From Psych Central by Janice Wood
April 10, 2012
The growing number of psychiatric disorders, and subsequent labels assigned to patients, may make it harder for those patients to get the support they need.
According to a new study, people who show signs of depression and other common mental illnesses are less likely to get a supportive response from friends and family members as are people with other severe mental disorders.
For the study, published in a recent issue of the Journal of Health and Social Behavior, author and sociologist Dr. Brea L. Perry studied interviews conducted with 165 patients with bipolar disorder, schizophrenia, major depression, and other less severe disorders, who were undergoing mental health treatment for the first time.
She found that those with more socially accepted and common mental illnesses, such as depression and mild mood disorders, did not receive strong reactions to their conditions from family members, friends, or others with whom they came in contact. As a result, their support networks may be less willing to take on caregiver responsibilities or to excuse them when their behavior deviates from what is considered normal, she said.
“Perhaps because so many people are diagnosed and subsequently treated successfully, signs of depression do not alarm friends and family members to the same degree as disorders known to severely affect functioning,” she said.
While a common mental illness such as depression is clearly defined by psychiatrists as a legitimate medical condition, Perry said the public does not always deem them as justifiable grounds for taking on a “sick” role.
The study also found that diagnosing someone with a severe mental illness that is more outwardly recognizable, such as schizophrenia or the manic phase of bipolar disorder, can lead to a higher amount of rejection and discrimination by acquaintances and strangers while at the same time creating a stronger social support system among close friends and family.
“Day-to-day emotional and instrumental support is likely to play a critical role in recovery from mental illness,” she added.
Live music at Fresno's VA hospital makes a big difference, January 16, 2012
Americans Less Willing to Pay to Prevent Mental Illness
From Psych Central by Rick Nauert April 9, 2012
A new survey discovers Americans are less willing to pay to avoid mental illness as compared to medical conditions.
Researchers analyzed responses from a nationally representative sample of 710 adults and found that while respondents viewed mental health as burdensome, in fact often more burdensome than general medical illness, they were less willing to pay for prevention of the condition.
Specifically, survey respondents were willing to pay 40 percent less than what they would pay to avoid medical illnesses, said study leader Dylan M. Smith, Ph.D.
Survey participants were presented with five health conditions. These included three medical illnesses or conditions (diabetes, below-the-knee amputation, and partial blindness), and two mental illnesses (depression and schizophrenia).
Participants rated each health condition for severity and level of burden in relation to quality of life. Then they indicated how much they would pay, out of pocket, to avoid the condition.
“Our results showed that participants understood that mental illness clearly has a very negative impact on quality of life yet were significantly not as willing to pay for effective treatments for these illnesses,” said Smith.
“The findings mirror the general pattern of health care spending, with less resources going to treat mental illnesses than might be expected given the overall level of burden they impose on society.”
Smith cited current World Health Organization statistics that indicate mental illnesses account for 15.4 percent of the total burden caused by all disease in industrialized countries, yet mental illnesses account for only 6.2 percent of U.S. health care expenditures.
“All else equal, the general public doesn’t think it is as valuable to treat mental illness as other types of illness,” said senior author Peter Ubel, M.D., of Duke University. “There is a fundamental disconnect between how bad they think it would be to experience depression and their willingness to spend money to rid themselves of the illness.”
Investigators discovered respondents generally considered the medical illnesses or conditions as less severe in comparison to the mental illnesses. Yet, when respondents were asked to rate the “burdensomeness” of each condition, schizophrenia received the highest mean burden score, but it did not have the highest willingness-to-pay value.
Similarly, despite a relatively high “burdensomeness” rating, depression received the lowest median willingness-to-pay value.
According to the authors, the results suggest that efforts to “eliminate the gap between mental health conditions and general health conditions will likely require targeting specific beliefs that people have about mental illnesses and the value of treatments for mental illness.”
They also point out that “public attitudes influence how much payers for health care are willing to spend to treat mental illness and how likely federal agencies are to invest in research on mental illness.”
In an era of health reform, researchers say additional investigation is needed to “explore the deeper underlying attitudes that reduce people’s willingness to spend money to avoid mental illness.”
The research results are published in the journal Psychiatric Services.
Adults Experiencing Mental Illness Have Higher Rates of Certain Chronic Physical Illnesses
From Newswise by Staff Writer, April 10, 2012
A new report shows that adults (aged 18 and older) who had a mental illness in the past year have higher rates of certain physical illnesses than those not experiencing mental illness. According to a report by the Substance Abuse and Mental Health Services Administration (SAMHSA), adults aged 18 and older who had any mental illness, serious mental illness, or major depressive episodes in the past year had increased rates of high blood pressure, asthma, diabetes, heart disease, and stroke.
For example, 21.9 percent of adults experiencing any mental illness (based on the diagnostic criteria specified in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)) in the past year had high blood pressure. In contrast, 18.3 percent of those without experiencing any mental illness had high blood pressure. Similarly, 15.7 percent of adults who had any mental illness in the past year also had asthma, while only 10.6 percent of those without mental illness had this condition.
Adults who had a serious mental illness (i.e., a mental illness causing serious functional impairment substantially interfering with one or more major life activities) in the past year also evidenced higher rates of high blood pressure, asthma, diabetes, heart disease, and stroke than people who did not experience serious mental illnesses.
Adults experiencing major depressive episodes (periods of depression lasting two weeks or more in which there were significant problems with everyday aspect of life such as sleep, eating, feelings of self-worth, etc.) had higher rates of the following physical illnesses than those without past-year major depressive episodes: high blood pressure (24.1 percent vs. 19.8 percent), asthma (17.0 percent vs. 11.4 percent), diabetes (8.9 percent vs. 7.1 percent), heart disease (6.5 percent vs. 4.6 percent), and stroke (2.5 percent vs. 1.1 percent).
The report also shows significant differences in emergency department use and hospitalization rates in the past year between adults with past-year mental illness and those without. For example, 47.6 percent of adults with serious mental illness in the past year used emergency departments as opposed to only 30.5 percent of those without past-year serious mental illness. Adults with past-year serious mental illness were more likely to have been hospitalized than those without past-year serious mental illness (20.4 percent versus 11.6 percent respectively).
“Behavioral health is essential to health. This is a key SAMHSA message and is underscored by this data,” said SAMHSA Administrator Pamela S. Hyde. “Promoting health and wellness for individuals, families and communities means treating behavioral health needs with the same commitment and vigor as any other physical health condition. Communities, families, and individuals cannot achieve health without addressing behavioral health.”
To that end, since 2009 SAMHSA has funded the Primary and Behavioral Health Care Integration (PBHCI) program, which works to improve the physical health status of people with serious mental illness and those with co-occurring substance use disorders by supporting community efforts to coordinate and integrate primary care services into publicly funded community-based behavioral health settings. Currently 64 community behavioral health providers receive the PBHCI grant, with the expected outcome of entering into partnerships to develop or expand their offering of primary healthcare services, resulting in improved health status for their clients. As of March 2012, over 17,500 adults with serious mental illness and/or co-occurring substance use disorders have been served via the PBHCI program. More information about the PBHCI program is available at http://www.integration.samhsa.gov/about-us/pbhci.
Another SAMHSA effort – its Wellness Initiative – builds on the HHS Million Hearts campaign and promotes wellness for people with mental and substance use disorders by motivating individuals, organizations, and communities to take action and work toward improved quality of life, cardiovascular health, and decreased early mortality rates. To learn more, please visit http://www.samhsa.gov/wellness and http://millionhearts.hhs.gov/index.html.
The report entitled, Physical Health Conditions among Adults with Mental Illnesses is based on SAMHSA’s 2008-2009 National Survey on Drug Use and Health (NSDUH) data. NSDUH is an annual nationally representative survey of the U.S. civilian, non-institutionalized population aged 12 or older. The report is available at:
For Mentally Ill Inmates, Health Care Behind Bars is Often Out of Reach
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 headlines last 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.
Slevin claims the only response he got while in Dona Ana Detention Center to his repeated requests for antidepressants was an increase in sedatives. Other mentally ill inmates at Dona Ana, according to the class-action lawsuit, struggled to get adequate care as well. One allegedly was punished by a medical technician, who discontinued his medications for two weeks; others complained of side effects but were not offered alternatives, the suit said.
“A jail like Dona Ana County was trying for years to cut costs, and nothing would force them to spend the money that they’re constitutionally required to,” Brendan Egan, an attorney who represented the plaintiffs on behalf of the ACLU and is now in private practice, told msnbc.com. “It’s cruel and unusual punishment. They weren’t willing to put money into it, even though they made money off of this jail. They’re paying the price for how they treated people for years.”
The primary plaintiff named in that suit, Jaime Bravo, was jailed from April 2007 until February 2008 after a domestic dispute. Bravo had depression, anxiety and acute psychosis, the suit said.
Four times during his detainment, Bravo attempted suicide, and each time he was then put in a padded cell or a restraint cell, said court documents.
“On or about November 15, 2007, Mr. Bravo made a fourth suicide attempt, by cutting his arm with a razor blade, necessitating stitches. DACDC staff placed him in a padded cell as a consequence … On or about November 16, 2007, Mr. Bravo tore out his sutures. DACDC staff placed him in a restraint chair as a consequence.”
In jail, mental illness will 'get exponentially worse'
While Dona Ana County was ordered to pay a total of $400,000 to the plaintiffs, a small amount compared to Slevin’s judgment, the bigger reward was that the jail changed how it handled mentally ill inmates, Egan said.
The jail renovated an entire section and “turned it into a very humane and real mental health unit,” he said. Officials also dedicated beds at a separate mental health hospital staffed by jail guards for the sickest detainees.
“Even if you take someone who has a slight mental illness like depression and you put them in a regular jail, they get worse,” Egan said. “[At Dona Ana County], they would just lock them in. They already had issues and you lock them up 22, 23 hours a day – they’re going to get exponentially worse.”
Just last month, the county approved a $2 million plan for a crisis triage center, which would offer an alternative for mentally ill people other than jail – something Egan believes will help.
“There were no mental health facilities or treatment for homeless people on the street, so you would have people on the street getting arrested basically for being mentally ill,” Egan said. “But once they got arrested, the county commissioners didn’t provide resources.”
According to Fred Osher, director of health systems and services policy at the Council of State Governments Justice Center, people with mental disorders are overrepresented in the mental health system.
"There's a variety of factors that contribute, but one of the research studies... looked at two jails in Maryland and three in New York. Seventeen percent [of inmates] met the criteria for mental illness," he told msnbc.com.
Nationwide, prevalence of severe mental illness among inmates is at least 15 percent, said Richard Bonnie, director of the University of Virginia’s Institute of Law, Psychiatry, and Public Policy.
“There are many factors at work here, but many us involved in this field are convinced that diversion from the criminal justice system into mental health services … can alleviate the problem without compromising public safety,” he told msnbc.com via email.
Jail diversion options include drug courts, where a substance abuse program is worked out instead of a jail sentencing; mental health courts, where a behavioral contract including drug tests and treatment appointments is drawn up; and sometimes, assignment to a mental health probation officer who is trained to handle mental issues and knows how to direct someone to health services.
"Lots of people have recognized there's this population with severe mental disorders that just isn't going to do well in a prison population," said Hafemeister, from the University of Virginia Law School.
Care doesn't have to cost more
And it doesn't always have to be expensive to divert those with mental issues, added Osher.
"What many systems are coming to realize is if you provide alternatives, then you can reduce length of stay. You can actually have this be a resource-neutral event. It doesn't necessarily require an infusion of dollars," he said. "We're spending tons of money warehousing, having people in a revolving door without producing good outcomes."
He cited Montgomery County, Md. as a successful example.
"They do a really nice job in screening and identifying folks with mental illness and diverting them when possible," he said. The county also tries get to them in psychiatric programs and help them with re-entry into the community, which reduces chances of them returning to jail, and helps them with their medication management as they transition out.
Similar programs are also happening at Alleghany County Jail in Pittsburgh and Miami-Dade, he said. Riker's Island in New York is undergoing a major transformation with their mental health care as well.
"Good things are happening at Riker's because of a settlement. The folks at Rikers with mental illness were ... without any resources to fend for themselves," he said. Baltimore and Memphis jails have also reformed their mental health care after being subject to lawsuits.
Training police officers to recognize mental illness is another key, Osher said, so those who need medical help can hopefully get diverted to emergency rooms or psychiatric centers before they are sent to jails in the first place - but only if that's not where they should be.
"We're not giving people a pass because they have mental illness," Osher said. "We're not being soft on crime. For those individuals that don't pose a public safety risk, there are these alternatives. There are treatments that can be provided."
Editor's note: An earlier version of this story incorrectly quoted Dr. Fred Osher as saying seventy percent, not seventeen percent, of inmates in a study met the criteria for mental illness.
May Is Mental Health Month: What to Do When Caregiving Threatens to
Published on April 3, 2012
by Diana B. Denholm, Ph.D, L.M.H.C.
in The Caregiver's Handbook
I have spoken to many wives who are caregivers for seriously ill husbands, and they often express a kind of shock and disbelief at the person they have become. "Who is this angry, mean, guilt-ridden person who lives in my body?"
Caring for a seriously ill husband can bring up many unexpected emotions, and it's no wonder. You feel angry because others offer to help him, but your husband turns them down. Not only do you wait on him hand and foot, but you are also the one who bears the brunt of his frustration and bad temper. He expects you to be his servant AND the sole provider for the family, and he complains when you come up short in either role. To make matters worse, while you're off working long, hard hours, he manages to rally the energy to get out of the house and go to the baseball field with his buddies. No matter what you do, he doesn't seem to appreciate you.
For the caregiving wife, stress and anger can spill over into everything she does, causing problems at work and affecting her ability to be compassionate. I've heard even the most kind-hearted wives confess that they yell at their dying husbands, delay giving them meals, cook food they dislike, and even throw plates at them when they complain. It's not atypical for wives in these kinds of situations to sometimes wish he would hurry up and die.
But more often than not, the caregiving wife wonders what became of the sweet lady she used to be. The person she's become frightens her.
There is hope and help for wives who find themselves in this situation. Caregiving does not have to destroy you, your life, or your marriage. When difficult emotions threaten your mental well-being, here are some strategies.
Understand your emotions.
Sometimes you feel guilty because you have bad thoughts, and sometimes you feel guilty because you have happy thoughts. This inner dialogue helps you survive because it allows you to let off small bursts of steam and keeps you from screaming things out loud or acting on them. Emotions are neither good nor bad, they just are. But too much pent-up anger or too many disturbing thoughts not only create negative outcomes, they also steal your energy. Among many healthy ways to release anger, try simply writing down, for your eyes only, all the things you'd really like to say but won't-just to get them out of your system.
A common mistake caregivers make is thinking that everything is their responsibility. This makes you resentful and makes you angry at those who aren't doing things, or aren't doing things your way. It steals your spare time, which keeps you from caring for yourself. To avoid this trap, don't do for the cared ones what they really can and should do for themselves. This enabling, or controlling the ill person, creates invalids. Don't micromanage what they are able to do, even though it may be far from perfect. The less you enable, manage, or control, the more likely you are to reclaim that "nice person" you know you are.
First and foremost, get on the same page as the ill person in terms of expectations for everyone involved in their care-including those "helpful" friends. Discuss and agree on what you'll expect of each other and what you are willing to do and not do. Topics can include the type of care and who will perform it, legal and financial matters, household management, visitors, sleep, and sex and intimacy, among others.
Use learned communication tools.
In my book, you'll learn how to raise issues, have problem-solving discussions with the ill person, and create agreements about expectations. Once these agreements are created, household battles and stress will greatly diminish, leaving a more peaceful and happier environment in its place. Because effective communication with the ill person produces these agreements, it is the single most helpful way to improve your mental health.
Give yourself permission for self-care.
Once you've manufactured more time by not enabling, give yourself permission to get away from caregiving. It's okay to have fun, even if your loved one is suffering. Start small. Give yourself permission to enjoy one simple thing, whether it's a short walk in the fresh air, sitting in the bathroom meditating, or spending a little time with a friend. As you become comfortable with small steps, branch out to other self-care activities.
Get help if you're near the edge.
While it IS your job to keep your loved ones safe, if they aren't able to, it is NOT your job to make them happy. Only they can do that. But if you sense your emotions are out of control, you need to get help before YOU become the threat to your loved one's safety.
Source: Psychology Today
Reporting from Fresno—The hospital was built in the years after World War II. Its ceilings are low, corridors long and corners sharp — all possible stress triggers for those who have been in combat.
Not to mention that a hospital waiting room can make anyone edgy. But the Veterans Affairs hospital in Fresno has found a way to make the experience easier: live music.
A musician playing amid the hustle and bustle is familiar to anyone who has ever sat at a cafe with entertainment or taken the subway. But this has proved to be more. The hospital set out to provide simple distraction, but soon doctors noticed a marked improvement in many of their patients, especially those with post-traumatic stress disorder or traumatic brain injury.
Dr. Hani Khouzam, a psychiatrist who treats both disorders, said patients have been arriving for appointments so notably calmer that it takes him longer to make a diagnosis — something he welcomes.
"You have to understand what it means for a combat veteran to be agitated in the waiting room. Their pupils are dilated. They are angry or waiting for something to happen," he said. "But when we have live music that day, they come to me far more relaxed. It's like an amazing miracle, and I don't say that lightly."
On a recent day in a busy main reception area, grandfathers waited for blood work and a young veteran was whisked through on a gurney, face-down and in restraints — possibly headed for a locked psychiatric unit. Jon Sharp, a classical guitarist, played Francisco Tarrega's "Recuerdos de la Alhambra," which begins in wistful melancholy and builds to an uplifting melody.
George Flores, head of the hospital's police force and himself an Iraq War veteran, paused to listen.
"Don't ask me how. It's doctor stuff," he said. "But I know the music makes our job easier."
Ervin G. Loman, a Korean War veteran, held a magazine to his face, but he wasn't reading it. He continuously looked slowly to the left, paused, then swiveled his head to the right. He'd driven more than an hour from Los Banos for diabetes treatment, then spent an hour looking for a parking space.
"It got me a little uptight, and that can — well, I don't want to think about it, I close it out — but I'm on alert like all those many years ago. This is mild," he said with a laugh. "The music is relaxing me. I hope it's a help to the younger ones. They've been to hell, and we all carry that demon."
There is an established health field of musical therapy that has been documented as helping patients with autism, Parkinson's or Alzheimer's disease, as well as those who have lost the ability of speech because of brain trauma. Rep. Gabrielle Giffords (D-Ariz.) relearned to talk largely through musical therapy after a gunman shot her through the head at close range last year.
But the benefits of the music at the Fresno hospital were more happenstance than intended therapy. First, hospital officials used funds donated for improving the hospital's aesthetics to bring in a harp player. When people seemed to like that, they added a classical guitar player. They were just trying to cheer the place up a bit.
The "amazing surprise," Khouzam said, has been that the random playing of live music in the waiting room — doctors and therapists have not seen the same result with recorded music — helped patients with psychological damage from war.
Daniel J. Levitin, a neuroscientist at McGill University in Montreal and author of "This is Your Brain on Music," suspects that the music not only masks triggers of trauma but also is adjusting patients' brain chemistry.
"We know that music that isn't adrenaline-pumping releases powerful hormones: dopamine and prolactin," he said. "Obviously, it isn't a controlled scientific study ... but something there is working."
Nick Carey, 28, who was in charge of convoy security in Iraq and later traveled with Marine One, the helicopter that carries the president, knows about waiting-room triggers.
"It isn't one thing. It's all of them. The hum of the air conditioner takes you back to being in a vehicle 20 hours a day never knowing when something might happen. It's all the sounds that you may recognize, but it takes you a second to identify them. They take you back to searching a house wondering what the sound is behind that wall," said Carey, a business management student who also works at the hospital through a work-study program.
He's from Coarsegold, a small Sierra foothill town where people are likely to graduate from high school with the same people with whom they started kindergarten. It's the kind of place that added to the Central Valley's large number of returning veterans. (The Fresno VA hospital has California's highest percentage of patients who are veterans of the Iraq and Afghanistan wars.)
"It doesn't sound right to say the small towns are more patriotic, but they do hold military service in honor," he said, noting that near his town there is a gas station with a wooden plaque for everyone who joined and that many of the people he knew in school went over.
Carey has not been diagnosed with post-traumatic stress, only with hyper-attentiveness, but he wonders whether that's because he doesn't talk about the times he needs to go to his car and just breathe for a while. He's worried about his younger brother, who recently returned from Iraq and listens to loud music with a driving fast beat all the time, much as he first did upon his return.
That's the reason he too thinks the music in the hospital waiting room may be about more than drowning out sounds that can be trigg
Fish Oil Can Head Off First Psychotic Episode