As records go online, clash over mental care privacy

By Liz Kowalczyk
The Boston Globe - Health and Wellness
Originally published June 21, 2012

At her weekly therapy sessions, Julie revealed her most uncomfortable secrets: depression, debt, childhood sexual abuse. Her psychiatrist at Massachusetts General Hospital would then type a summary into Julie’s computerized medical record.

With that, more than 200 pages of sensitive notes became available to any doctor who cared for her within the sprawling Partners HealthCare system. She discovered this only when one doctor later referenced the notes.

Julie, a 43-year-old lawyer, was unnerved, then angry. “The details are really nobody’s business,” she said.

But Partners disagrees. Doctors must have a complete picture to make accurate diagnoses, the organization argues. And having different rules for psychiatric records contributes to the stigma of mental illness.

The entire story is here.

Rates of Nonsuicidal Self-Injury in Youth: Age, Sex, and Behavioral Methods in a Community Sample

AUTHORS:

Andrea L. Barrocas, MA, Benjamin L. Hankin, PhD, Jami F. Young, PhD, and John R. Z. Abela, PhD

OBJECTIVE:

The goal was to assess the rate and behavioral methods of nonsuicidal self-injury (NSSI) in a community sample of youth and examine effects of age and sex.

METHODS:  

Youth in the third, sixth, and ninth grades (ages 7–16) at schools in the community were invited to participate in a laboratory study. A total of 665 youth (of 1108 contacted; 60% participation rate) were interviewed about NSSI over their lifetime via the Self-Injurious Thoughts and Behaviors Interview.

RESULTS: 

Overall, 53 (8.0%) of the 665 youth reported engaging in NSSI; 9.0% of girls and 6.7% of boys reported NSSI engagement; 7.6% of third graders, 4.0% of sixth-graders, and 12.7% of ninth-graders reported NSSI engagement. There was a significant grade by gender interaction; girls in the ninth grade (19%) reported significantly greater rates of NSSI than ninth-grade boys (5%). Behavioral methods of NSSI differed by gender. Girls reported cutting and carving skin most often, whereas boys reported hitting themselves most often. Finally, 1.5% of youth met some criteria for the proposed fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis of NSSI.

CONCLUSIONS:  

Children and adolescents engage in NSSI. Ninth-grade girls seem most at risk, as they engage in NSSI at 3 times the rate of boys. Behavioral methods of NSSI also vary by grade and gender. As possible inclusion of an NSSI diagnosis in the fifth edition of the DSM-5 draws near, it is essential to better understand NSSI engagement across development and gender. 

Pediatrics 2012;130:39–45 

The entire article is here.

Editors With Ethics

By Scott Jaschik
Inside Higher Ed
Originally published June 12, 2012

Many of the public debates over ethics in scholarly journals focus on such questions as conflict of interest by biomedical researchers. And various federal regulations (and journal codes of conduct) attempt to prevent conflicts.

Now some journal editors -- primarily in the social sciences but extending to other fields -- are trying to use a new code of conduct to address ethical issues that arise in fields beyond the biological sciences (though there, too), but that also have the potential to tarnish the image of the research enterprise. In the past few months, 88 journal editors have signed on to the principles outlined by 5 other journal editors, and 71 associate editors have signed on.

The entire article is here.

Putting dignity to work

By Charles Foster
The Lancet
Originally published June 2, 2012

A profoundly brain-damaged teenage girl is brought to hospital. The nurses undress her and leave her, uncovered, on a trolley in front of some lascivious youths who are waiting in the Accident and Emergency Department. She seems to enjoy receiving their attention; they enjoy giving it. Is this wrong? Yes it is. But what language describes the wrongness? Certainly the four principles laid out by Tom Beauchamp and James Childress in their classic Principles of Biomedical Ethics (autonomy, beneficence, non-maleficence, and justice) can't really help, or can't help without straining uncomfortably. Autonomy isn't offended. Insofar as the girl is capable of exercising autonomous thought, she's all for it, and so are the boys. And there's no real harm here, as harm would conventionally be described. One might say that the maxim “Do good” has been violated, but what does “good” mean?

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In answering that question, and in saying what is meant by “good”, it is hard to avoid using words like dignity. And that, for many, is rather embarrassing. Dignity has a bad reputation among some philosophers. It tends to be thought of as feel-good philosophical window-dressing—the name you give to whatever principle gives you the answer you think is right; as a substitute for hard thinking; as impossibly amorphous or (because of its historical association with the notion of the Imago Dei), as incurably theological. Dignity-peddlers, it tends to be thought, are selling metaphysical snake oil.

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Beauchamp and Childress sometimes falter because their principles are second-order principles, derived ultimately from dignity. Sometimes, to get the right ethical answer, you've got to go to the source. Burrow down deep enough into any bioethical conundrum, and you'll eventually hit dignity.

The entire article is here.

Psychologist D. Laurence More surrenders license on charges of sex with two patients

Psychiatric Crimes Database
Originally published on June 11, 2012

On November 16, 2011, D. Laurence More, M.Ed. permanently surrendered his psychologist’s license to the Pennsylvania State Board of Psychology.

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More admitted that, approximately one month following termination, he commenced a personal relationship with the wife and further admitted that approximately two to three months later, he commenced a sexual relationship with her.

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More engaged in a sexual relationship with a different patient without first waiting two years after terminating professional services, as required by Board regulations.

The entire story is here.

Secrets And Electronic Health Records: A Privacy Concern

By David Schultz
The KNH Blog
Originally published on June 11, 2012

Does your orthodontist or opthamologist need to know what you tell your psychotherapist in order to provide you with quality care? In the age of electronic medical records, a whole range of health care providers may have access to this information whether you want them to or not.

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Here’s what many say is the problem: If a mental health specialist types up his or her notes from a therapy session and puts them into a patient’s electronic medical record, that file can be shared with any doctor the patient sees within their health system. And, because of a loophole in the Health Insurance Portability and Accountability Act, or HIPAA, there’s nothing a patient can do to stop this from happening.

Many mental health professionals, who consider their patients’ privacy and confidentiality to be sacrosanct, find this appalling. But often times, the decision of how they file their patients’ records is not up to them.

The entire blog post is here.

UConn Researchers Voice Concern Over Proposed Addiction Guideline Changes

By Lisa Catanese
UCONN Today
Originally published June 2, 2012

Two prominent University of Connecticut Health Center researchers are adding their voices to a chorus of other national experts who are questioning proposed changes regarding substance abuse guidelines in a manual used internationally in the diagnosis and treatment of mental illnesses.

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Babor’s reservations about the proposed changes concern the broadening of language defining addiction and the lowering of the threshold of what counts as a substance use disorder. The revisions would expand the number of symptoms of addiction, reduce the number required for a diagnosis, and introduce a “behavioral addiction” category – all of which could lead to millions more people being categorized as addicts when they in fact are simply unhealthy users. This could put a strain on already-limited resources in schools, prisons, and hospitals, he says.

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Kaminer is concerned about the impact of the proposed DSM changes from two perspectives – classifying too many people as having a problem while deterring adolescents from seeking treatment. “There are not enough resources right now,” he says. “This country is collapsing under the burden of health care. Is it necessary to expand diagnosis to include mild cases and yet push away prospective clients by calling them addicts?”

The entire story is here.

The D.S.M. Gets Addiction Right

By Howard Markel
The New York Times - Opinion
Orignally published June 5, 2012

WHEN we say that someone is “addicted” to a behavior like gambling or eating or playing video games, what does that mean? Are such compulsions really akin to dependencies like drug and alcohol addiction — or is that just loose talk?

This question arose recently after the committee writing the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.), the standard reference work for psychiatric illnesses, announced updated definitions of substance abuse and addiction, including a new category of “behavioral addictions.” At the moment, the only disorder featured in this new category is pathological gambling, but the suggestion is that other behavioral disorders will be added in due course. Internet addiction, for instance, was initially considered for inclusion but was relegated to an appendix (as was sex addiction) pending further research.

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Disease definitions change over time because of new scientific evidence. This is what has happened with addiction. We should embrace the new D.S.M. criteria and attack all the substances and behaviors that inspire addiction with effective therapies and support.

The entire opinion is here.

Same-sex couples raising children on the rise

By Elaine Quijano
CBS Evening News
Originally published June 16, 2012

On this Father's Day Eve, we take notice of a sea change. The Census Bureau estimates that the percentage of same-sex couples raising children has more than doubled in just 10 years, from 8 percent in 2000, to 19 percent in 2010. We visit one of the couples behind the numbers.

As a same-sex couple, Sean McGill and Luigi Caiola say they never contemplated fatherhood.

"We never imagined or never thought that children would be an option for us," said McGill.

But after almost 10 years together, they were drawn to the idea of parenting.

The entire story is here.