Psychiatric hospitalizations increasing After nearly five decades of a steady drop in the numbers of people admitted to state psychiatric hospitals, a reversal might be underway say the authors of a study appearing in Psychiatric Services. Between 2002 and 2005, and based on patterns in 11 states, admissions increased 21 percent and the number of residents increased by 1 percent. The authors question the implications of this reversal for community-based mental health care. Medicare parity An article appearing in Journal of the American...
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Reform medicine, say authors iStock photo Stories about conflicts-of-interest in psychiatry are percolating regularly, and MIWatch readers will not be surprised by Dr. Marcia Angell's review of three books taking aim at doctors, regulatory agencies, academic medical centers and drug companies. "So many reforms would be necessary to restore integrity to clinical research and medical practice," writes the former editor of the New England Journal of Medicine, "that they cannot be summarized briefly." Angell has written extensively about these issues....
Biederman accepts limits The New York Times reports Harvard's child psychiatrist Dr. Joseph Biederman has agreed to accept limits on funding linked to pharma....
Martin Ramirez art exhibit in New York The work of Martin Ramirez who was hospitalized for 30 years with a diagnosis of schizophrenia, is on display at the American Museum of Folk Art, in New York. Ramirez died in 1963 and spent the last 15 years of his life in DeWitt State Hospital, a military barracks in California that was converted into a psychiatric hospital after World War II. It was one of the hospitals singled out for over-crowding and for poor standards of care in the...
Treatments lag for substance use Research appearing in the January 2009 issue of Psychiatric Services indicates fewer parents in the child welfare system are offered treatment for substance use if they do not also have a mental illness. At the same time, writes Benedict Carey in the New York Times, it is estimated that "20 million Americans who could benefit from treatment do not get it." A lack of uniformity about models for rehab and recovery has contributed to a recognition that evidence does not...
DSM-V controversies Preparation of the fifth edition of Diasgnostic and Statistical Manual (DSM-V) is underway along with a controversy about the process. Reports in major newspapers point to charges that deliberations are taking place behind closed doors despite earlier promises of transparency. The DSM V is scheduled for 2012 and has become a common language for psychiatrists as well as insurance companies....
Comfort Ye: Opera stars help homeless For the 14th year, soprano great Lauren Flanigan organized opera stars to perform for an evening of Comfort Ye, a unique benefit for the homeless in New York City. This year 25 people, including pianist Larry Woodward, John Musto, Stephen Gaertner, and Michael Chioldi, were part of the line-up for this heralded seasonal event at Symphony Space. Flanigan, who regularly performs in the New York City Opera, personally oversees the event which also enlists the local community. Volunteers help...
Forced ECT A court order mandating electroshock therapy (ECT) for a 54-year-old Minnesota man with schizophrenia has drawn public outcry. Ray Sandford has been receiving ECT since May against his will. Unable to get them stopped, he contacted MindFreedom International for help. Sanford, who is a guardian of Lutheran Social Services, complains of headaches and memory loss and his mother concurs. She told Minnesota Public Radio that after an initial improvement, she expected they would stop. He no longer recognizes family members....
Differences in anti-psychotic drugs Research supported by NIMH confirms second generation antipsychotic medications are not homogeneous. These findings add to a growing body of literature comparing drugs for efficacy, side-effects and costs. The current study from German researchers appears on-line in The Lancet....
Re-entry programs needed after jail Finding a better way to work with mentally ill people leaving jail and prison needs to be addressed, said Sen. Jim Webb (D-Va.) during a meeting at the Brookings Institution discussing re-entry programs. He also called attention to the failure to distinguish between crime and illness: "It's not a crime to be mentally ill. It's not a crime to be addicted to drugs. It is a crime to live by violence and to extort money from people who are trying...
Good economy requires health reform Half of all bankruptcies are tied to health costs President-elect Barack Obama said in a Chicago news conference today. This makes health reform essential, and in the words of the next president, Some may ask how, at this moment of economic challenge, we can afford to invest in reforming our health care system. Well, I ask a different question -- I ask how we can afford not to....If we want to overcome our economic challenges, we must also finally address...
Recovery concepts for schizophrenia Researchers from The Netherlands discuss concepts and measurement for recovery in "Clinical Recovery in First-Episode Psychosis." The research appears on-line in the free edition of Advance Access Schizophrenia Bulletin. Authors emphasize how different participants view the process, and differentiate between functional and symptomatic recovery....
Measuring recovery from psychotic illness As recovery is being realized by more and more, it's apparent than some people can manage a functional recovery despite lingering symptoms. And that remission of symptoms does not always improve function. In an attempt to create a scale to measure functional recovery, authors of an article in Schizophrenia Bulletin (Advance Access) encountered unanticipated issues for predicting real world situations....
Risky college-age drinking iStock photoNearly half of those between the ages of 18 and 24 are enrolled in college. And nearly half of those sampled in an epidemiological survey reported a mental health or substance use concern. But only one-quarter of the students sampled (n=2188) said they sought treatment. Comparing non-students to students, the college students were more likely to show alcohol dependence; non-students were more likely to have a nicotine dependence. Authors of the study appearing in the Archives of General Psychiatry...
Patients at risk in North Carolina hospitals Even before it was learned that a patient had been restrained inappropriately with his face held down, accreditation of North Carolina's hospitals was in jeopardy because of widespread patient neglect. That incident was yesterdays news, along with the documentation contained in 131-page federal report. Today's News Observer reports the sexual assault of a psychiatric patient at different hospital, Cherry Hospital. The technician involved in the assault was not fired until three weeks after the incident, the same day a reporter...
States in trouble South Carolina announced cuts of at least 12 percent to its mental health budget. This will come as a result of closing programs, staff cuts, a freeze on hiring, and eliminaitng 75 in-patient beds. The projected $26 million reduction might increase by another $7.8 million. Advocates worry that the impact of reducing services will be transferred to emergency rooms, jails and homeless shelters. Elsewhere: A spike in anxiety, depression and suicide risks in Denver. In New York, reports the Poughkeepsie...
Mental health rankings unchanged iStockphoto The United Health Foundation's annual rankings of health indicators show the nation's "poor mental health days" remained unchanged at 3.4 days from the previous year. They are up from 3 days in 2000. North and South Dakota tied for first place with the fewest number of days of activity missed. And Vermont, which ranked highest on 14 of 22 indicators, tied for 14th place on mental health -- a drop from 9th place last year. The rankings are based...
New magazine about anxiety and depression A Buffalo-based publisher launched a new magazine, Esperanza, focusing on anxiety and depression. Mariel Hemingway is on the cover of the premier issue. Esperanza means "hope."...
For-profits slated for Georgia's psychiatric hospitals Plans are underway to replace Georgia's public psychiatric hospitals with a system operated by for-profit private ownership. Documents obtained by the Atlantic Journal-Constitution indicate some mental health officials are fast-tracking the transformation, once considered an experiment, to begin in 2009 with a consolidation of forensic services for mentally ill inmates. Children and adolescent units close will close, adult programs will be consolidated and new buildings are proposed. Not all state officials share the enthusiasm of the commissioner of human...
Black youth and suicide After the on-line suicide of a 19-year-old from Florida, Newsweek online spoke with University of Michigan expert, Dr. Sean Joe. Suicide is the third leading cause of death for black men. Joe noted that stigma influences "the ways in which men perceive what it means to seek help for mental-health issues."...
Reactions to Biederman, Goodwin, The Infinite Mind Reactions to news about psychiatrists who failed to disclose their working relationships with drug companies appeared over the weekend. On the Media aired a segment discussing the relationship between producers of The Infinite Mind and Dr. Fred Goodwin. Producer Bill Lichtenstein replied to the show in an email. Lichtenstein spoke to The Injury Board which posted documents including a copy of Goodwin's contract. "Expert or Shill?" read the New York Times headline on Sunday's editorial page. In a very brief...
Harvard psychiatrist courted pharma Documents in a class action law suit show an active courtship between psychiatrist Dr. Joseph Biederman and Johnson and Johnson to fund a center at Massachusetts General Hospital to promote marketing goals. Discussions dating from 2002 address "deliverables" and positioning the company for child and adolescent pharmacology. Emails were posted on the Wall Street Journal. The documents are part of a class action law suit over pediatric use of Risperdal. Additional stories: Reuters, The Philadelphia Inquirer, Bloomberg News, The...
Rx for kids: problem with label or doctor? Despite lack of evidence, label warnings, side effects, and doubts about its efficacy for youngsters under 13, Risperdal and Zyprexa are being prescribed (including off-label use for ADHD) in record numbers for kids. How to change this becamse the subject of an FDA review panel....
Grassley widens probe The name of another prominent psychiatrist has been added to the list of expert physicians identified by Sen. Chuck Grassley because of lucrative speaking fees from pharmaceutical companies. Dr. Frederick Goodwin, recognized expert on bipolar disorder, former head of the National Institute of Mental Health, and current host of the popular NPR radio show, The Infinite Mind, was the subject of a story in Slate in May. Goodwin has apparently received more than one million dollars from just one drug...
Insurance shift on pre-existing condition The New York Times reports the insurance industry is discussing provisionally accepting coverge for pre-existing conditions. This exclusion has been a nearly insurmountable obstacle for many and coupled with the passage of insurance parity, may have broad consequences for people with a mental illness or substance abuse disorder....
Housing crisis for homeless, vets iStock photo Cities are struggling to provide housing for their homeless men and women, and in Seattle a controversy over whether to rebuild or repair is delaying this longer. The Seattle Post-Intelligencer reports that 200 people were shut out of boarding houses they had lived in for up to 30 years, waiting lists are 800 names deep, and 100 people are backed up in the hospital while waiting for a place in the community. In North Carolina, there is a...
Costs of treatment About 6 people in 100 will suffer from a serious mental disorder in any given year. When treatment requires hospitalization, the length of stay is nearly double that of other stays (8.2 days versus 4.6 days) according to a government report....
Other nations surpass US in chronic care Depression is one of the seven illnesses included in an international comparison of how nations treat chronic conditions. Authors report that the United States stands out for "gaps in coverage, and for high cost sharing even for patients with insurance" with more people suffering complex chronic health problems despite spending twice as much on health care ($7,000 per person versus $3,500 per person). Cost figured into the decision of more than half the American respondents not to seek care, and...
Resources for college students To help colleges meet the needs of students with a mental illness, two resources were recently released. Building Bridges from SAMHSA is a rich resource describing problems students have encountered, offering solutions student consumers recommend, and providing community resources. The Jed Foundation makes available Student Mental Health and the Law which answers questions about disabilities, the law, and services. Each is available in a pdf download....
Congress moves to reform health Sen. Max Baucus Congress is wasting no time in setting its health reform agenda or letting letting President-Elect Obama know its priorities. In the Senate, Montana's Max Baucus, Chairman of the Senate Finance Committee, is spearheading a substantial project, including a comprehensive report calling for widespread reform of health care: "The link between health care costs and the economy is undeniable. Reforming the health care system is essential to restoring America's overall economy and the financial security of our working...
General talks about PTSD and stigma On the eve of Veterans Day, Army Maj. Gen. David Blackledge is reminding the country that soldiers suffering from war-related trauma can benefit from treatment. Blackledge received psychiatric counseling for the symptoms of PTSD while recovering from combat injuries he received in Iraq....
Ohio voters continue services In addition to supporting Barack Obama on Tuesday, voters in several Ohio counties approved continuing mental health services. In Stark County a tax levy to fund the newly combined services for mental health and substance abuse was narrowly endorsed. The Stark county Board of Mental Health and Recovery Services funds 20 local agencies serving 22,000 people. Defiance, Fulton, Henry, and Williams counties voters also approved a replacement tax for the four county mental health board....
England's new law on forced treatments iStock PhotoLaws compelling outpatient treatment took effect in England earlier in the week, and the controversy mirrors debates in the US. Proponents argue mandatory treatment reduces hospitalization and promotes public safety while critics oppose coercion and point to considerable side effects. Results inconclusive In the end, reports the Guardian, analysis of 28 studies led experts to conclude, "There is very little evidence to suggest that CTOs [community treatment orders] are associated with any positive outcomes and there is justification for...
Company cuts mobile services A home visit. iStock PhotoMental health teams employed by Palmetto Lowcountry Behavioral Health will stop offering on-call mobile services in Charleston, South Carolina, which is likely to increase use of emergency rooms where people can wait days for service. Palmetto, which was funded in the 1980s, was purchased by Psychiatric Solutions, Inc., a Tenn. corporation, in 2004. The company owns a chain of hospitals, out-patient services, and wilderness programs in 31 states, with seven facilities in South Carolina, and anticipates...
In the journals. . .focus on youth From the Archives of Pediatric and Adolescent Medicine: In the 1960s an anti-war poster read, "War is not healthy for children or other living things." A study in the Nov. issue of the Archives of Pediatric and Adolescent Medicine confirmed this sentiment with a study of 169 families: "Children age 3 and older who had a deployed parent had significantly higher scores on measures of externalizing and overall behavior problems than children of the same age without a deployed parent."...
New books about bi-polar disorder and schizophrenia Two books have been published this month for an audience concerned about mental illness in their families. Author Michael Greenberg writes about his daughter and her hospitalizations, starting as a teenager, when she was diagnosed with bi-polar disorder. Greenberg's discussed Hurry Down Sunshine, with radio host Lenny Lopate on WNYC. Researchers at New York State's Nathan Kline Institute for Psychiatric Research, Irene and Jerome Levine, wrote a book they hope will debunk myths and explain current research and treatments....
Insurance costs outstrip wage growth iStockInsurance costs have outstriped wage increases since 2000, in some instances growing five times faster, according to reports of Families USA. In Vermont, where premiums increased $5,286 to $12,340 for family coverage, wages only grew $4,430 during that same time. Families USA lists a state-by-state breakdown....
Web site helps New Zealand teens Text messaging by teens is par for the course. But messages sent by teens to a website for depression is an indication of seeking and getting help. The Auckland-based site has been visited by nearly 100,000 people since it was launched in 2007 reports a New Zealand paper....
Lilly takes $1.4 billion charge for law suits Five years after investigations into Eli Lilly's marketing of Zyprexa, the company announced settlement talks of $1.4 billion relating to "past U.S. marketing and promotional practices." Lilly previously agreed to settlements with individual plaintiffs and 33 states for charges of deceptive marketing leading to Medicaid expenses and life-threatening side effects. The "Medicaid fraud control units of more than 30 states are coordinating with federal prosecutors," reports the New York Times....
Maryland counties return treatment funds Counties in Maryland regularly return money to the state and leave a treatment gap instead of expanding programs for substance and alcohol addiction, reports the Washington Post....
Antipsychotic meds and heart disease An NIMH study (n=1125) comparing antipsychotic medications and cardiac heart disease found the "risk for CHD differed significantly among the medications." Risk, marked by elevated cholesterol, was highest for those taking olanzapine (Zyprexa, Zydis) and quetiapine (Seroquel). A decreased risk was noted for those taking risperidone (Risperdal) and ziprasidone (Geodon). Cardiovascular disease is a contributing factor to the shorter life span of people diagnosed with schizophrenia....
St. John's wort and depression iStockFor many years the plant St. John's wort was considered a folk remedy to treat depression. Now an analysis of 29 clinical trials (n=5489) concludes Hypericum perforatum L. performed better than a placebo and as well as standard antidepressants and with fewer side effects. The Cochrane Library report sounded a cautionary note because numerous forms and extractions of Hypericum perforatum L. may not be identical to those in the study. Better study outcomes were also apparent in German-speaking countries where...
Mental health in Obama and McCain proposals With health care reform topping the list of voters' concerns, the Kaiser Family Health Blog created a chart comparing the proposals of Senators Barack Obama and John McCain. Click here to read their positions and learn who "supports housing for seriously mentally ill veterans," who calls for halting the discharge of military for "having a service connected psychological injury." Also included are statements about SCHIP, generic drugs, retired veterans....
Slowdown accelerates need for reform Sen. Max Baucus The Kaiser Family Health Blog reports that Senate Finance Committee Chair Max Baucus (D-Mont.) does not want to slow health reform: While some suggest that the current economic situation might thwart efforts to overhaul America's health care system, I believe the state of the U.S. economy makes the need for health care reform even more urgent....
Suicide risk increases during financial crisis iStock Financial insecurity, stress and unemployment are worrisome conditions to those who study suicide. Reuters spoke to experts who fear a global economic crisis will take a heavy toll on mental health. During previous periods of unemployment and bankruptcies, suicides jumped in Japan and Hong Kong....
Activisits push beds through London Dressed as patients and orderlies, British activists campaigned for mental health reform while pushing beds through the streets of London on Oct. 10th, World Mental Health Day. They pointed to a 20-fold increase in prescribing antipsychotic medication between 2002 and 2007, and want expanded access to psychological therapies....
NIH holds up Emory grant The National Institutes of Health (NIH) has frozen payments to Emory University as part of an investigation into conflicts of interest of Dr. Charles Nemeroff. Nemeroff, an expert on depression, stepped down last week as chairman of the psychiatry department. He is charged with failure to disclose $1.2 million he received from drug companies while engaged in research, a violation of NIH and Emory's own academic procedures. The Atlantic Journal Constitution broke the story after receiving a memo from...
Report issued on conflicts of interest In response to allegations of conflicts of interest and ethical misconduct between 2006 and 2007, the Office of Inspector General has issued a report outlining how they were resolved by the National Institutes of Health....
Global mental health challenges photo:iStock World Mental Health Day was the occasion for reports calling attention to the global marginalization of psychiatric conditions. A general assessment from the editors of The Lancet notes: "mental ill-health is likely to have been underestimated because the connection with other health conditions is often ignored. Worse still, the availability, accessibility, and quality of health services is poor and inequitable." Plans are underway for an international mental health summit next year in Athens. Ghana Officials in Ghana are joyful...
Parity a civil rights issue says Domenici Sen. Pete Domenici Time Magazine speaks with Sen. Pete Domenici, early proponent of eliminating insurance barriers for mental health and substance use treatments which became part of the $700 billion rescue package. Domenici learned of the bias in treating mental disorders first hand as the parent of a daughter diagnosed with schizophrenia....
Forecasting treatment costs A study published in the current issue of Health Affairs forecasts spending to treat mental health and substance abuse conditions will reach $239 billion by 2014. This is double what it was in 2003, but as a proportion of total, it represents a decline of public sector spending on health from 7.5 percent to 6.9 percent....
Eli Lilly settles $62 million case; more pending Eli Lilly announced a $62 million settlement in 32 states for the marketing of its block buster drug Zyprexa. In the 12 years it has been on the market, the company says it has been prescribed 26 million times. Zyprexa is known to cause weight gain leading to diabetes, heart disease, both of which are associated with early death. Other law suits are still outstanding. Since 2005, according to SEC filings, costs associated with Zyprexa lawsuits, including legal fees, amount...
Psychiatrist under investigation resigns Dr. Charles Nemeroff, under investigation for violating federal regulations to guarantee unbiased research while receiving funding from the National Institutes of Health, resigned as chair of department of psychiatry at Emory University. The resignation follows a New York Times story, and conversation in the blogs, about $2.8 million in fees he has received from different pharmaceutical companies. Although Emory had advised him to keep his consulting fees under $10,000, and Nemeroff presumably agreed, he did not. The university was reminded...
Effectiveness of therapies studied A study published in the October issue of the Journal of the American Medical Association (JAMA) examined how long-term psychotherapy (defined as 50 or more sessions) compared to other treatments for complex mental disorders. The authors evaluated 48 years of research involving 1053 subjects from 23 studies. (Abstract available.)...
Update on parity Mental health parity was tucked into the Senate's $700 billion revised rescue package which passed 74 to 25 on Wednesday evening. The package returns to the House where Rep. Jim Ramstad told reporters that the inclusion of parity will influence his vote. Parity has been a signature issue for Ramstad who was among the 122 Republicans voting against the bill....
Protecting children Following the death of a youngster in a residential treatment program, Maryland passed a licensing law requiring minimal educational and training requirements for child care workers in residential programs....
Protecting children Following the death of a youngster in a residential treatment program, Maryland passed a licensing law requiring minimal educational and training requirements for child care workers in residential programs....
Protecting children Following the death of a youngster in a residential treatment program, Maryland passed a licensing law requiring minimal educational and training requirements for child care workers in residential programs....
Protecting children Following the death of a youngster in a residential treatment program, Maryland passed a licensing law requiring minimal educational and training requirements for child care workers in residential programs....
Little time left for parity bill With little time left for passage of mental health parity, an editorial in the New York Times calls for "a statesman who can push this worthy parity legislation through to final passage before adjournment." Despite overwhelming support, the bill remains deadlocked over recouping tax revenues in the next decade. Health policy expert, Dr. Howard Goldman, explains why parity matters....
Little time left for parity bill With little time left for passage of mental health parity, an editorial in the New York Times calls for "a statesman who can push this worthy parity legislation through to final passage before adjournment." Despite overwhelming support, the bill remains deadlocked over recouping tax revenues in the next decade. Health policy expert, Dr. Howard Goldman, explains why parity matters....
Colleges proactive about mental health The needs of students attending college while managing a mental illness are being addressed more openly than ever before. In the month of September, typically associated with "back-to-school" news, NPR aired stories about managing depression, and campus organization such as Active Minds, Graduate students are writing about how knowledge of one's illness can influence how to select a pro