INdiana Systemic Thinking

February 19, 2008

Mental Health: Meds, Therapy, or Both?

In a story by the UPI, the Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services in Washington, said consumers spent 17 billion dollars on Anti-depressants and anti-psychotic drugs.  Accounting for just over 13 percent of the 127 billion U.S. consumers spent on prescription drugs in 2005.

However, in another UPI story today;

In a speech at the annual meeting of the American Association for the Advancement of Science in Boston, Jason Robert of Arizona State University said that while understanding biology is crucial to the understanding of psychosis, “there is more to psychosis than mere biology.”

Robert said claims that genetics and neuroscience will revolutionize medicine and elaborate predictions about new diagnostic tools and new treatments are not being borne out “because they fail to grapple with the complexity of human beings — as brains, bodies, and, embedded in culture, steeped in history, and dynamically creating their own worlds. If we’re really going to have personalized medicine, we have to be focusing not just on the genome, but the person.”

Rather that having a caricature of culture in mind, “what’s really critically important is understanding cultures dynamically, as complex, historic, social and political structures that dramatically influence people’s lives.”

Ignoring all except biology may mean never having the capacity “to actually influence the well-being of the patient,” he said.

Mental health professionals have long known of their patients propensity to want an easy way out of their difficulties by just taking a pill to address their mental health needs.  However, while medication is a wonderful way to feel better and treat the biology of a disorder, almost no one recommends pharmacology alone in the treatment of mental health difficulties.

When I was in school, the prevailing thought about how one develops some of these biologically based disorders was some people are more than likely born with the predisposition to develop these disorders, BUT it was an individual’s life experiences that brought these predispositions out.  Of course, I’m not including things like adjustment disorders (where the environment, social and otherwise, are to blame) or Developmental Disabilities (which are entirely biologically based).

Medication does not address any of the underlying experiences leading to a disorder.  Nor does it help develop new coping mechanisms for situations affecting the disorder.  Americans need to see psychotherapy as they do physical, occupational, speech, and/or other therapies that work in conjunction with medicine.   For example, if one breaks their leg, they would see a physician to set the leg, then begin working with a physical therapist to teach them how to use the newly set leg now and in the future.  They would probably also address what may have happened in the past to cause the fracture.  If Americans used this same rationale with psychiatrists and mental health therapists, we would probably see dramatic “cure” rates for those afflicted with mental health issues.

However, because of stigma, time constraints, or whatever else, we see more people taking medications to feel better about what is going on in their life, which never really seems to change.  Conversely, we also see people who spend years in therapy never getting better either, because, for one reason or another, they don’t want to see a psychiatrist.  However, the people who, in my experience, seem to get better faster and go on to live well adjusted lives are those who employ the services of both professionals.

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February 9, 2008

Inside H.B. 1288: Certified Behavior Analysts

H.B. 1288 requires the state to establish the State Board of Behavior Analysts.  Behavior Analysis, as defined by the bill “means the design, implementation, and evaluation of instructional and environmental modifications to produce socially significant improvements in human behavior through skill acquisition and the reduction of problematic behavior”.  It allows for two levels of Analysts, one requires a Bachelor’s degree, while the other requires a Master’s degree, although the degree can be in any area.  Both certifications require a test and supervised hours.  The requirements mimic the requirements of the Behavior Analyst Certification Board, a non-profit Florida Corporation.

Background

This legislation was first requested at an Indiana Commission on Autism meeting.  Specifically, the commission was asked by Michelle Trivedi, “parent of an autistic child, for the commission to support legislation to be introduced in the 2008 session of the General Assembly that would require board certification for applied behavior analysts.”  The commission heard from Ms. Trivedi, but had many significant questions and did not recommend the legislation be pursued in it’s final report.  However, Rep. Vanessa Summers and Rep. Phil Hinkle, both commission members, introduced the legislation in the 2008 session.

Legislative Progress

Upon introduction, the legislation became very controversial for several reasons.  First, it did not exempt any professionals currently licensed to practice medicine, psychology, mental health counseling, social work, and marriage and family therapy.  Because the definition of what behavior analysis is, it would require all of those professions to become certified as behavior analysts to continue to practice with the licenses they already have.  Thankfully, the authors of the bill agreed to amend the bill to effectively state no-one could use the title Certified Behavior Analyst, unless they are certified.  With this amendment, the concerns of the already licensed professionals were satisfied and they did not oppose the bill in the house.  The bill passed the House last week and is now awaiting a hearing in the Senate Corrections, Criminal, and Civil Matters Committee.

January 31, 2008

“Dr. Phil Show”: How’s That Working Out For You?

According to WTHR, Dr. Phillip McGraw “regrets” discussing his “visit” with pop singer Brittany Spears.  Here is the background:

Spears, 26, was hospitalized in Los Angeles after a child custody dispute with ex-husband Kevin Federline resulted in an hours-long standoff with police January 3. Federline has sole physical and legal custody of their two sons, Sean Preston, 2, and Jayden James, 1.

McGraw said he visited the pop singer as a family friend, and rejected critics who accused him of practicing psychology without a license.

This is what Dr. Phil has to say:

“I regret making the statement. It didn’t help. It didn’t work,” the syndicated TV psychologist said Wednesday on ABC’s “Good Morning America.”

“I did not go there to diagnose her. I did not go there to treat her,” said McGraw, who showed up at Cedars-Sinai Medical Center on January 5 as Spears was about to be discharged.

McGraw said he retired his Texas license after 25 years of private practice because of the demands of his “Dr. Phil” daytime talk show.

The Spears family has accused McGraw of betraying their trust by making an “inappropriate” public statement about the singer’s hospitalization.

McGraw had told celebrity news TV shows that Spears was in “dire” need of medical and psychological help.

In an appearance on NBC’s “Today” show Wednesday, McGraw said his public comments after visiting Spears were intended to prevent rumors and misinformation.

“I wanted to stop speculation about what may have gone on in there,” he said.

OK, whatever.  We all know he went there to get ratings for his pseudo-psychological show.  Anytime a person in the therapy, or psychological, field puts their needs in front of a person or family, in a professional situation, they act unethically.  Speaking of which, a formal complaint was filed in California over the incident.  The California Board of Psychology treats complaints as confidential, so we don’t know what will happen with this yet.  Interestingly, the complaint also alleges Dr. Phil violated Ms. Spears confidentiality rights under HIPA.  While the California complaint is a felony, the HIPA violation could result in federal charges.

January 29, 2008

Mental Health: Fourth Most Expensive Condition to Treat

Wow, I was really surprised when I read this today.  It’s a study estimating the top 10 most expensive health conditions.  It has the usual…heart conditions and cancer are numbers 1 and 3, respectively, but “Mental disorders, including depression”  came in at number 4 with an estimated cost of 56 billion.  I found that hard to believe because Therapists, Psychologists, and Psychiatrists don’t make anything near what a cardiologist or oncologist does.  Then I saw this:

The money paid for visits to doctor’s offices, clinics and emergency departments, hospital stays, home health care and prescription medicines [were included].

Okay, I get it now.  Most of the money in Mental Health care goes to hospitals, emergency departments and prescription medications.  This is due to the public perception they can handle any situation, or take a pill,  and do not seek help early.  When people figure out this strategy is usually ineffective, they usually end up in an emergency room or hospital, where the costs are astronomical.  This “solution” is vastly more expensive than outpatient therapy.  As an aside, most therapists, this one included, do not consider ER and hospital admissions treatment, but crisis management.  With those factors included, the numbers make sense.  If costs for “mental disorders including depression” are ever reduced, a correlating change in perception among the public would also have to occur.  In that regard, Mental Health is no different from any of the other conditions cited, where prevention and early detection is paramount to decreasing costs.

January 22, 2008

FSSA to Pay For Substance Abuse Program

Finally, someone, somewhere, is looking at treating Substance Abusers.  In an area where money is usually non existent, comes this from the Indianapolis Star about a pilot program in Vigo County.

The Indiana Family and Social Services Administration has been awarded $14.49 million over three years for the Access to Recovery program.

That includes more than $1.44 million annually targeted to people recovering from meth addictions, which will be the focus of the Vigo County program. He said 30 percent of the program’s money must be spent on meth users.

Addiction treatment providers, include faith-based agencies, will apply to participate in the program, Scott said. The agencies are reimbursed for services from state vouchers. Services include care coordination, clinical treatment and recovery support.

January 21, 2008

10% Laid Off At Dunn MHC

Calling it a “temporary reduction in force”, Dunn Mental Health Center is saying goodbye to 29 employees, according to the Indianapolis Star.  This accounts for almost 10% of their workforce.  Not wanting to sound partisean, here is the whole story from the Star.  Remember, she said it, I didnt.

Twenty-nine employees of Dunn Center Mental Health in Richmond have been laid off, said CEO Kay Whittington on Sunday.Whittington called the “temporary reduction in force” a result of Gov. Mitch Daniels’ proposed cuts in Medicaid and a bill that could limit how much Medicaid communal health centers may offer.
Dunn Center is comprised of a staff of more than 300.”We have had a temporary reduction in staff across (the) seven counties that we provide services to,” Whittington said.The Dunn Center is a Medicaid provider, and the state government has “dramatically reduced what (the center) can do for Medicaid rehabilitation options,” Whittington said.Gov. Mitch Daniels said in early January a new budget forecast that shows state revenue falling below predictions could lead to some cuts “in some of the entitlement programs like Medicaid.””It all relates to that,” Whittington said.Five of the 29 positions laid off are part-time and the rest are full-time, and Whittington said many of the employees were offered a transfer into other positions.

Whittington said she knows of other communal health centers in the state that have laid off workers.

“We’re all faced with the same thing,” she said. “You can’t wait for the ship to sink.”

Whittington will be available for further details about the situation today, she said.

“We wanted to make sure our staff had the weekend to think about (transferring).”

January 15, 2008

Big Insurance Chimes in on FW Smoking Ban

This opinion piece appeared in the Fort Wayne Journal Gazette yesterday about the smoking ordinance (if you are for it), or ban (if you are against it), enacted last year in Fort Wayne.  There is some talk of repealing it, as the city council was shaken up during the last election cycle.  However, as of right now, no one is allowed to smoke in any public building and if one wants to smoke outside, they have to be eight (I think) feet away from the door.  This had some unintended consequences when some “exotic dancers” needed a break from work, but that’s another story.

Anyway, a physician working for an insurance company based in Fort Wayne wrote the opinion piece.  The Blogmeister won’t name him or his company, so as to not give them any free advertising here.  In the spirit of full disclosure, the Blogmeister is not a provider for this company.  Mostly because they refuse to pay for Therapists, Social Workers, or Counselors unless there is a physician, on staff, in the building, at all times.  Thus, increasing costs for their members and allowing them to charge more for their insurance.

For those unaccustomed to Insurance speak, I’ll translate.  Here are the important parts of the story:

…It would also be unreasonable to hop back and forth on an important issue like this. Those it affects have for the most part made necessary adjustments to it, and businesses that were on viable footing before the ban are not threatened by it.

Translation:  If a business allowed smoking before and was doing fine, but now can’t make payroll it wasn’t a big chain restaurant to whom we were trying to sell insurance.  That’s okay though, because we will go across the line to all the mom and pop restaurants where all the smoking business has gone and sell them insurance because now they can afford it with all the increased revenue.

I have spoken to a number of our customers (employers in Fort Wayne who purchase insurance from ***) and have found that an overwhelming majority of them are happy to have the ban in place.

Translation:  I’m a doctor at an insurance company and people lie to me all the time because if they tell me how they really feel they are afraid my company will jump their rates. 

 Anything we can do to help make Fort Wayne a less expensive place to employ and provide health insurance for people makes Fort Wayne a more attractive city in which to locate businesses, do business and create jobs.

Translation:  The more people who don’t get sick, but who we can continue to charge outrageous rates is great for my company and me! 

We need to encourage smokers to quit in order to help get costs down, and most employers understand that.

Translation:  The insurance company’s costs will go down, but thats all, notice I didn’t say employers costs will go down.  Less people will go to the doctor and we will still charge more and more for insurance.  In addition, that pesky low cost insurance program started by Governor Mitch Daniels… you know the one, funded with cigarette taxes… won’t be “viable” and will go down in a blaze of glory.  Then all those people will have to come to my company for their insurance.  They will have to pay our exorbitant rates and I can make more money.  Dang,  all this sounds so good I can see that new BMW in my driveway now.  I just hope no one asks if we pay for smoking cessation or other preventative programs…   

…I urge the City Council to leave the smoking ban in place and not to move Fort Wayne backward along the road to making ours a better, healthier and more marketable city.

Translation:  Because I really, really want that beemer!

Now the Blogmeister realizes that translation was a little harsh.  However, if the City Council does decide to revisit the smoking issue, it is hoped the writer of the opinion piece will provide figures reflecting the dramatic decrease in insurance premiums (with the same level of benefits) his company is offering employers of Fort Wayne to back up his assertions. 

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