Outpatient Care of Young People After Emergency Treatment of Deliberate Self-Harm

By Dennis Thompson
MedicineNet.com
Originally published on May 25, 2012


Doctors have long known that some kids suffering severe emotional turmoil find relief in physical pain -- cutting or burning or sticking themselves with pins to achieve a form of release.

But researchers now are questioning whether enough is being done to reach out to these young people and help them before they do themselves irreparable damage.

One study this year found that six of every 10 adolescents who went to an emergency room for treatment after harming themselves were released without receiving a mental health assessment or any follow-up mental health care. The findings were reported in the February issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

Here is a link to the summary of this article.

The original research is below.

by Jeffrey Bridge, Steven Marcus, and Mark Olfson

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 51, Issue 2 , Pages 213-222.e1, February 2012

Objective

Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm.

Method

A retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed.

Results

Most patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63–0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27–2.94) and inpatient (ARR 1.33, 99% CI 1.14–1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64–0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73–0.97).

Conclusions

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.

Psychiatric Patients Languish In Emergency Rooms

By Eric Whitney
Colorado Public Radio in conjunction with Kaiser Health News
Originally published May 31, 2012

Last fall Kathy Partridge got a phone call from a local emergency room, telling her that her daughter, Jessie Glasscock, was there -- and was OK. Glasscock had gone missing overnight.  She was away at college, and had a history of manic episodes. Police had found her in a dumpster and brought her to the ER for her own safety.  It was a huge relief for her mother – but she was completely surprised by what happened next.

"It sort of seemed like, well, they'll stabilize her, help her get back on her meds and she'll pick up her pieces. Instead, I went down to this emergency room and just found her by herself, basically locked in a closet," Partridge said. 

The "closet" was actually an exam room, but Partridge explains it was small, windowless, and the only furniture was a stainless steel bed.  Her daughter waited there, wearing nothing but a hospital gown, without treatment or a decent meal for 24 hours.  Partridge was shocked to learn there was no place for her daughter to get treatment.  "There was not a single psychiatric bed to release her in in the entire state of Colorado," she says.

The entire story is here.

From an Ethics of Rationing to an Ethics of Waste Avoidance

By Howard Brody, MD, PhD
The New England Journal of Medicine
Originally published on May 24, 2012

Dr. Howard Brody

Bioethics has long approached cost containment under the heading of “allocation of scarce resources.”  Having thus named the nail, bioethics has whacked away at it with the theoretical hammer of distributive justice. But in the United States, ethical debate is now shifting from rationing to the avoidance of waste. This little-noticed shift has important policy implications.

 Whereas the “R word” is a proverbial third rail in politics, ethicists rush in where politicians fear to tread. The ethics of rationing begins with two considerations.  First, rationing occurs simply because resources are finite and someone must decide who gets what. Second, rationing is therefore inevitable; if we avoid explicit rationing, we will resort to implicit and perhaps unfair rationing methods.

The main ethical objection to rationing is that physicians owe an absolute duty of fidelity to each individual patient, regardless of cost. This objection fails, however, because when resources are exhausted, the patients who are deprived of care are real people and not statistics. Physicians collectively owe loyalty to those patients too. The ethical argument about rationing then shifts to the question of the fairest means for allocating scarce resources — whether through the use of a quasi-objective measure such as quality-adjusted life-years or through a procedural approach such as increased democratic engagement of the community.

The entire story is here.

An interview with Dr. Brody is here.

Thanks to Gary Schoener for this lead.

Damaged Fairview ousts exec

Mark Eustis was linked to firm behind high-pressure debt collections

by Maura Lerner and Tony Kennedy
The Star Tribune
Star Tribue Staff Writers
Originally published May 24, 2012

Mark Eustis, CEO of Fairview Health

Mark Eustis couldn't have known it at the time, but his downfall as president of Fairview Health Services began last summer with the report of a stolen laptop. Within 10 months, the incident had grown into a public relations nightmare that Fairview couldn't shake.

On Thursday, Eustis, 59, abruptly announced plans to retire, one day after Fairview's board voted not to renew his contract. It was just four weeks after Attorney General Lori Swanson released a scathing report about debt collectors badgering patients for money inside Fairview hospitals.

Initially, the board had said Eustis' job was safe. But criticism has mounted over Fairview's association with Accretive Health, the for-profit company Swanson blamed for the collection practices.

Eustis found himself at the center of the turmoil because he was instrumental in hiring Accretive and has a son who works for the firm.

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Dr. Steve Miles, a University of Minnesota physician and bioethicist, said the most disturbing revelations weren't just about heavy-handed debt collectors, but internal e-mails in which Accretive employees talked about patients as "lowlifes" and "deadbeats."

The entire article is here.

Thanks to Gary Schoener for this lead.

Stalking Patients at Hospitals

By Michele Goodwin
The Chronicle of Higher Education - Blogs
Originally posted on May 23, 2012

Next week, Sen. Al Franken, a Minnesota Democrat, will chair a field hearing on the effectiveness of federal laws to protect patients’ access to care and privacy.  The hearing comes on the heels of Minnesota Attorney General Lori Swanson‘s accusing Accretive Health–one of the nation’s largest debt-collection agencies–of excessive and possibly illegal tactics, including strong-arming patients in Minnesota hospitals.  A voluminous six part report can be found here.  However, the issue extends beyond Minnesota as Accretive has contracts with hospital systems throughout the nation.

According to the attorney general’s report, the Illinois-based collection agency hid in hospital waiting rooms and even stalked patients in convalescing rooms to collect payments before and after treatments.  Those desperate tactics are particularly troubling because they occur when patients are seeking emergency medical care.  The cases highlighted by Swanson’s office detail clandestine debt collection schemes that not only misrepresent hospital staff, but may have a deterrent effect on individuals seeking treatment.

The entire story is here.

The rise of the pop psychologists

By Margaret McCartney
The British Journal of Medicine
Originally published May 21, 2012

Soundbites, opinion, and statements from experts are integral to many newspaper stories and magazine television programmes.

Psychological and psychiatric comment are often sought, be it for a morning television programme featuring the motivations of celebrities or whether Anders Breivik, the Norwegian on trial for mass murder, is sane.

Informed debate and information sharing necessitates that healthcare expertise should be used.

But what is appropriate for healthcare professionals to comment on, and who is best qualified to take the call?

So called celebrity psychology--used to explain or discuss behaviour--is burgeoning in the entertainment industry, and central to many reality TV shows.

Emma Kenny, who has a psychology degree and is a member of the British Association of Counselling and Psychotherapy, says on her website that she has been "resident psychologist" on many television shows.

On ITV's This Morning she appeared with Samantha Brick, who had written an article stating that she is disliked by many women because she is attractive.

In the discussion Kenny said, "If, as a person, everywhere I go, I am met with a certain reaction from people . . . I have to embrace the fact that actually it might be me that needs to change and not the society around me. The very fact that you are entertaining these relationships with people--you instantly have a paranoia."1

Kenny runs a service called Exclusive Ethics, which helps programme makers to work within the 2009 Ofcom broadcasting code (the code contains provisions designed to ensure the emotional welfare of television participants), and offers to compile psychological profiles of contestants.

The entire article is here.

Thanks to Ken Pope for this information.

Dr. Marjorie Cooper, Baylor University – Ethics and Religious Belief

By Bradley Cornelius
Northeast Public Radio - WAMC
Academic Minute

Dr. Cooper

In today’s Academic Minute, Dr. Marjorie Cooper of Baylor University explains research examining why religious belief doesn’t always translate into ethical behavior.

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Overall,  both Nominals and Devouts showed better ethical judgment than Skeptics.  However, the more narcissistic the subjects, the worse their ethical judgment became.  In fact, at higher levels of narcissism, the ethical judgment of Nominals and Devouts was no better than that of Skeptics.

The brief transcript and audio file is here.

The paper in the Journal of Business Ethics is here.

South Shore Hospital to pay $750,000 to settle data breach charges

By Hiawatha Bray
The Boston Globe
Originally published on May 25, 2012

It will cost South Shore Hospital in Weymouth $750,000 to settle charges related to a 2010 data breach that compromised the personal information of more than 800,000 people.

The settlement, approved Thursday in Suffolk Superior Court, included a civil penalty of $250,000 and $225,000 for a fund to be used by the office of Massachusetts Attorney General Martha Coakley to promote education on the protection of personal data. South Shore Hospital was also credited for $275,000 it spent on security measures following the breach.

The entire story is here.

Mental problems top illness for GIs

By Sig Christenson
San Antonio Express-News
Originally published May 19, 2012

More active-duty troops were hospitalized for mental illnesses last year than any other major malady, a new military report says.

The Armed Forces Health Surveillance Center said 21,735 troops from the services were admitted to hospitals because of mental problems, up dramatically from previous years.

Most were men, with mental disorders the leading cause of hospitalizations for soldiers and Marines — the services that have carried the greatest burden in Iraq and Afghanistan.

Hospitalization rates for all causes among active-duty troops were up during the past decade, with one in every 15 troops treated, but mental-illness admissions grew 50 percent over the past five years.

The entire story is here.