We need more affordable, accessible, non-stigmatic mental health care.

[uppityperson]

Not as much fun to discuss as other posts related to mass murderers, but in the end it would probably help a whole lot.

[Brickbat]

1. You've summed it up quite well.

K&R.

[uppityperson]

4. Like the TSA trying to bandaid, going to the root of the "why" would help.

Yes, those most in need don't seek help. And if they do, it is costly, not accessible, and they run the stigma of "ohhhh, you say a nut doctor". Being able to refer people, friends, family, acquaintances, co-workers without all that would be helpful.

More fun to argue the weapon of choice though.

[HiPointDem]

25. i don't think a mental health dx is a brand of shame anymore. i hear people proudly discuss their

dx ("I'm bipolar and schizoid&quot , their med regimes, their kids' autism a/o ADD, and related topics -- almost daily.

and i wonder -- where are the people i keep hearing about who feel these things are shameful?

[uppityperson]

27. There are plenty of them, of us, who could use help. Not for major "bipolar and schizoid" issues but

for day to day crap.


To pick an example that I have personal experience with. How much domestic abuse is there in this country? How many of the people in those situations could use help? Why don't they? Affordability. Accessibility. Nonstigmatic-bility.

[HiPointDem]

36. as for the 'day to day' crap, my views are more akin to this former clinical psychologist's:

http://www.davidsmail.info/biograph.htm

The standpoint from which I write is a 'clinical' one, and the (tentative and provisional) conclusions I come to are the result of having struggled for years to make sense of the kinds of distress people bring to the psychological clinic, and how they cope with it....Though this is not a work of sociology, politics or philosophy, it will at times seem as if it is trying to be; but I want to insist, still, that it is a work of clinical psychology, and that is because it is throughout rooted in and informed by 'clinical' experience.

Even then, however, I have heavily to qualify the use of the word 'clinical' because it carries with it so many false assumptions. The majority of those who find themselves in distress in Western society turn to the clinic because there is nowhere else to go that carries the same promise of relief. They, as well as most of those who treat them, believe that they are hosts of a personal illness or disorder that can be cured by established medical and/or therapeutic techniques. That belief, however, is in my view (and the view of many others) false, and it is clinical experience itself that reveals it as false.

http://www.davidsmail.info/pubintro.htm

[Loudly]

2. By non-stigmatic, would that mean

it doesn't come with any regulatory impediments to the possession of guns and ammunition?

[uppityperson]

3. No. It means no one will mock you for it. That people won't hold you seeing a mental health

person over you. As far as gun stuff? No more than it does now. You can see a mental health professional without losing any rights right now so no. That wouldn't change.



I hope that clarifies it for you.

[Loudly]

5. So while seeking treatment, you could still settle personal grievances

against those who you believe have wronged you?

Yes, I think the NRA would approve of this approach.

[uppityperson]

7. You totally miss the point, don't you? Seeking help dealing with grief from a parent's death

what would you like to happen to me? Seeking help dealing with stresses of school?

As now, those who are a danger to others need to be stopped. Perhaps having more affordable accessible nonstigmatic mental health care might help them get to the point of being a danger to others.

I am sure you know that.

[Loudly]

8. Reducing access to guns and ammo has a more reliable positive outcome.

The success of mental health treatment is highly variable, and depends entirely on the patient to seek and accept help.

Now, if you'd care to advocate increased access to mental health AND decreased access to guns and ammo, then I think you might be offering a useful solution.

[soccer1]

9. My thoughts, as well...

[uppityperson]

10. Helping people not want to kill others isn't positive? Oh

Hence the more accessible, affordable, nonstigmatic mental health care.

Helping people deal with stressors in other ways than killing others isn't positive? Oh. Goodbye.

Edited to add that plenty of others are advocating restriction of guns and ammo. That is not my point here. Why don't you go to one of their threads?

[uppityperson]

14. The NRA wishes there was more affordable accessible mental health care? I never noticed that

part of their platform. Do you think there is enough mental health care out there that is affordable and accessible? Do you think there is no stigma attached to getting mental health care? Are you series?

[Jeff In Milwaukee]

12. Let me address that...

Because it's tougher nut to crack than you might think. Because of the rules under the Health Insurance Portability and Accountability Act (HIPAA) there are strict rules regarding the sharing of an individuals protected health information.

People say that we should have background checks to make sure that a gun buyer isn't insane, but unless that person has been found incompetent in a court of law (and only a fraction of mentally disturbed persons are) then the only way to have any indiciation that the person in unstable would be through their mental health records. Both those records are effectively sealed under HIPAA.

A healthcare provider can't even discuss a patient's diagnosis with other family members unless the patient gives permission, so letting the clerk at the local gun store go mucking through the data file would be, as you can imagine, right out of the question.

I'm not saying that there isn't any way to do it, but it IS a complicated matter.

[Loudly]

43. Agree, Jeff. The answer is less access generally.

It's the only fair way.

Sorry folks. There's just less to buy here today. Our allotment is run out.

Simple and even handed.

[Jeff In Milwaukee]

60. Several ways to do that

In many jurisdictions. the local police will take guns confiscated from criminals and at crime scenes and resell them to gun dealers, basically keeping these guns in circulation and keeping the price of guns low (supply and demand, don't you know).

The police should keep any weapons that would be useful for the department's own use, and melt down the rest. Take them out of circulation altogether.

Another method is to requires background checks at gun shows. It's ridiculous that if I want to buy a gun at Bass Pro Shop, I have to complete a background check, but if I buy one at the local Ramada Inn, I can skip the process.

[Posteritatis]

35. Not jumping directly to "we need to impose blanket legal restrictions" would be a nice start. (nt)

[flamingdem]

6. yup. This guy was a brainiac. PhD neuroscience but nuts nt

[nadinbrzezinski]

13. Yup

Oh and thank raygun for some of this.

[uppityperson]

15. That I do. We lost a lot of headway on mental health care from his time. And papabush the puppetmast

[HiPointDem]

16. "mental health care" = be seen by a psychiatrist or prescribing medical professional, get a script.

plenty of that already, no thanks.

[uppityperson]

17. That isn't mental health care but triage bandaid care. You seriously don't think

having more accessible affordable nonstigmatic mental health care would be a good thing? What you claim "=" is not what I am talking about but true health care.

[HiPointDem]

18. that's what mental health care is today. it's given to the poor and paid out of medicaid.

[uppityperson]

19. Which is another reason we need more affordable accessible nonstigmatic mental health care.

Not more of the little bits of crap there is, but true mental health care that is affordable, accessible and nonstigmatic.

[HiPointDem]

24. the only reason there's *any* mental health "care" for the poor is to send $$ to the mental/

pharma establishment & to control the poor, both through drugs and "stories".

i'm skeptical of the whole storyline, including the existence of this "we" who "needs".

[uppityperson]

26. I agree that it is too limited, for pharma sales and not accessible to many

That is why more is needed. True mental health care. Not bandaid care. Not to make money for pharma. But to help people deal with the stress and other stuff in their lives.

I am old enough to remember state mental hospitals which were warehouses. I am old enough to remember a brief period when there mental health care available. But not enough. And way not enough now.

Tell someone you saw a psychiatrist or counselor and how many times do you think they would look at you oddly? Tell them you saw a doctor for your high blood pressure or a broken bone and do they look at you the same way? Why? Because seeking mental health care is so frowned upon, so looked down upon. Why? Because it has turned into as you say a money making grab and because we're supposed to be able to take care of ourselves.

Perhaps "you" never "need" any outside assistance for anything, but many of "we" could personally do better for it.

If you have no need, then good for you. But you seem to want to pooh pooh it for the rest of us which makes me wonder why. Why?

[HiPointDem]

28. i can't look at it the way you do. i don't accept the current "mental health" v. "mental illness"

paradigm in any respect.

[uppityperson]

30. I see a difference between schizophrenia and situational stressors.

I'm not sure what "the current "mental health" v. "mental illness" paradigm" means.

I see a difference between situational and physiological issues. They can and do interact and combine, but they are different.

I see a difference between bandaid "give them a pill and send them on their way" vs "let's figure out what's going on and how you can react better in a more positive way for yourself".

[HiPointDem]

37. by "mental health" v. "mental illness" i mean to encompass the gamut.

[Odin2005]

44. Anti-psychotics are the only effective way to stop Schizophrenia.

We are not talking people who are depressed or have anxiety issues, we are talking about people with severe psychosis.

[HiPointDem]

45. what does it even mean, to "stop" psychosis?

Are Psychiatric Medications Making Us Sicker?

By John Horgan Scientific American March 5, 2012

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown 2010), by the journalist Robert Whitaker, is one of the most disturbing, consequential works of investigative journalism I’ve read in a long time. Perhaps ever. Whitaker has persuaded me that American psychiatry, in collusion with the pharmaceutical industry, may be perpetrating the biggest case of iatrogenesis—harmful medical treatment–in history...

As recently as the 1950s, Whitaker contends, the four major mental disorders–depression, anxiety disorder, bipolar disorder and schizophrenia–often manifested as episodic and “self-limiting”; that is, most people simply got better over time. Severe, chronic mental illness was viewed as relatively rare. But over the past few decades the proportion of Americans diagnosed with mental illness has skyrocketed. Since 1987, the percentage of the population receiving federal disability payments for mental illness has tripled; among children under the age of 18, the percentage has grown by a factor of 35.

This epidemic has coincided, paradoxically, with a surge in prescriptions for psychiatric drugs. Between 1985 and 2008, U.S. sales of antidepressants and antipsychotics multiplied almost fifty-fold, to $24.2 billion. Prescriptions for bipolar disorder and anxiety have also swelled. One in eight Americans, including children and even toddlers, is now taking a psychotropic medication...

Whitaker’s analysis of treatments for schizophrenia is especially disturbing. Antipsychotics, from Thorazine to successors like Zyprexa, cause weight gain, physical tremors (called tardive dyskinesia) and, according to some studies, cognitive decline and brain shrinkage. Before the introduction of Thorazine in the 1950s, Whitaker asserts, almost two thirds of the patients hospitalized for an initial episode of schizophrenia were released within a year, and most of this group did not require subsequent hospitalization.

Over the past half century, the rate of schizophrenia-related disability has grown by a factor of four, and schizophrenia has come to be seen as a largely chronic, degenerative disease. A decades-long study by the World Health Organization found that schizophrenic patients fared better in poor nations, such as Nigeria and India, where antipsychotics are sparingly prescribed, than in wealthier regions such as the U.S. and Europe.

http://survivingantidepressants.org/index.php?/topic/1867-rave-review-in-scientific-american-for-robert-whitakers-anatomy-of-an-epidemic/

[Odin2005]

46. So people don't have hallucinations and delusions?

So they are speaking coherently and not in word salad?

[HiPointDem]

47. i edited my post. pls rd

[Odin2005]

48. A lot of people back years ago were misdiagnosed with Schizophrenia.

A lot of those misdiagnoses were people who would now be correctly diagnosed as autistic (indeed, before the 70s Autism was treated diagnostically as a type of Schizophrenia), so using data from 50 years ago is completely misleading. I know an aspie Baby Boomer who was originally diagnosed with "Childhood Schizophrenia" back in the 50s.

[HiPointDem]

49. what does that have to do with my post? it doesn't answer the critique in any way. *more* people

are being diagnosed as schizophrenic today than in earlier times, not fewer. *more* people are being diagnosed as autistic, too.

Do symptoms of autism typically remit to "normal" after 6-18 months? Just wondering.


Whitaker, who was a finalist for the 1998 Pulitzer Prize for Public Service and is an award-winning author and a former director of publications for the Harvard Medical School... says a study of long-term outcomes for people with schizophrenia done by Martin Harrow in 2007 (which Whitaker thinks is the best work ever done on the subject in the U.S) was never in a National Institute of Mental Health press release and thus never reached reporters at U.S. newspapers...

Over a year after the book was published, Marcia Angell, former editor of The New England Journal of Medicine, published a two-part review of Whitaker's and other books in The New York Review of Books which received a great deal of publicity. Dr. Angell was seeking and not finding any evidence after 50 years of use that psychiatric drugs have given patients any benefit...

http://en.wikipedia.org/wiki/Anatomy_of_an_epidemic

[Odin2005]

51. Everything I've read says the rates of schizophenia are down.

And the explanation is that pregnant mothers are more well-fed now, it's been known for many decades now that children of undernourished mothers have a higher risk of developing Schizophrenia.

[HiPointDem]

53. 'down' since when? please show me these cites.

The strongest evidence that severe psychiatric disorders may be increasing comes from the Epidemiologic Catchment Area (ECA) study, carried out in the early 1980s, and the National Comorbidity Survey (NCS), carried out in the early 1990s. In a 1999 discussion, Darrel Regier, M.D., co-author of the ECA study, said the study found that, after accounting for duplicate diagnoses, 2.2% of adults (ages 18 years and over) met diagnostic criteria for schizophrenia or bipolar disorder over a one-year period. A recent reanalysis of this study revised this estimate to 1.7% (Narrow et al., 2002). This translates into a prevalence rate of 12 to 16 per 1,000 total population, not including any mentally ill adults with other severe psychiatric disorders such as major depression or severe obsessive-compulsive disorder.

Although comparisons of rates over time are fraught with diagnostic and other methodological pitfalls, the 12 to 19 per 1,000 rate contrasts sharply with prevalence surveys done in earlier years. For example, the 1958 Hollingshead and Redlich study of New Haven, Conn., one of the ECA study sites, reported a rate of 4.2 individuals who were being treated for schizophrenia and affective psychoses per 1,000 total population. Similarly, a census study of Baltimore, another ECA study site, found a rate of 7.1 individuals with psychosis or with psychotic traits, both treated and untreated, per 1,000 total population (Lemkau et al., 1942).

http://www.schizophrenia.com/newsletter/allnews/2002/disordersincrease.htm


The incidence of schizophrenia is highest among the poor and immigrants. That doesn't mean it has anything to do with nutrition, & i'm not aware of any serious research that has made the case that it does.

also, your nutrition hypothesis is contraindicated by findings like this:

The prevalence of schizophrenia in migrants was higher compared to native-born individuals: the migrant-to-native-born ratio median was 1.8 (0.9–6.4). When sites were grouped by economic status, prevalence estimates from “least developed” countries were significantly lower than those from both “emerging” and “developed” sites (p = 0.04). Studies that scored higher on a quality score had significantly higher prevalence estimates (p = 0.02).

http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.0020141

[Odin2005]

54. I most recently read of it in a book called "The Imprinted Brain.

The study looked at Dutch kids who were born during WW2-caused food shortages in contrast to kids born afterward.

[HiPointDem]

55. the dutch hunger winter = starvation.

In the west, or famine region, birth cohorts exposed to severe food deprivation (an average daily ration under 4200 kJ) during the first trimester showed a substantial increase in hospitalized schizophrenia for women but not for men. Relative risks for women were 2.17 for "broad" and 2.56 for "restricted" schizophrenia. Moderate food deprivation during the first trimester (average daily ration under 6300 kJ) was not associated with increased risk of schizophrenia in the famine region.

http://www.ncbi.nlm.nih.gov/pubmed/1449385

not "poor nutrition," starvation. <1000 kcal/d. and it's a funny kind of nutritional effect that only impacts female children.

[Odin2005]

56. Here is a study:

http://www.springerlink.com/content/jr243q247766255w/

[HiPointDem]

58. the chinese case is also *famine* -- starvation. not "poor nutrition," starvation in the first

trimester.

you haven't produced any evidence that rates of schizophrenia are down or that schizophrenia is caused by "poor nutrition".


The most complete enumeration of severe psychiatric disorders ever carried out by the U.S. Census Office was done in 1880. Because of widespread fears at the time that insanity was increasing, census enumerators were given special forms and extra pay to identify all severely mentally ill people, including querying neighbors of the person in question. In addition, all 100,000 physicians in the United States were asked to report "all idiots and lunatics within the sphere of their personal knowledge," and over 80% did so. Insanity was classified by seven subtypes using definitions supplied by the New England Psychological Association. All duplication between the enumerator and physician lists was eliminated.

A total of 91,997 insane people were identified. Of these, 38,047 were in asylums, an increase of 115% in hospitalized insane since the 1870 census. The prevalence of insane people, both hospitalized and living in the community, was 1.83 per 1,000 total population. In 1880, asylum superintendent Foster Pratt called that increase an "important and alarming fact…a great question of public health that demands careful study" (as cited in Grob, 1980). And yet the ECA study from 1980 reported a prevalence rate for schizophrenia and bipolar disorder that was almost 10 times higher than the 1880 prevalence rate.

http://www.schizophrenia.com/newsletter/allnews/2002/disordersincrease.htm

[cbayer]

20. Getting parity payment for psychiatric disorders would be a first good step.

We are so behind the curve on this.

[woo me with science]

21. "Mental Health Care" has increasingly become "Profit from new Drugs,"

even though we're not exactly sure how they work or what they do.

And notice the new trend. It used to be that when a psychiatric medication was not working, it was discontinued and a new one tried. Now, a new drug is just as often ADDED to the mix instead, even in the treatment of young children. It is a frightening trend.

[uppityperson]

22. Indeed and I do not consider that mental health care.

[woo me with science]

23. I agree with you that that's not mental health care.

We need a human-centered, scientific approach to mental suffering. The corruption and abuse come from corporate involvement and the profit motive.

Most of all, I think we need a reevaluation of our entire profit-centered, callous, isolating, and impoverishing culture that devalues human life and relationships and leaves people feeling alone, angry, and hopeless.

[Posteritatis]

34. Funny, the people I know getting treated have all had the "new one tried" approach instead. (nt)

[woo me with science]

38. "Funny"?

I am happy for your friends, but I hope you are not doubting the problem exists based merely on their experiences.

[Posteritatis]

39. I'm rejecting your claim that the rule is "throw something else into the cocktail," yeah. (nt)

[woo me with science]

40. First of all,

please don't misrepresent my words. I made no mention of any "rule." It is, however, a significant and measurable trend.

Second, you are just wrong. Do a simple search. I'll start you with just one source, but a simple click will give you many, many more:

http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/17785

Primary source: Archives of General Psychiatry
Source reference:
Mojtabai R, et al "National trends in psychotropic medication polypharmacy in office-based psychiatry" Arch Gen Psych 2010; 67: 26-36.

Psychiatric Polypharmacy Continues to Grow
By John Gever, Senior Editor, MedPage Today
Published: January 04, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner


About 60% of patients with psychiatrist office visits leading to a drug prescription received at least two medications in 2005-2006, according to government survey data analyzed by Ramin Mojtabai, MD, PhD, MPH, of Johns Hopkins University, and Mark Olfson, MD, MPH, of Columbia University.

That was up from about 43% in 1996-1997 (P<0.001), the researchers reported in the January Archives of General Psychiatry.

They also found that 33% of prescription-associated visits led to three or more medications in the latter period, compared with 17% nine years earlier (P<0.001)....

Third, why be nasty or sarcastic? There was no call for it.

[Egalitarian Thug]

29. K&R Agreed. The fundamental problem here is a combination of the lack of care,

blatant prejudice against the mentally ill, and an epidemic of desperately unhappy, unfulfilled people that feel trapped in their misery.

As the pressure increases, so has this kind of aberrant behavior. I see no signs of relief in our future.

[uppityperson]

31. Thank you. Upthread someone discounts this prejudice. I see no signs of relief in the near

future and see it getting worse for so many. The wars, economics, the bipololarization, so much going on and hurting so many.

Note that this in no way excuses any acts like today. I am trying to figure out how to help decrease the epidemic you speak of.

[Egalitarian Thug]

41. I don't think anyone is trying to excuse this, just too many trying to lay the blame

on the easy mark. Kind of metaphorical of our whole society.

Got a really big problem? No problem at all, just declare it a small problem, lay the blame wherever it is easiest, declare a solution and get back to Dancing with the Stars.

Our problem is that everybody is waiting for somebody else to provide an answer to a question they are too afraid to ask. We have created a profoundly sick society where the stronger prey on the weaker while pretending that it is equitable. The first step to solving any problem is to identify the problem, and that's something we are just not willing to do.

[uppityperson]

42. It isn't "THE" answer but something I'd like to have happened for a long time, could help a lot

of people.

As far as a sick society? You mean this one that worships the Almighty Dollar, that thinks each is the most important of all, that should never need any help of any sort? This one? Where people are to be used and discarded or ignored? This one?

There are a lot of good people but a whole lot wrong overall.

[Egalitarian Thug]

50. That's the one. Oh, and the TV, we worship money and the magic box. n/t

[Marrah_G]

32. Bingo

[Posteritatis]

33. Especially the "non-stigmatic" part. People tend to fail pretty goddamn hard on that one.

For everyone who wants treatment and can't afford it, I'll bet there's another who wants treatment and is pressured away from it.

[DirkGently]

52. Yes. This huge point seems to always gets lost.

[Posteritatis]

57. Not lost as much as wilfully cast aside; it's depressing. (nt)

[DirkGently]

59. People don't want their anger diluted.

Mental illness doesn't necessarily relieve anyone of culpability for horrific acts, but I think resentment over the perception that it could makes people resist acknowledging it, perhaps especially when it seems likely.