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 21, 2008

Suzanne Pleshette Dies

Ok, I know this is really pushing the relevance of the blog, but actress Suzanne Pleshette has died.  She played the wife of Bob Newhart in “The Bob Newhart Show”.  Newhart, in turn, played a Chicago Psychologist (see how I worked that in).  Many news outlets have the story.  Here is one from the Fort Wayne Journal Gazette.

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 6, 2008

APA Elections: Big Pharma’s Candidate

This should scare everyone whether you see a psychiatrist or not.  The practice of “paying” doctors with the unspoken agreement they will prescribe more of a company’s drug is prevalent in all areas of medicine.  Today, Dr. Daniel Carlot, a psychiatrist campaigning against such practices, brings to light ties one of the candidates for the American Psychiatric Association’s presidency has with Big Pharma.

In one corner, we have Donna Norris, M.D., a child and adolescent psychiatrist who has been active in APA governance for 25 years. She is currently the secretary-treasurer of the APA, chair of the Ethics Appeals Board, and a past speaker of the APA Assembly. More to the point, she is concerned about the pharmaceutical industry’s influence on our profession. She chairs a special task force in charge of screening all potential members of the DSM-5 committee for commercial conflicts of interest. On a more personal note, she receives no financial compensation from drug companies, depending on her private practice for all of her income.

By contrast, Alan Schatzberg, M.D., has no APA governance experience, although he once served as vice president of the Northern California Psychiatric Society. Even more troubling, he was involved in what many consider an ethical breach in 2002, when he wrote an article endorsing mifepristone for psychotic depression without disclosing the full extent of his financial involvement in Corcept, the company that has tried to develop the drug for this purpose. At that time he owned 3 million shares; the current value of these shares is about $12 million. Currently, Schatzberg is the editor-in-chief of a journal entitled the “International Journal of Sleep and Wakefulness” which is funded wholly by Cephalon, a pharmaceutical company that sells Provigil. The purpose of this pseudo-journal appears to be to convince readers that sleepiness is a huge public health problem and that Provigil is the mainstay of treatment.

[Blogmeister Note:  DSM-5, referred to above, stands for the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.  Currently under development, it is the “Bible” of psychiatric diagnosis and treatment.]

Everyone should be aware of Pharma’s practices in medical treatment.  The Blogmeister would even go so far as to encourage you to ask your physician if they have received ANYTHING from the company who makes the drug you are prescribed (they ethically have to tell you).  If so, you could be prescribed medication that has less to do with your physical condition, than how much they are compensating your physician.

In the spirit of full disclosure, the Blogmeister barely gets paid by insurance companies and patients, let alone Big Pharma.

December 4, 2007

Four Teenagers Escape from Madison Center

From the been there done that file;

The South Bend Tribune reports today four teenagers escaped from the Madison Center Inpatient unit after overpowering a staff member.  The girls jumped into the St. Joseph River to escape pursuers and were promptly apprehended.  The girls, although no doubt wet and cold, were not injured.  No injuries were reported to the staff member.

Hate it when that happens!

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