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Welcome to the New Year!

As I have posted over and over again, if you take away the services available to stabilize the mentally ill, you will increase the use of ER and police tenfold.  These are two areas of service that are already overburdened and in trouble.  Now, as you can see in the article below, the crushing feeling is now beginning to be noticed.

Here’s an article from Reuters, and I hope you will click over and read the article fully, not just what I posted below.  This is just the beginning.  We definitely need a better solution to this problem.

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By Julie Steenhuysen and Jilian Mincer | Reuters – 21 hrs ago

C

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HICAGO/NEW YORK (Reuters) – On a recent shift at a Chicago emergency department, Dr. William Sullivan treated a newly homeless patient who was threatening to kill himself.

“He had been homeless for about two weeks. He hadn’t showered or eaten a lot. He asked if we had a meal tray,” said Sullivan, a physician at the University of Illinois Medical Center at Chicago and a past president of the Illinois College of Emergency Physicians.

Sullivan said the man kept repeating that he wanted to kill himself. “It seemed almost as if he was interested in being admitted.”

Across the country, doctors like Sullivan are facing a spike in psychiatric emergencies – attempted suicide, severe depression, psychosis – as states slash mental health services and the country’s worst economic crisis since the Great Depression takes its toll.

This trend is taxing emergency rooms already overburdened by uninsured patients who wait until ailments become acute before seeking treatment.

“These are people without a previous psychiatric history who are coming in and telling us they’ve lost their jobs, they’ve lost sometimes their homes, they can’t provide for their families, and they are becoming severely depressed,” said Dr. Felicia Smith, director of the acute psychiatric service at Massachusetts General Hospital in Boston.

Visits to the hospital’s psychiatric emergency department have climbed 20 percent in the past three years.

“We’ve seen actually more very serious suicide attempts in that population than we had in the past as well,” she said.

Compounding the problem are patients with chronic mental illness who have been hurt by a squeeze on mental health services and find themselves with nowhere to go.

On top of that, doctors are seeing some cases where the patient’s most critical need is a warm bed.

“The more I see these patients, the more I realize that if it’s sleeting and raining outside, the emergency room is the only place they have,” said Dr. R. Corey Waller, director of the Spectrum Health Medical Group Center for Integrative Medicine in Grand Rapids, Michigan.

Government agencies such as the National Institutes of Mental Health, the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration could not provide fresh data on use of psychiatric services in recent years.

But doctors from more than a dozen hospitals nationwide, mental health advocacy groups and state-funded agencies told Reuters they are all seeing a marked increase in psychiatric emergencies.

A WORSENING PROBLEM

The National Association of State Mental Health Program Directors (NASMHPD), an organization of state mental health directors, estimates that in the last three years states have cut $3.4 billion in … [read more]

This is an interesting article from the Guardian on Facebook.  I highly recommend you check them out and read other interesting articles they have there.  This article, for me, is just too sad.  It’s also sad to see, here in print, that this is a global issue, not a local one.  With our global economy in the tank, homelessness is on the rise.  What do we plan to do about it?  Anything?

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Wednesday 21 December 2011

 By Pem Charnley

It’s not the weather that tends to kill homeless people – it’s a descent into addiction and a dearth of services catering to them

A new report from Crisis highlights the short life expectancy of people who live on the streets – just 47 years, which is 30 fewer than the general population. How can we start to unknot the various and intricate threads that lead up to someone finding refuge in a car park at three in the morning, trying to find a safe place for the night?

In a relatively temperate climate such as ours, not having a roof over your head seldom is the killer. Not in my experience anyway. The homeless people I’ve once known who passed away either drank themselves to a jaundiced death, or hanged themselves because they couldn’t set themselves free from heroin. When you appreciate that waiting lists for help with addiction are frustratingly lengthy for those who do have a home, then you begin to understand how precious little it amounts to when a homeless person has a brief moment of clarity in a sleeping bag. You can’t just hang in there until 8am and call your GP. There’s no referral letters for treatment through the post, no phone calls from a key worker confirming an appointment for the following week. No peck on the cheek from a relieved spouse as you have a quick shave and disappear off to an AA or NA meeting, hope restored.

Homelessness and addiction, the perennial Catch-22. It’s nigh on impossible to separate these two; you’d call them bedfellows, only in this instance, there is no bed. And when there’s no bed, it’s hardly down to a lack of willpower if you’re going to use drugs or drink to numb your sense of helplessness and isolation: four out of five people start using at least one new drug after becoming homeless. That’s some bleak statistic.

The Crisis report finds that a third of all deaths amongst the homeless are attributed to alcohol or substance abuse. Can those numbers ever be brought down? Well, how can you realistically turn your life around under such circumstances? We are always told that health should come first, but is this possible when you haven’t got a fixed address? Specialised services catering to those on the streets do exist in some places, but just as postcodes can be pivotal in our children’s education, they also play a part in support for the homeless. It’s a rather cruel irony when you haven’t actually got a postcode to begin with.

Speaking to my local homeless charity here in Exeter, it was pleasing to know that the centre organises GP visits, which are scheduled on a regular basis – an encouraging fact, yet you can’t help but wonder why this can’t be a given regardless of where you are living. Immediate health advice (including mental health – homeless people are nine times more likely to kill themselves than the general population) and reliable support is of paramount importance to those living on the streets. When you’ve experienced how hopeless addiction can feel, it’s more than likely that substance abuses and suicides are one and the same statistic, and it desperately needs to be addressed holistically.

So, where to start? Sadly, the downturn has brought with it an almost inevitable increase in homelessness. Never was there such a poor time to cut back on budgets, yet with our government-led savings of up to 65% in key services who cater to vulnerable people, it seems unlikely that we’ll see any kind of improved outreach or support any time soon.

Related articles

• National News: Homeless men ‘die 30 years early’ (coventrytelegraph.net)
• Homeless women ‘die by age 43′ on average (telegraph.co.uk)

Peer Specialists must undergo significant training and certification to be allowed onto mental health units, but even that is not enough to prevent these wonderful people from “giving back” and staying healthy.

Please read this article entirely at the site, The New York Times.  You won’t regret reading it and you will learn quite a bit about who a peer specialist is.
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After Drugs and Dark Times, Helping Others to Stand Back Up

  View the Video Feature »

Dual Diagnosis: Antonio Lambert, diagnosed with a mood disorder and addiction, manages through faith, medication and companionship – leaning the same “peer specialist” skills he teaches.

By BENEDICT CAREY

Published: December 19, 2011

SMYRNA, Del. — The taste of cocaine and the slow-motion sensation of breaking the law were all too familiar, but the thrill was long gone.

Antonio Lambert was not a young hoodlum anymore but a family man with a career, and here he was last fall, high as any street user, sneaking into his workplace at 9 o’clock at night, looking for — what, exactly? He didn’t really know.

He left the building with a few cellphones (which he threw away) and a feeling that he was slipping, falling back down into a hole. He walked in the darkness, walked with no place to go, and then he began to do what he has taught others in similar circumstances to do: turn, face the problem, and stand back up.

“I started talking to myself, out loud; that’s one of my coping strategies, and one reason I relapsed is I had forgotten to use those,” said Mr. Lambert, 41, a mental health educator who has a combined diagnosis — mood disorder with drug addiction — that is among the scariest in psychiatry.

He texted a friend, someone who knew his history and could help talk him back down. And he checked himself into a hospital. “I know when it’s time to reach out for help.”

The mental health care system has long made use of former patients as counselors and the practice has been controversial, in part because doctors and caseworkers have questioned their effectiveness. But recent research suggests that peer support can reduce costs, and in 2007, federal health officials ruled that states could bill for the services under Medicaid — if the state had a system in place to train and certify peer providers.

In the years since, “peer support has just exploded; I have been in this field for 25 years, and I have never seen anything happen so quickly,” said Larry Davidson, a mental health researcher at Yale. “Peers are living, breathing proof that recovery is possible, that it is real.”

Exhibit A is Mr. Lambert, a self-taught ex-convict who is becoming a prominent peer trainer, giving classes in Delaware and across the country. He is one of a small number of people who have chosen to describe publicly how difficult it is to manage such a severe dual diagnosis, including the sudden setbacks that often come with it.

“He is an extreme example of how much difference passion and commitment can make, given where he’s come from,” said Steve Harrington, the chief executive of the National Association of Peer Specialists, a group devoted to promoting peer support in mental health care.

Mr. Lambert, who has climbed out of a deep hole with the help of religious faith, medication and his own forms of self-expression, puts it this way: “There are a lot of people dealing with mental illness, drugs, abandonment, abuse, and they don’t think there’s a way out. I didn’t. I didn’t.”

Bean Bean in Spider City

His grandmother was the first person to call him Bean Bean, and the boy was so skinny that he couldn’t shake it.

He couldn’t avoid the older toughs in the Brighton section of Portsmouth, Va., either, and he spent some of his school-age years taking beatings. That was Brighton back in the day, and at least those fights taught survival skills. Not everything did: He remembers being sexually abused at age 6, by an older boy in the neighborhood — brutally.

He had no one to tell, even if he had known what to say. His mother and father were split, living blocks apart, each a fixture in the neighborhood’s social swirl of house parties, moonshine “shot shops,” card games and other attractions. His mother, called Chucky, was often out, sometimes leaving the boy at a friend’s house for “a few hours” that turned into an entire weekend. For much of that time, he waited on the porch.

He idolized his father, a truck driver and warehouse worker who lived nearby but spent his free time out, too, drinking and playing cards.

“During that time I was an alcoholic, but I would go out and try to find him when I heard he was out,” said his father, Edward Lambert, in a recent interview at his house in Brighton. He gave up drinking years ago for God, and father and son would eventually become close…[read more]

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• Report on Tennessee’s First Peer Specialist Conference (hopeworkscommunity.wordpress.com)

Here’s some of this article.  I suggest you click over to read the full article if this story scares you as much as it does me.

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SACRAMENTO, Calif.—California has begun transitioning its mental health services program to concentrate care on the most serious patients residing in state mental hospitals and prisons, but the cost-cutting move is raising concerns about patient care from state workers.The state announced last week it will hand off more responsibility for public mental health programs to counties as part of Gov. Jerry Brown’s ongoing push to move services to California’s local governments. The administration says the reorganization will allow the state to form a new Department of State Hospitals that focuses exclusively on 6,300 patients in state hospitals and prisons.

“We think that as a package we’re providing a set of proposals that saves money but doesn’t change the quality of care and also increases safety,” Department of Mental Health acting-chief deputy director Kathy Gaither said in an interview Monday.

Earlier this year, state mental health officials assigned a committee to come up with a plan to improve care and safety while also finding places to cut costs within the state’s mental hospital system. The committee returned with a blueprint for overhauling the department’s policies and procedures. It cuts 346 positions in the current year to save $122.6 million and eliminates 620 positions to save $193 million next year.

The administration says it does not plan layoffs because many of those positions are already vacant or can be done through attrition.

The department currently has a $1.3 billion general fund budget.Safety Now!, a coalition of psychiatric technicians, physicians and other state hospital workers, warns that the plan would reduce staffing ratios by nearly one-third.

“It is clear that only short-term monetary goals are driving the state’s decision to cut staff,” Stuart Bussey, a doctor and president of the Union of American Physicians and Dentists said in a statement. “We know that if treatment staff are cut, patient safety will certainly deteriorate further, and assaults will increase—and that will ultimately cost the state of California more money in lawsuits than these proposed cuts will save.”

The new structure reduces patient-to-staff ratios, a move state officials say is needed to cut down on the use of overtime and contract staff—the two single biggest drivers of increased hospital spending. The department plans to modify staff levels based on the patients’ needs, putting more psychologists and psychiatrists with the most serious and aggressive patients and fewer with the more stable patients.

This week the Department of Mental Health will start with a pilot program at Atascadero State Hospital to treat its most aggressive patients together. If successful, that approach could expand to the state’s four other mental hospitals, Metro, Napa, Coalinga and Patton, along with two psychiatric programs at Vacaville and Salinas Valley state prisons.

Felisa Hamman, a nurse at Atascadero State Hospital, said it’s good the state is testing out the enhanced treatment unit, but she worries about other patients with personality disorders who have assaulted staff…[read more]

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I thought this article was interesting and felt it needed to be posted here for your perusal.  Won’t you read this article and then let me know what you think?  Is there a connection between infection and mental illness?

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Brody Kennedy was a typical sixth-grader who loved to hang out with friends in Castaic and play video games. A strep-throat infection in October caused him to miss a couple of days of school, but he was eager to rejoin his classmates, recalls his mother, Tracy.

Then, a week after Brody became ill, he awoke one morning to find his world was no longer safe. Paranoid about germs and obsessed with cleanliness, he refused to touch things and showered several times a day. His fear prevented him from attending school, and he insisted on wearing nothing but a sheet or demanding that his mother microwave his clothes or heat them in the dryer before dressing.

So began a horrific battle with a sudden-onset mental illness that was diagnosed as pediatric autoimmune neuropsychiatric disorder associated with streptococcus, or PANDAS. The puzzling name describes children who have obsessive-compulsive disorder that occurs suddenly — and often dramatically — within days or weeks of a simple infection, such as strep throat.

“He washed his hands over and over and was using hand-sanitizer nonstop,” said Tracy Kennedy, who has home-schooled her 11-year-old son since early November. “He had never been like this before. Ever. He just woke up with it.”

The bizarre illness, first recognized in the mid-1990s, has been cloaked in controversy. Now, however, studies are reinforcing the belief that some psychiatric illnesses can be triggered by ordinary infections and the body’s immune response. While the theory remains unproved, the research raises the possibility that some cases of mental illness might be cured by treating the immune system dysfunction.

“Some people get sick with whatever infection, and they recover and they’re fine,” says M. Karen Newell Rogers, an immunologist at Texas A&M Health Science Center College of Medicine in Temple, Texas, who studies such illnesses. “Other people get sick and recover, but they are not the same.”

PANDAS is thought to be caused by antibodies generated as a result of an infection, usually strep. Normally, an infection causes the body to generate antibodies that fight the infection and promote healing. But in PANDAS, the antibody response is thought to go awry, attacking brain cells and resulting in OCD symptoms.

A greater understanding of the link between strep and OCD has opened the door to the study of other psychiatric or neurological illnesses that may be linked to improper immune response, including cases of autism, schizophrenia and anorexia.

“The whole area of mental illness caused by infections is being looked at more closely because of PANDAS,” says Dr. Michael A. Jenike, a professor of psychiatry at Harvard Medical School and chairman of the International OCD Foundation’s scientific advisory board. “If you can prevent lifelong suffering by using antibiotics or some acute intervention, that would be huge.”

Little understood disorder

PANDAS is generally poorly understood in the medical field, said Dr. Margo Thienemann, a Palo Alto child psychiatrist who has treated several cases. There is no test to help doctors diagnose it, although the National Institute of Mental Health says that PANDAS can be identified after two or three episodes of OCD or tics that occur in conjunction with strep infection — a vague guideline that results in much confusion.

Thienemann says patients tend to fall between the cracks of psychiatry and immunology. But early diagnosis is important.

“In psychiatry, we generally spend our time treating diseases without knowing the reason they happen,” she says. “With PANDAS we are able to see the cause of a problem rather than the downstream effects. This is the exciting part.”

OCD affects about 1% of people and can feature a fear of contamination by germs or other substances, hoarding, intense anxiety over one’s moral behavior, tics, compulsive skin-picking or body dysmorphic disorder (obsession with some perceived bodily imperfection). The disorder tends to run in families and usually appears around the ages of 10 to 12, with a later spike in rates from age 18 to 22.

No one knows what portion of obsessive-compulsive disorder cases may be tied to PANDAS — or even how prevalent the condition may be, Jenike says.

“I used to think it was exceedingly rare,” he says. “Now I think it’s exceedingly common.”

Recent research has strengthened support for PANDAS. For instance, one study demonstrated that in mice prone to autoimmune disorders (in which the immune system attacks healthy cells), exposure to strep led to OCD-like behavior. The study was published in 2009 in the journal Molecular Psychiatry.

A 2010 Yale study found that tic symptoms worsened somewhat in children with OCD following a strep infection. That study, published in Biological Psychiatry, suggests some children are vulnerable to flare-ups of OCD symptoms when stressed by infections.

Another paper, published online in August in the Journal of Pediatrics, found that, compared with children with typical OCD, children diagnosed with PANDAS were more likely to have biological evidence of a recent strep infection, a sudden onset of psychiatric symptoms and an easing of those symptoms while taking antibiotics…[read more]

Related articles

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Image by Feggy Art via Flickr

Here’s an article that describes just how poorly we, as a society, are doing in helping those who have a mental illness or are having emotional/psychological issues that are situational.  California leads the nation in the healthcare field.  This article is based on a study funded by the California Department of Mental Health.

The statistics in this article are certainly eye-opening.  If we continue to ignore this problem, it obviously is not going to go away.  Many people are suffering unnecessarily because of stigma, money, lack of availability of care, or just lack of knowledge about mental illness.

Do we really want to be ostriches with regard to the issue of mental health?  It seems we do.  Please read this article from the Central Valley Business Times and then let me know your opinion on this topic, won’t you?

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LOS ANGELES
December 5, 2011 10:42am

Serious psychological distress, event difficulty functioning, are commonplace

•  ‘There is a huge gap between needing help and getting help’

 
Nearly two million California adults need mental health treatment, but most receive no services or inadequate services, says a new report by the UCLA Center for Health Policy Research.

The lack of treatment is in spite of a state law mandating that health insurance providers include mental health treatment in their coverage options, the report says.

How bad are the problems? The UCLA researchers say one in 12 Californians reported symptoms consistent with serious psychological distress and experienced difficulty functioning at home or at work.

Over half of these adults reported receiving no treatment for their disorders, and about one-quarter received “inadequate” treatment, defined as less than four visits with a health professional over the past 12 months or using prescription drugs to manage mental health needs.

The study draws on data from the 2007 California Health Interview Survey (CHIS), which is conducted by the Center.

“There is a huge gap between needing help and getting help,” says David Grant, the study’s lead author and director of CHIS. “The data also shows large disparities in mental health status and treatment by demographic, economic and social factors. These findings can help direct the state’s limited resources to those in greatest need of help.”

Unsurprisingly, says the report, uninsured adults had the highest rate of unmet needs (87 percent), which includes receiving no treatment or receiving less than minimally adequate treatment; 66 percent of these adults received no treatment.

By contrast, 77 percent of privately insured and 65 percent of publicly insured Californians reported unmet needs. Although poverty and mental health needs are strongly correlated, the lower rate of unmet needs by public program participants suggests that these programs are more likely to effectively offer mental health services than even private insurance policies.

Other findings include:

• Single adults with children had more than double the rate of mental health needs (17 percent) when compared with all adults (8 percent). Single adults without children had the next highest rate (11 percent). Married adults with or without children had the lowest rates of mental health needs (6 percent and 5 percent, respectively.)

• Nearly 12 percent of Hispanics born in the U.S. needed mental health treatment, almost twice the level of Hispantic immigrants.

• Approximately 17 percent of American Indians and Alaska Natives had mental health needs, the highest of all racial and ethnic groups. Native Hawaiian, Pacific Islander and multi-racial groups had the next highest rate, at 13 percent.

• Nearly 20 percent of these adults needed mental health treatment — more than double the statewide rate.

• Compared to the general adult population, those with mental health needs had higher rates of chronic diseases such as high blood pressure, heart disease, diabetes and asthma. They were more than twice as likely to report fair or poor health status and five times more likely to report poor health.

The report was supported by a grant from the California Department of Mental Health.

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Here’s an interesting article I found on DailyRx about research investigating the incidence of two or more disorders being present at one time.  I have often wondered about OCD and Bipolar in my 20 years of psychiatric nursing.  They seem to share common characteristics.  Although with a bipolar, the OCD may not express itself quite as obviously as it does in someone who only has OCD; there are, however, many similarities to the behaviors expressed by both groups.

Please read this article and visit the site for more interesting articles.  Let me know your views on the topic if you care to.  I am always open to hearing other people’s ideas about mental health issues.

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The prevalence of mental health disorders along with a recent increase in mental health awareness is beginning to help researchers understand how these disorders develop.

Considering the rarity of mental health diseases such as obsessive compulsive disorder (OCD) and bipolar disorder, one would think it would be quite uncommon for such diseases to occur concurrently in an individual. However, a new study shows very high rates of comorbidity in mental health disorders, increasing the severity of some diseases.

A recent study, available through the Anxiety Disorders Association of America’s journal Depression and Anxiety, investigated the role of comorbidity in the expression of OCD. Kiara Timpano, Ph.D., an assistant professor of psychology at the University of Miami, led the study.

The Structured Clinical Review for DSM-IV was used to evaluate 605 OCD patients. Split into three groups, 13.1% of the group was bipolar, 64.1% were largely depressed, and 22.8% had OCD alone.

Comparisons among the groups analyzed comorbidity patterns, OCD symptoms, and impairments in order to determine the severity of their ailments.

Bipolar disorder patients revealed the most severe symptoms, followed by depression, and finally those with OCD alone. Fortunately, bipolar comorbidty represents a smaller segment.

Timpano explains, “those individuals with comorbid affective disorders, particularly BPD (bipolar disorder), represent a clinically severe group compared to those without such comorbidity.”

Treatments are available for obsessive compulsive disorder, bipolar disorder, and major depression and show great results to many sufferers.

Talk with your doctor if suffering from a mental health disorder.

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