Feds want Medicaid money back

When needing mental health treatment, many of the nation's poor have been turned away at the door. A new move by the federal government may lock them out entirely, at least in Texas.
According to a story in today's Houston Chronicle, the feds have required the state to repay them $1.67 million in Medicaid reimbursements for inpatient psychiatric care. Medicaid does not provide for adults living in psychiatric institutions.
About 200 psychiatrists and institutions in the state received notices from the Texas Health and Human Services Commission in June requesting the return of reimbursements from 2001 to 2007. A few individual practitioners received bills for $40,000 and one medical group was hit with a $130,000 demand, according to the article.
Will other states be next?Sphere: Related Content
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State settlements called into question

As covered extensively in this blog, Georgia's mental health system has been under scrutiny and finally reached an agreement with the federal government to overhaul patient care (see "Georgia reaches agreement with feds.")
According to an NPR report today, however, the Justice Department's agreement with Georgia and five other states, including Hawaii, Washington, South Carolina, Tennessee and Connecticut, are on ice. According to the NPR report, "Advocacy groups say the terms of these last-minute settlements are inexcusably weak and that the agreements don't do enough to make sure the states fix their problems."Sphere: Related Content
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Georgia reaches agreement with feds

Georgia Governor Sonny Perdue announced yesterday that his state has reached an agreement with the Justice Department to overhaul patient care seven state psychiatric hospitals.
The agreement, which still needs judicial approval, covers almost every area of patient care:

• Incident reviews and investigations
• Treatment planning
• Seclusion and restraint protocols
• Medical and nursing care
• Discharge planning

The tentative agreement also calls for the state to develop new suicide risk assessment tools to prevent patient suicides. They are also to examine approaches to deter assaultive behavior.
As discussed on this blog, Georgia has been under intense scrutiny after an Atlanta Journal-Constitution investigation uncovered 136 deaths and nearly 200 cases of patient abuse since 2002. Recently, the state has been exploring privatizing its crumbling public psychiatric hospital system.Sphere: Related Content
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Deep problems in the Grand Canyon State

While many of us were sleeping last night, the lines in Arizona's mental health battle were etched deeper into the sand. At issue are the number of patients being un- or under- served by the state's partially privatized system, particularly in Maricopa County. At midnight, the Arizona Republic published a story appearing today, "Audit calls county's mental care worse."

"They've really gone to hell in a handbasket."
Nancy Diggs, court-appointed monitor.

Based on an analysis by court-appointed monitor Nancy Diggs, Magellan Health Services, the company which won the contract in 2007 to manage mental health services in Maricopa County, has failed to meet the needs of 83% of the county's most seriously ill clients. If that weren't damning enough, the report also found three in five patients do not have "an adequate clinical team" and four in five don't even have a completed mental health assessment.

Magellan won their contract promising to clean up the mess left by their predecessor, Value Options .

Among the lightning rods for the current controversy is the case of Joe Gallegos, a longtime mental health client who had been court-ordered into treatment at a Glendale, Arizona clinic. He didn't receive help from Magellan and on December 23, murdered two young boys in a Southwest Phoenix park, beating them to death with a baseball bat.


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The high risks of homophobia

A new study published in the December 29 online edition of Pediatrics adds further evidence that parental attitudes toward their gay, lesbian, bisexual and transgendered children can have deleterious effects on the youth.
Based on their sample of 224 gay, lesbian, bisexual and transgendered adults in California, researchers found that teens rejected by their families were eight times more likely to attempt suicide, six times more likely to struggle with depression, and three time more likely to engage in high risk drug and sexual behaviors.
Two additional notes of interest: First, gay Latinos encountered the most negative reactions from their families and had the highest risk factors for HIV and mental health problems.
Second, the study found that forbidding a gay teen from socializing with their gay peers carried the same risk as physical or verbal abuse.
You can read more about the study at Discover.Sphere: Related Content
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Young schizophrenic man shot in Florida

In Hallandale Beach, Florida, on Wednesday, December 17, an 18-year-old schizophrenic male named Johnny Mario Silfrain was shot in the leg by a Broward County Sheriff’s Deputy, according to the South Florida Sun-Sentinel. Mr. Silfrain had led police on a brief chase in a hearse he stole from a funeral he was attending. At the end of the pursuit, he attempted to run over deputies, leading them to open fire. Now, Silfrain has been undergoing evaluation at Memorial Regional Hospital in Hollywood, Florida.
Just the day before this incident, deputies had been called to the apartment Silfrain shares with this mother. He had become increasingly agitated, she told them, but by the time officers arrived, Silfrain had calmed down and was no longer judged to be dangerous, so the authorities left him at home. According to his mother, Silfrain was quite paranoid, believing people were watching and following him.
Prior to his first psychotic break, the young Silfrain was football player and a student in Advanced Placement classes.
While there aren’t enough details available at this time, it appears this crisis may present an opportunity for examining what systemic failures may have occurred in this case.Sphere: Related Content
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A beautiful mind in Bakersfield

Finding good news about mental health can be positively daunting these days, so thank goodness for Ashley Nommensen, a Bakersfield, California high school senior who is making an impact beyond her years.
According to a December 12 post from columnist Marylee Shrider on Bakersfield.com, this brave young woman helped create a first-of-its-kind peer support group for teens and young adults experiencing mental illness. It is labor of love, borne of her own psychological struggles dating back to a bipolar-induced psychotic break at the age of 13.
Her group's moniker, Outspoken Young Minds, is certainly appropriate for Ashley, who has been traveling to tell her own story to gatherings of school counselors and community organizations. In July, she'll say even more at the 2009 NAMI (National Alliance on Mental Illness) National Convention when she appears there with her mother and Russ Sempell, president of the Kern County NAMI chapter, which has partnered with Ashley on this project.
Ashley's commitment to spreading the word that "normal is just a cycle on the washing machine" is a commendable breath of fresh air.Sphere: Related Content
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Psychiatric Issues Weigh Down Economy

In a report by the World Health Organization cited by News Blaze today, mental health issues account for more than 15% of the disease burden, or loss of productivity, in established economies such as the US. Psychiatric illness, then, weighs heavier than cancer.
The findings echo those of the journal Lancet which credited mental health dificulties for 14% of the disease burden.Sphere: Related Content
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Beating Victim at Patton State Dies

Patton State Beating Victim Dies A 49-year-old patient at Patton State Hospital has died at St. Bernardine Medical Center in San Bernardino, CA, according to a San Jose Mercury News report published this morning. The man was beaten 15 days ago by a 25-year-old peer who has since been charged with battery resulting in serious bodily injury. The victim's cause of death has not been immediately identified.Sphere: Related Content
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Mental Illness Can Kill

A brief article published on the Time web site December 3 shed long-overdue attention on the tragically shortened lifespan of patients enduring chronic mental health conditions. All the anecdotal observations of behavioral health professionals, though, had never framed our patients' untimely deaths as starkly as the National Association of State Mental Health Program Directors (NASMHPD).

Scrutinizing data from 16 states, the organization concluded severe mental illness mercilessly shaves an average 25 years off a patient's life. This study, titled "Morbidity and Mortality in People with Serious Mental Illness," was published two years ago, however. Time's citation of this rather dusty report is telling about the dearth of literature questioning this sobering state of affairs.
While this health crisis results from the conspiracy of mutltiple factors, incuding an impetuous healthcare system and an uneven system of decision-making among non-psychiatric care providers, our patients' lives provide the most direct and disquieting call for more attention.

The Psychiatric 'Lifestyle'
Undoubetdly chemical abuse portends an abbreviated life for anyone and psychiatric patients abuse alcohol and drugs at an alarmingly high rate. Estimates vary, but investigators more or less agree around 50% of the chronic mentally ill are substance abusers or addicts. Pair that with the emerging rule of thumb that drug addicts die within 15 to 20 years of the onset of their addiction and an unsettling outlook materializes.
Beyond the socially proscribed drugs, the chronic mentally ill smoke tobacco at nearly twice the rate of the rest of us. In a 2000 study published in the Journal of the American Medical Association, examiners found that 41% of psychiatric patients smoked versus 22.5% of the general population. Patients rhapsodize romantically of their tobacco because a good smoke really is the brightest moment in their otherwise hellish existence. Hospitals encourage the habit, too, because we know that nicotine provides a soothing balm to our customers’ otherwise pulsing nerves. Nurses distributing cheap generic cigarettes to a patient's trembling, nicotine-stained hands is a common visual in our post-modern mental health system.
Beyond the high walls of the hospital grounds, clients often lead cruel, unforgiving lives, especially those most seriously ill. They may sleep in parks or homeless shelters, with little or no money either because they are locked outside the entitlement system or because they spend what few dollars they do get on alcohol and drugs.
The luckier ones--those whose behavior can be maintained with minimal supervision and who receive government benefits--may win a bed at a board and care facility. Some of these housing businesses are well-maintained in tidy neighborhoods. All too many of them, though, are in dilapidated buildings where the stench of feces on bed sheets, urine in hallway corners and aging cigarette smoke permeate the air. Their locations are often in the tenderloin, where scoring a gram of crack is easier than buying a gallon of milk. Typically these patients receive the Federal government’s $637 per month in Supplemental Security Income, plus any additional monies their state provides. Typical board and care rents are around 90% of that amount. Filling our belly on $50 or $100 a month is virtually impossible for even the most frugal of us.
Feeding a drug addiction costs even more dearly. One favorite drug among psychiatric patients is crack, a 1/10th gram of which costs $10-$25 on the street. Another cherished drug, methamphetamine, will set a patient back about $25 for 1/4 gram, barely enough to get a party started. The swift decline of a drug-addicted client's cash supply, then, is easily predicted.
When one is fiending for another fix, there is no limit to what they might do or with whom they may do it. Trading sex for drugs is hardly unusual, but as condoms became a must-have for recreational intercourse, the opportunities for exposure to HIV and assorted other bugs increased. If you have to be anally penetrated by a stranger for your next bump of crystal, chances are you didn't stop off at the market for a pack of Trojans.
Injectable drugs are as much to blame as any informal sodomy for our patients' deteriorating health. Dirty needles carry the double trouble of HIV and Hepatitis C. People with chronic mental illness are infected with Hepatitis C at a staggering 11times the rate of the general population, and carry HIV at eight times than the rest of the population, according to a 2001 study published in the American Journal of Public Health. Survival rates for Hep C hover around a depressing 50% after just five years of infection.

In the face of these unforgiving statistics, the disheartening NASMHPD study referenced at the beginning of this post looks almost sanguine. The numbers reveal more than just life expectancies and callous realities, though. They mirror a blind spot in our present system of care that taunts us with the question, Do we care enough to do anything about it?

PHOTO: Courtesy of Martin Walls, Kent, UK.

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Half of College-Aged Adults are Mentally Ill... Right?

In an astonishing study published in this month's Archives of General Psychiatry, researchers found that nearly 50% of college-aged adults in the US struggle with some sort of mental health or chemical dependency issue.
A team led by Dr. Mark Olfson, a professor of clinical psychiatry at Columbia University Medical Center, mined the data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. The college-aged group was then split between students and non-students.
Among those in school, the team detected 20% of the college-age adults wrestled with alcohol issues followed by a startling 18% displaying personality disorders. Among the non-students, nicotine dependence and personality disorders topped the list. Meanwhile, mood disorders surfaced in a relatively paltry 11% for students and 12% for those out of school.
The findings are staggering for the simple fact that they turn conventional wisdom on its head. According to the Diagnostic and Statistical Manual IV (DSM-IV), the bible of the metal health industry, Borderline Personality Disorder has been estimated to affect nearly 2% of the general population, Obsessive-Compulsive Personality Disorder shows up in about 1% and Narcissistic Personality Disorder trails them both, presenting in less than 1% of us.
Meanwhile,the same DSM-IV finds 1%-3% of us experiencing the symptoms of panic or generalized anxiety disorders. Even depression is believed to affect less than 10% of the general population.
This study's breathtaking findings can only lead us to conclude either we have an extraordinarily sick generation coming of age, or the study is flawed. Perhaps the devil is in the design. The data for the 2001-2002 study were gathered from face-to-face interviews and the current study's authors deconstructed their information. The real questions revolve around diagnosis versus presenting symptoms. Had those interviewed been formally diagnosed with the conditions reported? Or had they scored in certain ways on psychological testing scales during the survey? Given that only 25% of those surveyed actually sought out mental health treatment, one would be tempted to assume that their conclusions are based on series of questionnaires and behavioral scales. Today's study would be tenuous at best.
Until knowing the full design of the 2001 study and thereby making an informed conclusion, I for one will remain in blissful ignorance of the more alarming alternative.Sphere: Related Content
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The Deadliest Kind of Economic Depression

Here’s a sobering kind of economic indicator: The number of suicides peak at the lowest point of a recession, according to Elizabeth Bernstein’s thoughful piece, “Angst Is Rising, but Many Must Forgo Therapy” in today’s Wall Street Journal Online.
Mind you, as a clinician on the front lines every single day, I haven’t seen evidence of this spike yet. In fact, I don’t think the recession or a depression will particularly affect the most seriously mentally ill patients. After all, they are on the receiving end of government benefits which, barring social cataclysm, is unlikely to end.
The people I worry about, though, are the middle-class clients, squeezed in every way possible. These are the folks who could lose their benefits if they lose their jobs, who are having to scale back just to feed their gas tanks, who are paying soaring prices at the grocery, and who have virtually no safety net, unlike the rich and the poor. They are, in my opinion, most at-risk for stopping or curtailing therapy, becoming more depressed and finally attempting suicide, some of them successfully.
See Bernstein’s article for a discussion on how many therapists and clients are managing in this miserable climate.Sphere: Related Content
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Police Have it Tough

According to a new study from the University of Buffalo, the stresses of police work increase officers’ risks for high blood pressure, insomnia, increased levels of destructive stress hormones, heart problems, post-traumatic stress disorder (PTSD) and suicide. Based on data from over 400 officers, the study specifically reported that officers over age 40 had a higher 10-year risk of a coronary event compared to average national standards. Seventy-two percent of female officers and 43 percent of male officers had elevated cholesterol levels. As a whole, police officers as a group had higher-than-average pulse rates and diastolic blood pressure.
You can read more on this at ScienceDaily.com.Sphere: Related Content
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Self-Hatred Bodes Ill for Gay Men

“Homonegativity,” or gay self-loathing, predicts a dim future for gay and bisexual men held captve by it, University of Minnesota researchers reported today.
In a study published in the Journal of Homosexuality, researchers surveyed 422 gay and bisexal men in the Midwest at an HIV prevention conference. The surveys gathered data on the men’s attitudes toward affectional and sexual orientation as well as a set of physical and mental health variables. As one might expect, the higher degree of “homonegativity,” the more frequent depression, isolation and poor sexual health occurred.
I say “as one might expect” because it is well-known that secrecy and shame serve as mental prisons where, in their dark, dank interiors, substance abuse, unprotected sex and lies proliferate. Oddly enough, just before reading this story today, I had been discussing the startling death of a colleague’s friend. Otherwise healthy and highly functioning, this young man fell ill on a Wednesday and died two days later. Something about a perforated bowel from an undisclosed anal sex practice, my friend recalled. Of course, this young man was deeply in the closet about his homosexuality and wouldn’t dream of telling any physician he willingly allowed some foreign object to penetrate his rectum. Ultimately, his secrecy, born of his internalized homophobia, killed him.
How many lives have we lost because of the shame and stigma tarnishing otherwise naturally-occurring variations of human sexual and affectional variations?Sphere: Related Content
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Weekly Psych News Roundup

Three Cheers for this Doctor
Dr. Raj Sherman, parliamentary assistant to Canadian Health Minister Ron Liepert, spoke publicly and boldly about his own suicide attempt at 16 years of age. He told his story as he announced that the government will invest $50 million over the next three years into children's mental health services. Read it online at the Edmonton Journal.Sphere: Related Content
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Weekly News Roundup

If We Took a Holiday
UK residents regard their vacation as vital to their mental health, according to a new study. Of course, it's published by Just the Flight, an online travel agent.

Execs Need Help, Too
UC San Diego has created the Executive Mental Health Program which encourages executives, who are feeling the economic pinch in terms of pressure to perform, to take care of themselves as well as their bottom line. Read more about it in the San Diego Business Journal Online.

Suicide Prevention Tips
All too often we hear the words, "I never knew so-and-so was depressed. He just killed himself out of the blue." In fact, most people who suicide leave a trail of clues. They key is knowing what to look for. Here's a helpful piece from the Capital Flyer at Andrews Air Force Base in Maryland.Sphere: Related Content
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Anthrax Suspect Took Secrets and Demons to the Grave

At first blush, news that federal investigators had fingered a respected Army scientist post-mortem as the culprit behind the cryptic 2001 Anthrax scare seemed, well, flimsy. Now some of the facts of this rather bizarre case are surfacing and the accusations seem more justified.


Puzzling and even disturbing is the fact that scientist Bruce Ivins was apparently a troubled soul plagued by dual demons of depression and paranoia yet continued his work as a bioweapons specialist. He struck without warning, without overt provocation. How many others are lurking in our military laboratories, toiling feverishly on their concoctions and twisted plans, known to be possessed by similar demons, but operating without impediment?


Much to his credit, though, Ivins seemed to be more messenger than rogue domestic terrorist. His point seemed to be to scare us out of our complacency. "Look at what the terrorists can do!" he was exclaiming. He hinted that he knew something we didn't. Perhaps, but we'll likely never know. He took his secrets to the grave when he kiled himself a few weeks ago.


What, if anything, could have been done differently? Could Ivins have been stopped before the end to his Anthrax terror spree? Could he have been better protected from his own illness?Sphere: Related Content
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Your Economic State of Mind

The Atlanta Journal-Constitution today published an editorial that captures what must really be the overarching mental health story of the year: What toll has our faltering economy taken on the American psyche?

Mention is made in the piece of a woman who killed herself after her home went into foreclosure. Surely she is neither the first nor the last. While our leaders focus on bail-outs and shake-outs, perhaps it is time that states and local governments pay attention to what is surely a growing mental health crisis.Sphere: Related Content
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Weekly Psych News Roundup

Mentally Ill Murders Decline in the UK
A new study pubished by BBC News this week found that murders committed by mentally ill perpetrators has fallen by two-third in the last 30 years...

Psychiatric Issues Clog Massachusetts Courts
The Wicked Local reports the Commonwealth's district courts were packed with mental health and substance abuse cases in 2008, to the tune of some 9,000, not including criminal cases with psych issues...

The Sadder Sex?
Fox News cited a study that found women may start off happier in life than men, but after 48, the happiness roles reverse...

Popal was Insane
This week, Omeed Aziz Popal, the man who went on a hit and run rampage in San Francisco in 2006, was found legally insane. See the full story at NBC...Sphere: Related Content
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California Takes A Stand for Teen Suicide Prevention

In the ongoing and long-overdue flurry of activity around mental health services for our young people, Gov. Arnold Schwarzenegger here in California this week signed a bill for teen suicide prevention.
Known as the Jason Flatt Act, named after a 16-year-old who successfully suicided, the law allows school districts in California to use a handful of dollars from their Professional Development Block Grants for suicide prevention training of teachers.
This sort of legislation makes for decent ink for both the Governor and the California Teachers Association, which supported the bill. But the reality is the Jason Flatt Act falls very flat. Schools can't use the funds until 2014. When that day comes, they can provide faculty with a paltry two hours of training.
This hardly seems like an urgent response to a very real crisis. The bill itself points out that suicide is the third-leading cause of death for American youth 15 to 24, fourth for kids 10 to 14 and second for college-aged young people.
With tragic numbers like those, it's almost embarrassing that this is the best our Golden State can do.Sphere: Related Content
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