Tag Archives: mental health

The New Asylum: Revisiting an Old Approach to Mental Health Care

In the context of mental illness, the word “asylum” conjures, for many of us, some very negative images. We picture a scene with characters like the abusive Nurse Ratched from the movie “One Flew over the Cuckoo’s Nest,” or even worse, tragic true stories of the overcrowded, understaffed psychiatric hospitals of the last century where healthy, sick, disabled, and poor patients alike were locked away for years with no effective treatment or hope of release.

These images may be the reason that a JAMA viewpoint published last month has garnered so much attention: Bioethicists from the Perelman School of Medicine at the University of Pennsylvania are calling for a return to asylums for long-term psychiatric care.

At Penn, Dominic Sisti, PhD, Andrea Segal, MS, and Ezekiel Emanuel, MD, PhD, have been studying the current system for treating the chronically mentally ill and the evolution over the past half-century away from inpatient psychiatric hospitals. They observe that although the United States population has doubled since 1955, the number of inpatient psychiatric beds has been cut by nearly 95 percent to just 45,000—a very small number when compared to the 10 million U.S. residents who are currently coping with serious mental illness.

According to Sisti and his colleagues, the result of this trend has not be “de-institutionalization” but rather “trans-institutionalization.” That is, people with chronic mental illness are being treated in hospital emergency rooms and nursing homes at best, and more often receiving no treatment and living on the street. “Most disturbingly, U.S. jails and prisons have become the nation’s largest mental health care facilities,” say the authors, in a January 20 Penn Medicine press release. “Half of all inmates have a mental illness or substance abuse disorder; 15 percent of state inmates are diagnosed with a psychotic disorder…. This results in a vicious cycle whereby mentally ill patients move between crisis hospitalization, homelessness, and incarceration.”

As a solution, the authors propose a modern and humane asylum—but they use the word in its original sense, that is, a place of safety, sanctuary, and healing. In addition, they advocate reforms in the psychiatric services offered in such institutions, including both inpatient services, for those who are a danger to themselves and others, as well as outpatient care for those with milder forms of mental illness.

The proposal has been controversial, to say the least.  Some in the mental health community find the idea of a return to asylums misguided and even frightening. In her article called “Asylum or Warehouse?” author Linda Rosenberg, President and CEO of the National Council for Behavioral Health, asserts that although Sisti and his colleagues accurately describe the problems of the current mental health system, their solution is to “just simply lock some people up” and that “the simple solution offered, recreating asylums, is not helpful—it’s dangerous.”

Others have viewed the proposal in a more positive light. Christine Montross, a staff psychiatrist at Butler Hospital in Providence, Rhode Island and author of “Falling into the Fire: A Psychiatrist’s Encounters with the Mind in Crisis” wrote an op-ed piece in the February 18 New York Times in support of a move toward modern asylums.

“The goals of maximizing personal autonomy and civil liberties for the mentally ill are admirable,” says Montross. “But as a result, my patients with chronic psychotic illnesses cycle between emergency hospitalizations and inadequate outpatient care. They are treated by community mental health centers whose overburdened psychiatrists may see even the sickest patients for only 20 minutes every three months. Many patients struggle with homelessness. Many are incarcerated. A new model of long-term psychiatric institutionalization, as the Penn group suggests, would help them.”

What do you think? Are modern, reimagined asylums a potential solution for the chronically mentally ill, or has history proven that institutions cannot work? PAR wants to hear from you, so leave a comment and join the conversation!

 

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Crisis Intervention Training: A New Approach to Police Work

Every day, police officers across the U.S. respond to calls involving people with mental illnesses. These individuals are often incarcerated, and nationwide jails hold 10 times as many people with serious mental illnesses as state hospitals, according to a report from Kaiser Health News.

“There are, shamefully, lots of people with public mental illness who are known to public systems, out there on the streets, very much at the risk of being victimized or engaging in conduct that could get them in trouble with the police,” says Robert Bernstein, president and executive director of the Bazelon Center for Mental Health Law, in an article in the online newsletter The Science of Us. When mentally ill persons are approached as possible perpetrators, the mental health system is failing, Bernstein says.

Michael Woody knows this scenario firsthand: on a call for the Akron, Ohio, police department several years ago, he encountered a 27-year-old mentally ill individual who threatened his life and ultimately committed suicide. This prompted him to question the small amount—just five hours—of mandatory mental health training officers were then required to take, and he pushed for more. Since then, he has become an advocate for training to help police officers de-escalate crisis situations involving the mentally ill. Today he serves as president of CIT International, a nonprofit whose primary purpose is to support mental health training for police forces across the country.

According to a recent FBI report, the expense to implement and maintain crisis intervention training (CIT) outweighs the cost of not establishing a program. Injuries to law enforcement personnel and individuals with mental illness as well as repeat calls for these issues are considerably reduced when CIT programs are in place which encourage officers to direct persons with mental illness to mental health-care facilities for treatment prior to issuing any criminal charges. This process reduces lawsuits, medical bills, and jail costs and improves the quality of life for the community, according to the FBI report.

Through the work of people like Woody and CIT International, police departments are beginning to take note and to require CIT. In San Antonio, Texas, police officers now take 40 hours of crisis intervention training, and the city has a six-person unit specially equipped to respond to 9-1-1 calls involving mental health disturbances.

The officers’ training helps them better determine whether people need to go to jail or a hospital or would be best served by being taken to the city’s Restoration Center. The centralized complex, across from the city’s homeless shelter, was built using cross-departmental resources to divert people with serious mental health illness from jail and into treatment instead. Among other things, it provides a space for police to bring arrestees to sober up, which saves them a costly trip to the emergency room. Together the CIT training and Restoration Center have saved the City of San Antonio and its police force an estimated $50 million over the past five years and at least $600,000 a year in overtime pay, according to the Kaiser Health News report.

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Soldiers Using More Mental Health Services, Stigma Down

According to new research conducted at Walter Reed Army Institute of Research in Silver Spring, Maryland, the proportion of soldiers using mental health services nearly doubled between 2003 and 2011. Furthermore, researchers found a small but significant decrease in the perceived stigma associated with seeking mental health services.

In 2003, only about 8 percent of soldiers sought mental health services. In 2011, about 15 percent of soldiers did so. Even with the increase in the number of soldiers seeking mental health help, researcher Phillip Quartana stated that two-thirds of soldiers with post-traumatic stress (PTSD) or major depression symptoms did not seek treatment between 2002 and 2011. More than 25 percent of active infantry soldiers from the conflicts in Afghanistan and Iraq, dating back to the beginning of the conflicts in 2001, met self-reported criteria for these diagnoses. While the number of soldiers seeking help has increased and the stigma associated with seeking mental health services has decreased, these results demonstrate that more progress is needed to increase soldiers’ use of mental health care services.

Researchers used data from active-duty personnel who completed Health-Related Behavior Surveys between 2002 and 2011. This study is the first to empirically examine trends concerning utilization of services and stigma across multiple wars.

The study was published online in the American Journal of Public Health.

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Unemployment Rises Among Those with Serious Mental Health Problems

According to a new report from the National Alliance on Mental Illness (NAMI), adults with serious mental health problems face an 80 percent unemployment rate, a rate that continues to become more dire over time.

In 2003, 23 percent of those receiving public mental health services had jobs; by 2012, only 17.8 percent did.

The survey reports that most adults with mental illness want to work, and 60 percent can be successful if they have the right support. However, only 1.7 percent of those surveyed received supportive employment services. Study author Sita Diehl says the employment problem has less to do with the workers themselves and more to do with the lack of organizations providing supportive services for individuals with serious mental illnesses. Due to decreases in funding, services have not been as available.

On a related note, people with mental illnesses are now the largest and fastest-growing group to receive Supplemental Social Security Income and Social Security Disability Income.

Unemployment rates varied greatly by state, with 92.6 percent of those receiving public mental health services in Maine being without jobs to 56 percent of those in Wyoming reporting they are without employment.

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Students Speak Out about Mental Illness

As those who work in the mental health arena know all too well, the stigma associated with mental illness often prevents people from seeking the help they need. Students at the University of Leeds in the U.K. chose to confront that stigma by sharing their personal struggles with mental illness in a powerful video. Directed by the university union’s welfare officer Harriet Rankin and featuring members of the Leeds “Mind Matters” mental health support group, the video has gone viral and is now being shared by major internet news outlets in the U.K. and the U.S.

The students’ message is very simple: You are not alone, and help is available. Please take a moment to view the video now!

 

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Mental disorders are most costly medical expense for children

According to a just-released statistical brief from the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality, mental disorders were the most costly medical expenditure for those under 18 years of age during 2011, the most recent year for which statistics are available. More than 5.6 million children were treated for mental disorders at a mean expenditure of $2,465 each, for a total expense of $13.8 billion. In 2011, $117.6 billion was spent overall on the medical care and treatment of children.

The top five medical conditions that ranked highest in terms of spending included mental disorders, asthma ($11.9 billion), trauma-related disorders ($5.8 billion), acute bronchitis and upper respiratory infections ($3.3 billion), and otitis media ($3.2 billion). Although mental disorders affected the fewest number of children of the other top five medical conditions, they had the highest average expense per child.

In 2008, mental disorders ranked as the fifth most commonly treated condition; according to survey data, the expense per child has remained steady.

Nearly half the expenditures for mental disorders in children were paid by Medicaid.

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Fight Mental Health Stereotypes for a Happier Halloween

Halloween is coming! Children and adults alike are carving pumpkins, dressing in costumes, and getting ready for an exciting evening of trick-or-treating. For those suffering with mental health issues, however, this can be an especially difficult time of year as they are reminded of the heavy stigma associated with their illness. A drive through your city or a stroll down the aisles of your local department store is all it takes to confirm that offensive stereotypes are alive and well when it comes to the mentally ill. Billboards and advertisements depicting “Haunted Asylum” or “Psychopath Sanctuary” attractions are hard to miss. “Mental Patient” costumes, complete with straightjackets, perpetuate the stereotypes further.

The National Alliance on Mental Illness (NAMI) is an advocacy group that is fighting these stereotypes and pressuring businesses to remove offensive attractions and costumes. “NAMI loves Halloween as much as anyone else,” says Bob Corolla, NAMI Director of Media Relations, in a recent blog. “But would anyone sponsor a haunted attraction based on a cancer ward? How about a veterans’ hospital with ghosts who died from suicide while being treated for posttraumatic stress disorder?”

NAMI encourages its members to help raise awareness about the problem in their own communities. Corolla says that the first step is to personally contact sponsors of “insane asylum” attractions or stores that carry offensive costumes. In some cases, small changes to the attraction or its marketing can make a big difference. Further steps include enlisting others to make calls and write emails of protest. Local television stations and newspapers can be educated about the problem—and many are willing to cover a protest as a news event.

Will it make any difference? In response to protests from mental health advocates, the U.K. superstore Asda (a Wal-Mart company) and major grocery chain Tesco were persuaded to remove offensive costumes from their shelves. Both stores apologized for their insensitivity; Asda called it “a completely unacceptable error” and has donated £25,000 to the U.K. mental health charity Mind.

Corolla cautions that you should be prepared for a backlash when people feel that you are criticizing their fun. But even then, you may be more effective than you know. “Even if it seems that too many people disagree with your position,” he says, “you win simply by raising awareness.”

Visit the NAMI Web site to learn more about what you can do to fight the stigma against mental illness.

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Music “Reawakens” Alzheimer’s Patients

A remarkable transformation is taking place in nursing homes around the country as elderly patients are reconnecting with life through music. The brainchild of social worker Dan Cohen, a program called Music & Memory has created personalized iPod playlists for residents of elder care facilities, many of whom have Alzheimer’s type dementia. The results have been truly life changing for patients as they are “reawakened” by the music of their youth.

Cohen is now working with renowned neuropsychologist Oliver Sacks (author of Musicophilia: Tales of Music and the Brain) on a documentary about Cohen’s program and the elderly patients who are responding so positively. In a clip from this documentary, a man reacts to hearing music from his past:

 

 

“Our approach is simple, elegant and effective,” says Cohen on his Music & Memory Web site. “We train elder care professionals how to set up personalized music playlists, delivered on iPods and other digital devices, for those in their care. These musical favorites tap deep memories not lost to dementia and can bring residents and clients back to life, enabling them to feel like themselves again, to converse, socialize and stay present.”

What do you think? Has music helped your clients with dementia to access memories and engage more positively in daily life? PAR wants to hear from you, so leave a comment and join the conversation!

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Psychology News by the Numbers

$4 Million: The fine Kaiser Permanente will face for failing to provide mental health treatment in a timely manner.

1 in 4: The number of stroke survivors who are suffering from post-traumatic stress disorder, according to a new study from Columbia University Medical Center.

70%: The ability of a computer to accurately guess a person’s emotions in a new study by researchers at Carnegie Mellon University.

85.8%: The percentage of gang members diagnosed with an antisocial personality disorder in new research from the Forensic Psychiatry Research Unit at Queen Mary, University of London.

49.4%: The number of adolescents reporting zero mentally unhealthy days in 2010 (a significant decrease from 60.9%, which was reported in 2005-2006).

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Stress levels highest for youngest adults, study shows

A recent study conducted by the American Psychological Association found that the generation known as Millennials, defined as 18- to 33-year-olds in the U.S., reported the highest stress levels along with the most stress-caused ill effects among the four groups surveyed.

On a 10-point scale, Millennials reported an average stress level of 5.4, the same as that reported by individuals in Generation X (ages 34-47 years). However, more than 52 percent of Millennials reported stress-induced sleeplessness, compared to 48 percent of Generation Xers, 37 percent of Boomers (ages 48-66 years) and 25 percent of Matures (67 years and older). In addition, more Millennials and Generation Xers reported anger and irritability due to stress than Boomers or Matures.

Stress is a risk factor for many health conditions, including high blood pressure, headaches, sleeping problems, heart disease, ulcers, and stroke.

It’s not hard to understand why young Americans are on edge. Work was named as a “somewhat or significant stressor for 76 percent of Millennials,” and the U.S. unemployment rate is 7.9 percent. Thirty-nine percent of Millennials have experienced an increase in stress over the past year. And despite efforts to reduce their stress (i.e., 62% have made attempts to decrease their stress levels over the past five years), 25% of Millennials believe they’re not doing enough to manage it.

The good news? Apparently, we experience generally lower levels of stress as we age—Matures’ average stress level was 3.7 out of 10—and we get better at dealing with stress: 50 percent of Matures think they’re doing an excellent or very good job at managing their stress.

What do you think? Does maturity play a big role in handling stress? What can be done to reduce stress in Millennials and in general? Leave a comment and let us know what you think!

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