Health Care Workers Win Big

Cal Wilslow

Counterpunch.org

Originally posted 24 OCT 22

Two thousand mental health clinicians have won; Kaiser Permanente has lost. The 10- week strike has ended in near total victory for the National Union of Healthcare Workers (NUHW). The therapists, walked out on August 15; it became the longest mental health care workers’ strike recorded.

Two issues dominated negotiations from the start: workload for Kaiser therapists and wait time for Kaiser patients. The strikers won on both, forcing concessions until now all but unheard of. The strikers won break through provisions to retain staff, reduce wait times for patients and a plan to collaborate on transforming Kaiser’s model for providing mental health care. The new four-year contract is retroactive to September 2021 and expires in September 2025. Darrell Steinberg, Mayor of Sacramento served as a mediator. Members of the NUHW voted 1561 to 36 to ratify it.

Braving three- digit heat, strikers walked picket lines throughout Northern California and the Central Valley. They picketed, marched and rallied at Kaiser hospitals – in a strike that caught the attention of mental health care advocates everywhere. “Our strike was difficult and draining, but it was worth it,” said Natalie Rogers, a therapist for Kaiser in Santa Rosa. We stood up to the biggest nonprofit in the nation, and we made gains that will help better serve our patients and will advance the cause of mental health parity throughout the country.”

The mental health clinicians I’ve met are almost universally modest and careful in their choice of words, and here is an example. To say that that Kaiser is “the biggest non-profit” is an understatement to say the least – its revenues are in the billions, and its managers make millions while this giant among giants, typically in the world of corporate health care, oversees its empire as if it were making cars and trucks.

I’ve seen NUHW rallies well-attended by patients themselves, also family members and supporters who are angry, bitter. Where frequently they carry signs to the effect that the issues here are life and death, rallies where speakers break down in tears, where placards tell us that suicide can be the outcome of care denied – “Stop the Suicides!” It’s a wonder more therapists don’t move on. The world of pain of the mental health patient can be just as acute as that of the medical patient. Ask a therapist. It’s not that the clinicians don’t want to tell us this.; it’s that, in their own way, they are telling us. It’s why they fight so hard.

The info is here.

9th Circuit Upholds Ban on Conversion Therapy for Minors in First Amendment Challenge

Debra Cassens Weiss

ABA Journal

Originally published 7 SEPT 22

Washington state’s ban on conversion therapy for minors does not violate the First or 14th Amendments, a federal appeals court ruled on Tuesday.

The San Francisco-based 9th U.S. Circuit Court of Appeals upheld the law, which subjects licensed therapists to discipline if they practice therapy that seeks to change the sexual orientation or gender identity of a person under age 18.

The appeals court said the law was intended to prevent psychological harm to LGBTQ minors subjected to conversion therapy, including depression, self-stigma and emotional distress.

The appeals court ruled against Christian marriage and family counselor Brian Tingley, who claimed the ban on conversion therapy for minors violated his free speech and free exercise rights under the First Amendment. He also claimed the Washington state law was unconstitutionally vague under the 14th Amendment.

The appeals court noted its 2014 decision, Pickup v. Brown, upheld a nearly identical law in California. Tingley had argued, however, that the U.S. Supreme Court abrogated the Pickup decision in 2018 when it ruled for anti-abortion crisis pregnancy centers challenging California’s required notice on the availability of state-subsidized abortions.

The Supreme Court held the abortion-notice law was a content-based restriction that was likely unconstitutional. The case was National Institute of Family & Life Advocates v. Becerra.

The info is here.

Defining Their Own Ethics, Online Creators Are De Facto Therapists for Millions—Explosive Demand & Few Safeguards

Tantum Hunter

The Washington Post

Originally posted 29 AUG 22

Here are two excerpts:

In real life, mental health information and care are sparse. In the United States, 1 in 3 counties do not have a single licensed psychologist, according to the American Psychological Association, and Americans say cost is a top barrier to seeking mental health help. On the internet, however, mental health tips are everywhere: TikTok videos with #mentalhealth in the caption have earned more than 43.9 billion views, according to the analytics company Sprout Social, and mentions of mental health on social media are increasing year by year.

The growing popularity of the subject means that creators of mental health content are filling a health-care gap. But social media apps are not designed to prioritize accurate, helpful information, critics say, just whatever content draws the biggest reaction. Young people could see their deepest struggles become fodder for advertisers and self-promoters. With no road map even for licensed professionals, mental health creators are defining their own ethics.

“I don’t want to give anyone the wrong advice,” Moloney says. “I’ve met some [followers] who’ve just started crying and saying ‘thank you’ and stuff like that. Even though it seems small, to someone else, it can have a really big impact.”

As rates of depression and anxiety spiked during the pandemic and options for accessible care dwindled, creators shared an array of content including first-person accounts of life with mental illness and videos listing symptoms of bipolar disorder. In many cases, their follower counts ballooned.

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Ideally, social media apps should be one item in a collection of mental health resources, said Jodi Miller, a researcher at Johns Hopkins University School of Education who studies the relationships among young people, technology and stress.

“Young people need evidence-based sources of information outside the internet, from parents and schools,” Miller said.

Often, those resources are unavailable. So it’s up to consumers to decide what mental health advice they put stock in, Fisher-Quann said. For her, condescending health-care providers and the warped incentives of social media platforms haven’t made that easy. But she thinks she can get better — and that her followers can, too.

“It all has to come from a place of self-awareness and desire to get better. Communities can be extremely helpful for that, but they can also be extremely harmful for that,” she said.

The article is here.

Advance directives for mental illness raise deep ethical questions

Tania Gergel

psyche.co

Originally posted 3 AUG 2022

Here is an excerpt:

What about the potential drawbacks? 

Medical ethicists worry that self-binding directives might allow involuntary treatment to be imposed on someone at an early stage of illness, while they are still capable of making an informed decision about treatment. How can we be sure that someone lacks what is known, in medical law, as ‘decision-making capacity’ and that we should be turning to the instructions in a document rather than what they are saying right now? Human rights advocates, such as the United Nations Committee on the Rights of Persons with Disabilities, go so far as to state that all involuntary treatment is a violation of an individual’s fundamental human rights.

The debate over self-binding directives has been working through these issues since the 1980s. However, one voice that was largely missing was the voice of ‘lived experience’. The arguments have gone backwards and forwards without asking the opinions of those who have the most intimate knowledge of what it is like to be unwell, and the likely consequences of illness; the very people who have found themselves hospitalised for mental illness and who may well have received involuntary treatment.

As part of ongoing research into mental health advance directives, our team at King’s College London conducted an internet survey in partnership with the charity Bipolar UK. We asked people who have lived with bipolar lots of questions about their views and any experiences of any forms of advance decision-making in relation to their condition. One of the questions we asked participants was whether they thought self-binding directives were a good idea and why they thought this. We found that 82 per cent of participants endorsed the self-binding directive idea, with the vast majority explaining this endorsement in terms of experiencing a determinate shift to distorted thinking and decision-making when they are unwell.

While ethicists might feel that the risk that someone retains decision-making capacity is a barrier to self-binding directives, many participants were adamant that their decision-making is impaired when they are unwell, and often mentioned ‘capacity’ in their responses, even though it was not alluded to within the questions themselves. A good example was this response:

You are unwell and lack capacity. I [recognise this now] looking back at when I was last sectioned, but my views were very different at the time due to my illness. It is my well views and opinions that should be acted upon.

Some people described this transition in terms of a shift of ‘self’, suggesting that illness makes them an entirely different person from their well self. As a philosopher working on medical ethics and law, I am particularly interested in questions about personal identity and illness, so it was fascinating to see answers such as this:

When psychotic or manic or depressed you can become another person and irrational. It is easy to make bad decisions when ill that may not be in my best interest.

When participants referred to the practical consequences and risks of illness, they were often related to suicide. People talked about how their ill self impelled them towards death in a way that was utterly inconsistent with their wishes when well.

The info is here.

Unemployment, Behavioral Health, And Suicide

R. Ramchand, L. Ayer, & S. O'Connor

Health Affairs

Originally posted 7 APR 22

Key Points:

• A large body of research, most of which is ecological, has investigated the relationship between job loss or unemployment rates and mental health, substance use, and suicide.

• Groups historically experiencing health disparities (for example, Black and Hispanic populations and those without a high school or college degree) have been differently affected by unemployment during the COVID-19 pandemic. Similarly, preliminary evidence from three states suggests that suicide has disproportionately affected Americans who are members of racial and ethnic minority groups over the course of the pandemic.

• COVID-19 has affected the workforce in unique ways that differentiate the pandemic from previous economic downturns. However, previous research indicates that increases in suicide rates associated with economic downturns were driven by regional variation in unemployment, availability of unemployment benefits, and duration and magnitude of changes in unemployment.

• Policy mitigation strategies may have offset the potential impact of unemployment fluctuations on suicide rates during the pandemic. Policies include expanded unemployment benefits and food assistance, as well as tax credits and subsidies that reduced child care and health care costs.

• Research is needed to disentangle which populations experienced the most benefit when these strategies were present and which had the greatest risk when they were discontinued.

• Evidence-based strategies that expand the mental health workforce and integrate mental health supports into employment and training settings may be promising ways to help workers as they navigate persistent changes to workforce demands.

Suicide In The United States

A recent Health Affairs Health Policy Brief provides an overview of suicide in the United States. In 2019, 47,511 Americans intentionally ended their lives, making suicide the tenth leading cause of death. This is likely an underestimate—in 2019, 75,795 Americans died of poisonings, the majority of which were drug poisonings categorized as unintentional, although some were likely suicide overdoses that were misclassified.

Suicide is a growing national concern despite the fact that the national suicide rate decreased between 2018 and 2019 and again in 2020. This decrease comes after nearly twenty years of the national suicide rate increasing annually, and it was not observed in some minority racial and ethnic groups. In addition, although suicide rates decreased between 2018 and 2020, the drug overdose death rate increased.

The info is here.

Suicides of Psychologists and Other Health Professionals: National Violent Death Reporting System Data, 2003–2018

Li, T., Petrik, M. L., Freese, R. L., & Robiner, W. N.

(2022). American Psychologist. 

Advance online publication.

Abstract

Suicide is a prevalent problem among health professionals, with suicide rates often described as exceeding that of the general population. The literature addressing suicide of psychologists is limited, including its epidemiological estimates. This study explored suicide rates in psychologists by examining the National Violent Death Reporting System (NVDRS), the Centers for Disease Control and Prevention’s data set of U.S. violent deaths. Data were examined from participating states from 2003 to 2018. Trends in suicide deaths longitudinally were examined. Suicide decedents were characterized by examining demographics, region of residence, method of suicide, mental health, suicidal ideation, and suicidal behavior histories. Psychologists’ suicide rates are compared to those of other health professionals. Since its inception, the NVDRS identified 159 cases of psychologist suicide. Males comprised 64% of decedents. Average age was 56.3 years. Factors, circumstances, and trends related to psychologist suicides are presented. In 2018, psychologist suicide deaths were estimated to account for 4.9% of suicides among 10 selected health professions. As the NVDRS expands to include data from all 50 states, it will become increasingly valuable in delineating the epidemiology of suicide for psychologists and other health professionals and designing prevention strategies. 

From the Discussion

Between 2003 and 2018, 159 cases of psychologist death by suicide were identified in the NVDRS, providing a basis for examining the phenomenon rather than clarifying its true incidence. Suicide deaths spanned all U.S. regions, with the South accounting for the most (35.8%) cases, followed by the West (24.5%), Midwest (20.1%), and Northeast (19.5%). It is unclear whether this is due to the South and West actually having higher suicide rates among psychologists or if these regions have greater representation due to inclusion of more reporting states. It should also be noted that these regions make up different proportions of the population for the entire United States. According to the U.S. Census Bureau (n.d.), the proportion of each region’s population as compared to the entire U.S. population for the year 2019 was South (38.3%), West (23.9%), Midwest (20.8%), and Northeast (17.1%). This could have affected the number of cases seen within each region, as could other factors, such as the trend for gun ownership to be more than twice as common in the South than in the Northeast (Pew Research Center, 2017). The 2003–2018 psychologist suicide deaths were more than 13 times higher than NVDRS-identified psychologist homicide deaths (n = 12) for that same period (Robiner & Li, 2022).

The number of psychologist suicides identified in the NVDRS generally increased longitudinally. It is not clear whether this might signal an actual increasing incidence, and if so what factors may be contributing, or how much it is an artifact of the increasing number of NVDRS-reporting states. Starting in 2020, the data will more clearly reveal temporal patterns, with variation reflecting changes in suicide incidence rather than how many states reported. In the future, we anticipate longitudinal trends will not be confounded by variation in the number of reporting states.

Most psychologist suicide decedents were White (92.5%). Smaller percentages were Black, Indigenous, and People of Color (BIPOC): Black (2.5%), Asian or Pacific Islander (1.9%), and two or more races (3.1%). These proportions align largely with the racial/ethnic makeup of the psychologist workforce in APA’s Survey of Psychology Health Service Providers for White (87.8%), Black (2.6%), Asian (2.5%), and multiracial/multiethnic psychologists (1.7%; Hamp et al., 2016). The data are generally consistent with earlier findings of psychologist suicide (Phillips, 1999) that most psychologist suicide decedents are White and reveal slightly greater diversification within the field. CDC data from 2019 reveals rates in the general population of suicide per 100,000 are greatest in Whites (29.8 male, 8 female), followed by Blacks (12.4 male, 2.9 female), Asians (11.2 male, 4.0 female), and Hispanics (11.3 male, 3.0 female; NIMH, 2021). There were no cases of Hispanic psychologist suicide in this sample, which is generally consistent with the relatively lower numbers of suicides reported for Hispanics by the CDC. The relatively small numbers of suicides within subgroups limit the certainty of inferences that can be drawn about the association of ethnicity, and potentially other demographics, and suicide incidence. As the demographic composition of the field diversifies, the durability of the present findings for subgroups remains to be seen.

The research is here.

Bias in mental health diagnosis gets in the way of treatment

Howard N. Garb

psyche.co

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.

The info is here.

Implementing The 988 Hotline: A Critical Window To Decriminalize Mental Health

P. Krass, E. Dalton, M. Candon, S. Doupnik

Health Affairs

Originally posted 25 FEB 22

Here is an excerpt:

Decriminalization Of Mental Health

The 988 hotline holds incredible promise toward decriminalizing the response to mental health emergencies. Currently, if an individual is experiencing a mental health crisis, they, their caregivers, and bystanders have few options beyond calling 911. As a result, roughly one in 10 individuals with mental health disorders have interacted with law enforcement prior to receiving psychiatric care, and 10 percent of police calls are for mental health emergencies. When police arrive, if they determine an acute safety risk, they transport the individual in crisis for further psychiatric assessment, most commonly at a medical emergency department. This almost always takes place in a police vehicle, many times in handcuffs, a scenario that contradicts central tenets of trauma-informed mental health care. In the worst-case scenario, confrontation with police results in injury or death. Adverse outcomes during response to mental health emergencies are more than 10-fold more likely for individuals with mental health conditions than for individuals without, and are disproportionately experienced by people of color. This consequence was tragically highlighted by the death of Walter Wallace, Jr., who was killed by police while experiencing a mental health emergency in October 2021.

Ideally, the new 988 number would activate an entirely different cascade of events. An individual in crisis, their family member, or even a bystander will be able to immediately reach a trained crisis counselor who can provide phone-based triage, support, and local resources. If needed, the counselor can activate a mobile mental health crisis team that will arrive on site to de-escalate; provide brief therapeutic interventions; either refer for close outpatient follow up or transport the individual for further psychiatric evaluation; and even offer food, drink, and hygiene supplies.

 

Rather than forcing families to call 911 for any type of help—regardless of criminal activity—the 988 line will allow individuals to access mental health crisis support without involving law enforcement. This approach can empower families to self-advocate for the right level of mental health care—including avoiding unnecessary medical emergency department visits, which are not typically designed to handle mental health crises and can further traumatize individuals and their families—and to initiate psychiatric assessment and treatment sooner. 911 dispatchers will also be able to re-route calls to 988 when appropriate, allowing law enforcement personnel to spend more time on their primary role of ensuring public safety. Finally, the 988 number will help offer a middle option for individuals who need rapid linkage to care, including rapid psychiatric evaluation and initiation of treatment, but do not yet meet criteria for crisis. This is a crucial service given current difficulties in accessing timely, in-network outpatient mental health care.

The info is here.

High rates of burnout among college mental health counselors is compromising quality of care, survey says

Brooke Migdon

thehill.com

Originally posted 17 FEB 22

College counselors and clinicians are reporting increasingly high levels of burnout and stress as the pandemic enters its third year. Experts say it’s going to get worse before it gets better.

Just under 93 percent of clinicians on college campuses reported feeling burned out and stressed during the fall semester this year, according to a survey by Mantra Health, a digital mental health clinic geared at young adults. More than 65 percent of respondents reported a heavier workload and longer hours worked compared to the fall semester in 2020. 

Another 60 percent said their workload had compromised the quality of care they were able to provide to students in the fall.

Caseloads aren’t expected to fall anytime soon, as overworked clinicians are leaving the field at a rate similar to that of students asking for help, according to David Walden, the director of Hamilton College’s counseling center. Qualified candidates are also hard to come by.

“Over the last year college counseling centers have seen an uptick in professionals leaving the field and a smaller pool of applicants to refill their positions while the demand from students seeking treatment continues to rise,” he said Thursday in a statement.

Walden noted that, importantly, clinicians are also contending with their own pandemic anxieties that impact their ability to care for themselves, let alone others.

It is “increasingly difficult for directors and clinicians to avoid burnout while institutions of higher education are having increasing trouble hiring and retaining quality mental health staff,” he said.

With college-aged students reporting alarming rates of depression, anxiety and substance abuse, providing quality on- and off-campus care is critical.

The info is here.

Parents protesting 'critical race theory' identify another target: Mental health programs

Tyler Kingkade and Mike Hixenbaugh

NBC News

Originally posted 15 NOV 21

At a September school board meeting in Southlake, Texas, a parent named Tara Eddins strode to the lectern during the public comment period and demanded to know why the Carroll Independent School District was paying counselors “at $90K a pop” to give students lessons on suicide prevention.

“At Carroll ISD, you are actually advertising suicide,” Eddins said, arguing that many parents in the affluent suburban school system have hired tutors because the district’s counselors are too focused on mental health instead of helping students prepare for college.

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In Carmel, Indiana, activists swarmed school board meetings this fall to demand that a district fire its mental health coordinator from what they said was a “dangerous, worthless” job. And in Fairfax County, Virginia, a national activist group condemned school officials for sending a survey to students that included questions like “During the past week, how often did you feel sad?”

Many of the school programs under attack fall under the umbrella of social emotional learning, or SEL, a teaching philosophy popularized in recent years that aims to help children manage their feelings and show empathy for others. Conservative groups argue that social emotional learning has become a “Trojan horse” for critical race theory, a separate academic concept that examines how systemic racism is embedded in society. They point to SEL lessons that encourage children to celebrate diversity, sometimes introducing students to conversations about race, gender and sexuality.

Activists have accused school districts of using the programs to ask children invasive questions — about their feelings, sexuality and the way race shapes their lives — as part of a ploy to “brainwash” them with liberal values and to trample parents’ rights. Groups across the country recently started circulating forms to get parents to opt their children out of surveys designed to measure whether students are struggling with their emotions or being bullied, describing the efforts as “data mining” and an invasion of privacy.

The information is here.

A brain implant that zaps away negative thoughts

Nicole Karlis

Salon.com

Originally published 14 OCT 21

Here is an excerpt:

Still, the prospect of clinicians manipulating and redirecting one's thoughts, using electricity, raises potential ethical conundrums for researchers — and philosophical conundrums for patients. 

"A person implanted with a closed-loop system to target their depressive episodes could find themselves unable to experience some depressive phenomenology when it is perfectly normal to experience this outcome, such as a funeral," said Frederic Gilbert Ph.D. Senior Lecturer in Ethics at the University of Tasmania, in an email to Salon. "A system program to administer a therapeutic response when detecting a specific biomarker will not capture faithfully the appropriateness of some context; automated invasive systems implanted in the brain might constantly step up in your decision-making . . . as a result, it might compromise you as a freely thinking agent."

Gilbert added there is the potential for misuse — and that raises novel moral questions. 

"There are potential degrees of misuse of some of the neuro-data pumping out of the brain (some believe these neuro-data may be our hidden and secretive thoughts)," Gilbert said. "The possibility of biomarking neuronal activities with AI introduces the plausibility to identify a large range of future applications (e.g. predicting aggressive outburst, addictive impulse, etc). It raises questions about the moral, legal and medical obligations to prevent foreseeable and harmful behaviour."

For these reasons, Gilbert added, it's important "at all costs" to "keep human control in the loop," in both activation and control of one's own neuro-data. 

The info is here.

The AMA needs to declare a national mental health emergency

Susan Hata and Thalia Krakower

STAT News

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.

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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.

The info is here.

Social Media and Mental Health

Luca Braghieri, Ro’ee Levy, and Alexey Makarin

Independent Research

August 21

Abstract 

The diffusion of social media coincided with a worsening of mental health conditions among adolescents and young adults in the United States, giving rise to speculation that social media might be detrimental to mental health. In this paper, we provide the first quasi-experimental estimates of the impact of social media on mental health by leveraging a unique natural experiment: the staggered introduction of Facebook across U.S. colleges. Our analysis couples data on student mental health around the years of Facebook’s expansion with a generalized difference-in-differences empirical strategy. We find that the roll-out of Facebook at a college increased symptoms of poor mental health, especially depression, and led to increased utilization of mental healthcare services. We also find that, according to the students’ reports, the decline in mental health translated into worse academic performance. Additional evidence on mechanisms suggests the results are due to Facebook fostering unfavorable social comparisons. 

Discussion 

Implications for social media today 

Our estimates of the effects of social media on mental health rely on quasi-experimental variation in Facebook access among college students around the years 2004 to 2006. Such population and time window are directly relevant to the discussion about the severe worsening of mental health conditions among adolescents and young adults over the last two decades. In this section, we elaborate on the extent to which our findings have the potential to inform our understanding of the effects of social media on mental health today. 

Over the last two decades, Facebook underwent a host of important changes. Such changes include: i) the introduction of a personalized feed where posts are ranked by an algorithm; ii) the growth of Facebook’s user base from U.S. college students to almost three billion active users around the globe (Facebook, 2021); iii) video often replacing images and text; iv) increased usage of Facebook on mobile phones instead of computers; and v) the introduction of Facebook pages for brands, businesses, and organizations. 

The nature of the variation we are exploiting in this paper does not allow us to identify the impact of these features of social media. For example, the introduction of pages, along with other changes, made news consumption on Facebook more common over the last decade than it was at inception. Our estimates cannot shed light on whether the increased reliance on Facebook for news consumption has exacerbated or mitigated the effects of Facebook on mental health. 

Despite these caveats, we believe the estimates presented in this paper are still highly relevant today for two main reasons: first, the mechanisms whereby social media use might affect mental health arguably relate to core features of social media platforms that have been present since inception and that remain integral parts of those platforms today; second, the technological changes undergone by Facebook and related platforms might have amplified rather than mitigated the effect of those mechanisms. 

The research is here.

Understanding Suicide Risk Among Children and Preteens: A Synthesis Workshop

National Institute of Mental Health

June 15, 2021

NIMH convened a four-part virtual research roundtable series, “Risk, Resilience, & Trajectories in Preteen Suicide.” The roundtables took place between January and April 2021, and culminated in a synthesis meeting in June, 2021. The series brought together a diverse group of expert panelists to assess the state of the science and short- and longer-term research priorities related to preteen suicide risk and risk trajectories. Panelists’ expertise was wide ranging and included youth suicide risk assessment and preventive interventions, developmental psychopathology, child and adolescent mood and anxiety disorders, family and peer relationships, how social and cultural contexts influence youth’s trajectories, biostatistical and computational methods, multilevel modeling, and longitudinal data analysis.