Blog Archives

THE ECONOMICS OF BRINGING MENTAL HEALTH PRACTICE IN LINE WITH THE MARCH 2019 FRONTIERS IN PSYCHIATRY EDITORIAL & CURRENT RESEARCH

8/31/2019

We need Federal and State governments to obtain independent analysis of the ECONOMICS of rapidly bringing Mental Health Clinical Practice in line with current research, especially regarding abnormalities in the Immune System.
The HARD TRUTH is we have a Mental Health Crisis in large part because our treatments aren't very good.
If we really want to TURN THIS AROUND, that is going to require new understandings of "Mental Illness" -- which we are beginning to have.
Unfortunately, we have a very POOR INFRASTRUCTURE to get these new understandings to Clinicians in a TIMELY MANNER.

Precision Health Economics

Frontiers In Psychiatry Editorial -- March 29, 2019

CALIFORNIA'S ‘MENTAL HEALTH CZAR’ DR. THOMAS INSEL SEEKS A NEW BLUEPRINT FOR CARE

8/29/2019

Excerpt

Q: How would you describe the state of mental health in California and in the U.S.?

California has all the issues every other state has — incarceration, homelessness, fragmentation. More than half of people with mental illness are not getting care. There is a very shallow workforce, particularly for kids. We don’t have inpatient beds where we need them.

I’ve spent 40 years working in this field. We have seen vast improvement in those 40 years in infectious diseases, cardiovascular care, many areas of medicine, but not behavioral health.

Suicides are up about 33% since the turn of the century. Overdose deaths are skyrocketing. People with serious mental illness die about 23 years early — and we’re not closing that gap. We’ve got to come up with better solutions now.

. . .

Q: How should the system be designed?

The system now is crisis-driven. The biggest transformation will come when we can identify problems and intervene earlier. That’s when we get the best outcomes in diabetes, heart disease, cancer. It’s equally true in behavioral health.

We have to manage crisis better, keep people out of the criminal justice system, provide more continuity of care.

But we also have to move upstream and capture people much earlier in their journey. This will require building infrastructure we don’t have right now: crisis residential beds, sub-acute beds, places for people to live.

Q: So how do we bring about the needed changes?

California has one advantage few states enjoy. The Mental Health Services Act (MHSA) will provide $2.4 billion this year, including for early intervention, prevention and innovation. We also have [other] funds. Every county is using those funds in the way it sees fit.

The time has come to ask: How can we reduce suicide, overdose deaths and re-hospitalization in California?

One approach would be to set goals for these, i.e., reduce suicide by X% in Y years.

Housing and incarceration have gotten worse over time. Should the state make a pledge to its citizens to do better in those areas?

. . .

Q: Can technology play a role in improving mental health?

As much as one might hope there’d be an app for that — it’s really complicated. In the months I’ve focused on creating a mental health plan for California, technology is barely in the conversation. Having said that, I do think in the future using digital tools to connect people to care will be transformative.

Q: The recent mass shootings in El Paso and Dayton, like numerous others before them, were perpetrated by angry, alienated young men. What does this say about our culture and the American psyche?

It’s a complicated question. There is an element of untreated mental illness that leads to high risk of violence.

That violence is usually self-directed in the form of suicide; occasionally, it’s other-directed.

We did better, oddly enough, when I started in the field than we’re doing today in providing more comprehensive, continuous care.

I think we are in a crisis, but it’s a crisis of care. So whether the mass shootings are a reflection of that or not — maybe to some extent, but they’re a small part of a much bigger issue. We are failing to provide care to people with brain disorders. We need to do better.

Dr. Thomas Insel

The BIGGEST PROBLEM with Colorado Behavioral Health Policy is it is focused on CRISES and NOT on providing LONG TERM Housing & Supports.

THIS IS IMPORTANT. Insel is really arguing for Olmstead:

Measurable Goals
Reasonable Time Frames, and
Funding to Support the Plan

THE US MENTAL HEALTH DEBATE-- WHERE IT "IS" AND WHERE WE WOULD LIKE TO SEE IT GO

8/29/2019

The US Mental Health Debate gets caught up in whether "mental illness" is the source of violence in Society.
This proves to be pretty problematic because we currently don't have a consistent definition of "mental illness" or a valid psychiatric diagnostic manual.
What we do have is a HUGE CATEGORY of millions of people and that category is not very helpful in trying to really FOCUS on the biological underpinnings of violence -- which can include traditional or classic notions of mental illness but also involve brain injury, developmental disorders, biological changes due to environment, etc.
A lot of our laws are based on this HUGE "Mental Illness" Category and may often consciously or unconsciously try to limit the concerns to PSYCHOSIS. Psychosis is a BIG BIOLOGICAL ISSUE -- there are a lot of others.
So our concern when we use "Mental Illness" as the FILTER to discuss violence and biology in society -- things go OFF THE RAILS pretty quickly because "Mental Illness" is really NOT the right FILTER and is very poorly defined and understood.
Just adding BRAIN INJURY to the question of biology's relationship to violence brings us a lot closer to REALITY than the current debate.
So we want to see the DEBATE both expanded and narrowed to hone in on specific BIOLOGY that leads to violence.
Currently researchers are working on a BLOOD TEST for SUICIDALITY -- it is not too hard to imagine that at some point we will have bio-markers for homicidality.
If we don't have all the ANSWERS to BIOLOGY AND VIOLENCE -- AND WE DON"T -- that places some HEAVY ETHICAL DUTIES on the LAW or it SHOULD -- both to treat individuals humanely and to provide protection from what may be much more complicated than an individual, isolated bad act with "bad intent."

Debating Workshop @ The Oxford Union

COMING TO TERMS WITH SOME "MENTAL ILLNESS"-- AS A "DEVELOP-MENTAL DISORDER" AND A DISORDER OF THE "IMMUNE SYSTEM"

8/26/2019

OUR Science Information really points to the need for Federal Leadership in synthesizing research and making it more available to the PUBLIC as well as TRANSLATING that Research to CLINICAL PRACTICE.

NIMH does some of that -- BUT NOT NEAR ENOUGH.

This must become a PRIORITY @ the Federal Level. There is an ENORMOUS AMOUNT of CURRENT RESEARCH INFORMATION that should be influencing Individuals, families and clinicians and ISN"T because they don't have easy access to it.

This needs to be centrally located and constantly updated.

A HUGE ISSUE is: Who should be screened for immune encephalitis -- a recently identified disease sometimes mistaken for mental illness? We should easily know that.

More Thoughts on Ramifications of Current Research

Dr. Gail Saltz in her book -- "The Power of Different" recommends that:

80% of the time be spent on developing people's STRENGTHS, and
20% of the time on WORKAROUNDS for Weaknesses

This is more in line with the emerging science of some Mental Illness as a developmental disorder. We can't really ignore weaknesses -- BUT it makes a lot more sense to look for WORKAROUNDS than trying to CHANGE people. Further, the expression of those weaknesses sometimes is markedly reduced with focus on development of STRENGTHS.

We think some of the CHALLENGES some people are facing involve genetic and epigenetic pathways related to the IMMUNE SYSTEM which appear to implicate autism, ADHD, bipolar diorder, schizophrenia, and depression. This is our understanding of the research from the National Institute of Mental Health (NIMH).

Further, this may also make some people more @ risk for other immune disorders such as Thyroid Disorders, Celiac Disease or Sensitivities, and the more recently recognized immune or Anti-NMDA Encephalitis. Many immune diseases/disorders do have psychiatric impacts.

So first off -- the ALARM BELLS should really be ringing regarding the high level of Immune Disorders in the US, the Developed World, and increasingly the Developing World.
There are a lot of things that can harm the Immune System -- BUT it appears that we're doing a lot more damage than previous generations.

We have to get a handle on this -- and this likely relates to a lot of things. Two of the factors we want to highlight include:

destruction of the diversity of the human Microbiome and
the rise of smoking during the 20th Century -- and impacts that haven't gone away even as the rate of smoking has declined.

University of Michigan:
Cells of people with Bipolar Disorder are developmentally different than the cells of people without Bipolar Disorder.

Blurred Lines

Old Friends Hypothesis

ADHD: A Public Health Crisis

Mental Illness/Immunology Timeline

Immunology, Physical Illness and Mental Health

THE BIZARRE INTERSECTION BETWEEN LAW AND "GIFTEDNESS": ADULTING WITH "EXCEPTIONALITIES" IN THE CRIMINAL JUSTICE SYSTEM

8/25/2019

Some Not So Random Thoughts
Who you find in the Criminal System -- lawyers, judges, defendants are largely the "EXCEPTIONALITIES" in our Society.

    Further, attorneys tend to be hit pretty hard with addiction and mental health problems -- not unlike the defendants in the Criminal Justice System.

  Further, many of those gifted kids in the Humanities did go into LAW [see video below].

BUT there is a BIG DIFFERENCE between REASONING & LOGIC ability and EMOTIONAL REGULATION -- and in fact we would argue INTENSE EMOTION is NOT logic's opposite -- but rather often logic's fuel.

  Further, there is a REASON why so much is made of "JUDICIAL TEMPERAMENT" and that is because it is so hard to find among lawyers.

   Ironically, Society needs the DEVELOPMENTAL DIFFERENCES of attorneys, judges and defendants to craft innovative solutions to our most long standing problems in the Criminal Justice System.

Tonic on Demand
Bipolar Disorder (2016)

See 3:18: Bipolar linked to the EXCEPTIONALITIES in the Humanities -- above average, below average -- the main thing -- NOT AVERAGE.

Often, the Criminal Law is a lot about:

MORAL OUTRAGE
SELF RIGHTEOUSNESS
PERFORMANCE ART

and this all gets wrapped up in some authentic and not so authentic concerns for JUSTICE.

Historically, the SEARCH for JUSTICE has typically TRUMPED the SEARCH for SOLUTIONS to pretty COMPLEX PROBLEMS.

In fact, Judges would likely say they CANNOT SOLVE those problems for fear of intruding on the sphere of influence of the Legislative Branch.

The Blurred Lines Between Developmental Disability & Mental Illness, and Some Thoughts about "Giftedness"

Bringing Giftedness Down To Earth So We Could Start Recognizing It in Unlikely Places

Report from the National Task Force on Lawyer Well-Being

"Exceptionalities" include learners with disabilities, learners who are gifted and talented, and learners with disabilities who are gifted and talented

Click Image to go to Slide Player.

Acclaimed Neuroscientist & Author Antonio Damasio explains why the Mind encompasses more than just the Brain.

The BIAS in FEAR

8/23/2019

The FEAR of REASON as our Mental Health Profession:

lacks a scientifically valid diagnostic manual;
is handing out "anti-social personality disorder" diagnoses like candy in the Criminal Justice System; and
our Mental Health Crisis rages.

    I'm pretty critical of the Mental Health Profession -- but the reality is -- I spend a lot of time trying to pull my punches so as a mental health patient I don't come off as even more "crazy" than I really am. I'm not sure I always succeed.

It is pretty unbelievable how BAD this has gotten without somebody/somebodies assuming some LEADERSHIP to address the CRISIS which is brought on by NEW KNOWLEDGE.

AND the Mental Health Profession CANNOT do this by themselves.

  The LOGIC IS NOT Rocket Science -- BUT the SOCIAL RAMIFICATIONS are -- and that is really the cause of the FEAR that is paralyzing our society and preventing us from fully dealing with these issues.

  At its most BASIC -- the mental health profession is NOT competent to make "diagnoses" without a scientifically valid diagnostic manual. -- THEY DON'T HAVE ONE.

On the other hand, the lack of a scientifically valid diagnostic manual did NOT MAGICALLY eliminate the biological realities of various forms of "mental illness" among some people across the planet -- even while we can't accurately describe or define them and we're @ the earliest stages of identifying BIOMARKERS.

It is PUBLIC POLICY regarding COGNITIVE DISABILITIES that has the best shot @ ethically and morally addressing the situation of HUNDREDS OF THOUSANDS of people with cognitive disability in the US who are homeless and/or incarcerated.

   Most of the LAWS are already there -- WE JUST NEED TO COMPLY WITH THEM.

[At 15:20: death of Keira Johnson and the horrofic bind her husband as a black man was placed in as he realized doctors were not taking the life-threatening situation seriously]

Mental Health's Tower of Babel

whatslarrysproblem.com

THE NEED FOR EVOLVING RELIGIOUS & PHILOSOPHICAL IDEAS TO ADDRESS THE EVER-GROWING "GAPS OF SCIENCE"

8/21/2019

These days the religion and philosophy departments of most universities are pretty limited if they exist @ all.

Hasn't SCIENCE eliminated the need for those disciplines?

We would argue that it is the SUCCESS OF SCIENCE that has increased the need for FAITH & REASON.

The brush-off of religion as a "God of the Gaps" -- misses the point that the more we know -- the more we are aware we don't know -- and the larger those GAPS appear to become.

A lot of the current problems with the CRIMINAL LAW involve unethical treatment of IGNORANCE. "Oh we'll solve that just as soon as SCIENCE gives us all the answers" -- well, SCIENCE has put the GAPS in pretty HIGH RELIEF.

FAITH is NOT divorced from SCIENCE -- and social crises often follow when FAITH & Public Sentiment cannot keep up with SCIENCE or are afraid of it.

Human reason, faith and science are NOT INFALLIBLE and often make mistakes and require constant vigilance just as much as LIBERTY.

BUT without human reason, faith and science we don't have the necessary tools to make our way in the world in which much remains unknown, and the more we learn -- the more we realize we don't know.

COMING TO TERMS WITH VERY FLAWED PSYCHIATRIC MEDICATION-- SOME PEOPLE WILL CHOOSE JAIL OVER THE HOSPITAL IF IT MEANS THEY CAN ESCAPE COERCIVE MEDICATION

8/18/2019

So Psychiatric Medication CAN BE a GODSEND to many people.

The HARD, HARD REALITIES we are having to come to terms with -- are that for a significant percentage of people with serious mental illness -- psychiatric medications don't work very well.

Why has Community Mental Health FAILED, really? Those medications didn't work as well as everyone had hoped.
Just because the medications don't work very well does NOT mean:
- the person is okay -- or
- the person has a "PERSONALITY DISORDER" -- absolving the Mental Health profession of pretty much all responsibility -- and providing a handy rationalization for CRIMINALiZATION.

We've seen so much "mis-diagnosis" of "anti-social personality disorder" even for people who have well documented histories of biological mental illness as soon as the professional exhausts his or her toolbox. ADD IN some racial and ethnic minority statuses and the rate goes up even higher.

The medication has problems, the profession doesn't have a good sense of its limits----primarily because the SOCIETY isn't willing to responsibly deal with those limits.

AND a significant percentage of people with serious mental illness are confronted with:

Medication that doesn't work very well, AND
Mental Health professionals who are:
- behind in the RESEARCH,
- don't have a scientifically valid diagnostic manual
- and may not even understand why any of that matters anyway.

We're NOT going to get out of this MENTAL HEALTH CRISIS without providing ENORMOUS support to the Mental Health Profession in terms of:

Scientifically Valid Psychiatric Diagnostics or perhaps even more importantly just an honest acknowledgement of the profound scientific challenges with the current state of psychiatric diagnostics and the rapid increase in research that has NOT been effectively integrated into Clinical Practice.
The HUGE policy implications for the Society and Individuals regarding psychiatric medications that are much more COMPLICATED than we've had the COURAGE to recognize.

In fairness, researchers and individual professionals often do understand the problems.

Our impression is that the American Psychiatric Association has been pretty slow to assume a Leadership Position to deal with the challenges and has on occasion resisted addressing these complex issues.

Science Up

Dr. Daniel Amen on Brain Scans & Modern Psychiatry

Dr. Russell Copelan's Aug. 2019 Medpage Today Article on the Failures of Psychiatric Diagnostics

GROWING UP TO REALITY & MOVING AWAY FROM HUMAN SACRIFICE: AGAIN

8/16/2019

One of the many problems of looking @ things through the lens of the "good people" and the "bad people" --- is that harsh environments and challenging biology -- don't discriminate on that basis.
Further, some of the people who have suffered the most in our society -- are not surprisingly struggling with the biological and cognitive ramifications of that.

Thomas Hobbes' famous line," "Life is solitary, poor, nasty, brutish and short" is kinda catchy-- my political theory professor in college made us recite that line every day of class in unison.
    Life can be every bit of that brutality and more, it can be beautiful and it can be blah and meh.
But in any case LIFE IS SHORT -- even with a longer life span -- it is pretty short in the scheme of things.
   So if you're facing significant "UNFAIRNESS" in your life, community, society, and/or world -- you DON"T have a LONG TIME TO FIX IT -- even if you are PROACTIVE.
   That desire for FAIRNESS and JUSTICE in the WORLD has led to a lot of wonderful things -- and it's led to a whole lot of PRETENDING throughout HUMAN HISTORY, often to HORRIFIC EFFECT.
HUMAN SACRIFICE is one of the great HORRORS of Human History -- supposedly -- we largely got out of that with Isaac.
  BUT the CRIMINAL LAW has sought to pretty-up Human Sacrifice by conditioning it on the proving of elements of a crime and "intent."
AND in fairness -- people were often just trying to protect the community -- even though it often degenerated into ENTERTAINMENT -- and it still does.
  We like to have TOWERING BINARY DEBATES about FREE WILL and DETERMINISM -- in the meantime, the vast majority of people incarcerated in the most incarcerated country in the world --- have recognized cognitive disabilities and often a combination of those cognitive disabilities, including brain injury, mental illness, developmental disability, substance issues, etc.
It is TIME for us to get away from our LEGALISTIC RATIONALIZATIONS for MODERN DAY HUMAN SACRIFICE -- We MUST:

Protect the Community,
Provide evidence-based treatment where we have it and
Humane custodial care where we don't.

What's our point with this image? We don't really think Buddhist Karma is quite as sophisticated an idea as it is sometimes taken, especially in the West. People may object that this isn't a fair representation BUT we think the idea of "karma" is another example of people's desperate struggle with the "unfairness" of life.

THE HARD ISSUES REGARDING THE SHAKY FOUNDATION OF PSYCHIATRIC DIAGNOSTICS

8/16/2019

Our Mental Health Profession has so many FUNDAMENTAL logical and scientific problems.

We're NOT going to solve our Mental Health Crisis until we get the COURAGE to tackle those issues.

Russell Copelan, M.D.

August 13, 2019

By Russell Copelan, M.D.

Despite the Zero Suicide initiatives, information resources, telephone numbers, best practices, mental health first aid -- and yes, board certification and other tools distributed for safer suicide care -- from 2000 to 2017, the suicide rate in the U.S. increased to a 50-year high, and the youth suicide rate of 14.6 per 100,000 appears to be the highest it's been since the government began collecting such statistics in 1960.

Among other reasons, two of the primary and persistent puzzlements affecting these dreadful statistics include:

(1) the incongruity between society's obvious mental health needs and what society chooses to pay for suicide and violence risk assessment, and

(2) the presence of high barriers to implement innovative tools that guide clinical judgment, such as pervasive administrative resistance and special organizational interests, for example, the APAs valuable DSM property.
In part, these stupefactions stem from:

(1) the troika of ineffective access, incompetent training, and inept assessment in psychiatric emergencies,

(2) the painstaking difficulty in defining "mental illness" and suicide and, relatedly,

(3) the unsettling amorphous shape of diagnostic psychiatry.

<<Previous

Val's Blog