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

By Mary Elizabeth Dallas
MedicineNet.com

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

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

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

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

The story can be found here.

The study is from Child & Adolescent Psychiatry, Volume 51, Issue 2, pages 213-222.  Here is the conclusion of the study from the abstract.

"A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care."

Diagnosis of a DSM 5 News Cycle

By John Grohol

World of Psychology

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

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

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

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

Grohol's critique is here.

New Mental Health Manual is "dangerous" say Experts

By Kate Kelland

Health and Science Correspondence

Reuters

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

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

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

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

The DSM is published by the American Psychiatric Association (APA) and has symptoms and other criteria for diagnosing mental disorders. It is used internationally and seen as the diagnostic "bible" for mental health medicine.

No one from the APA was immediately available for comment.

More than 11,000 health professionals have already signed a petition (at dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.

Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medical zing behaviors most people would consider normal or just mildly eccentric, the experts said.

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

The entire story is here.

Critics attack DSM-5 for overmedicalising normal human behaviour

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

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

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

<snip>

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

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

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

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

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

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

 He gave as an example the diagnosis of gambling disorder.

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

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

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

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

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

8 Breach Prevention Tips: Action Items Based on Lessons Learned

By Howard Anderson

Govinfosecurity.com

Originally published February 8, 2012

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

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

1. Don't Forget Risk Assessments

The details of the biggest breaches last year "make it painfully clear that inadequate, if any, HIPAA security risk analysis took place prior to the breaches," says Dan Berger, CEO at Redspin.

2. Encrypt Mobile Devices, Media

"Even though encryption is what's referred to as an addressable standard in the HIPAA security rule - which means it's not actually mandated in all cases - I don't see any reason why information shouldn't be encrypted in all cases on portable media and devices," says Robert Belfort, partner at the law firm Manatt, Phelps & Phillips LLP. "That's one step that organizations can take that can address a very significant share of the types of breaches that are occurring."

3. Beef Up Training

"People have to be trained to understand the policies of the organization, and they have to be trained about common-sense safeguards that they can follow to avoid breaches or the misuse of information," Szabo stresses.

4. Conduct Internal Audits

In addition to training, an important step toward addressing internal breach threats is to conduct audits of records access, Belfort says.

5. Monitor Business Associates

About 22 percent of major breaches, including many of the largest incidents, have involved business associates. As a result, it's essential to work with vendor partners to ensure they're taking adequate breach prevention steps.

The rest of details are here.

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

Preventing a Data Breach and Protecting Health Records

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

Patient Communication Study Shows Doctors Regularly Withhold Truth

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

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

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

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

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

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

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

The entire story is here.

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

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

The New Synthesis in Moral Psychology

The New Synthesis in Moral Psychology

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

By Elizabeth Chuck, msnbc.com

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

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

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

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

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

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

'Cruel and unusual'

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

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

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

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

The rest of the story is here.