Reflection on Depression

Mental illness, violence, and psychiatric treatment

Ronald Reagan is more to blame for the shooting in Tuscon than Sarah Palin (of course, it's a simplification to blame any one person).  Still, Ronald Reagan did more to dismantle America's mental health system than anyone else.  Although he promised adequate "community care" in its place, a system of outpatient facilities capable of handling the country's mental health burden never materialized. 

 

In my opinion, at least two things necessary for adequate reform:  

1) A bigger budget for mental health care services.  This is probably unrealistic given the deficit and the economy. But I wonder if teaching children emotional resilience at an early age could help reduce the burden (and expense) of treating mental illness later on. Also, families need to get sick loved ones into care much sooner, since early intervention improves the prognosis of most mental illnesses. A great example of a program teaching kids emotional resilience skills is Project Happiness.

2) Changes to the legal criteria for involuntary treatment or commitment.  There's a fine line between providing psychiatric treatment and harming civil liberties, but it's a line that we need to look at more closely. In the following MSNBC interview a forensic psychologist discusses the need to loosen the legal criteria for involuntary commitment. Currently, only people who are seriously at risk of harming themselves or others (for instance, as he notes, people who have waived a gun at someone over the last 24 hours) can be held. He thinks that courts should also consider what doctors call "insight" when deciding whether to commit someone. Those patients who lack insight into their illness (i.e don't believe they are sick) should be easier to commit. 

  MSNBC forensic psychologist interview

The Dr. also makes the point that the main reason for getting the mentally ill into treatment is because they are suffering, not because they are dangerous. This suffering is undeserved and thwarts many people with mental illness from reaching their full potential.

Plus, as one commentator points out, a higher percentage of intoxicated people commit violent acts than people with mental illness. In fact, the mentally ill are far more likely to be victims of crime (given their vulnerability) than perpetrators of crime.  

 

Federal High-Risk Insurance Pool Goes Into Effect

High risk pool going into effect soon

Good news. The temporary insurance plan for uninsured individuals with pre-existing conditions went into effect. The program will provide coverage to the "uninsurable" until 2014 when new regulations kick-in to prevent insurance companies from turning away customers with pre-existing conditions. 

Yay!  I was disqualified from individual insurance last year because of my mental health treatment.  As a result, I had to pay for services out of pocket for several months before I was able to join a group plan provided by my new employer. I'm glad to know that new safeguards are in place to help others in a similar condition obtain coverage. (I was very lucky to be able to afford $800 a month in medical expenses!)

Rosalynn Carter writes new book about mental illness

Rosalynn Carter's new book about mental illness is out. In "Within Out Reach: Ending the Mental Health Crisis" the former first lady discusses what needs to be done to improve services for the mentally ill. (I haven't read it yet so that's about as specific as I can get, but I'm looking forward to it).

Carter has campaigned for better mental health services for over three decades. She's been pivotal in putting an end to the era of institutionalization and to campaigning for better community services. It's clear, though, that Mrs. Carter remains concerned that community services today are not adequate to meet the needs of the mentally ill, and so, at 82, she's still working to improve funding and access. Not bad for someone in "retirement"!

Mother's Day: Celebrating the Melanie Blocker Stokes MOTHERS Act

This Mother's Day is extra special because we can finally celebrate the passage of the Melanie Blocker Stokes MOTHERS Act--legislation passed as part of healthcare reform that creates a federally funded research program for postpartum depression and psychosis. Yay for mothers' health!  

See here for coverage from Postpartum Progress, including a video of the press conference.  

May is Mental Health Awareness Month!

I'm working extra hard all month to bring you good content because May is Mental Health Awareness Month!  There's a lot coming up--Children's Mental Health Awareness Day on May 6th, Mother's Day on May 9th (I'll highlight postpartum depression), and Rosalynn Carter's release of her new book on mental illness in America.  More later, but for now see here for Mental Health America's press release for Mental Health Awareness Month.

Depression initiative aimed at reducing depression among African-Americans

 Check out this depression initiative aimed at African-Americans. The two-year campaign was kicked off in February at Howard University by depression activist and author Terri Williams and leaders from the Substance Abuse and Mental Health Services Administration. To see the website for the campaign check out Share Ourselves at www.storiesthatheal.samhsa.gov. The site has video resources as well as links to organizations and agencies that provide help for people with depression.

Paolo del Vecchio of SAMHSA noted that African Americans between the ages of 18 and 25 have a higher incidence of mental health disorders than the overall population, and that the increase in the suicide rate among young African Americans is twice the rate of their white counterparts. Yet less than one half of African Americans who need treatment receive it.

"Depression is killing black people by the thousands," Williams said, "and it's important to talk about it, no matter what our own personal fear might be. We must share our stories with each other, especially our young."

(Image of Terri Williams, businesswoman and Mental Health Activist)

Healthcare reform: New "centers of excellence" for depression treatment

Taking a cue from the war on cancer, the Patient Protection and Affordable Care Act (H.R. 3590) provides for "centers of excellence" for the treatment of depression and bipolar disorders.  The legislation includes grants for up to 20 centers across the country the first year and up to 30 within the first 5 years.  Hosted by eminent research facilities, each center of excellence will engage in research on the causes and evidence-based treatments of depressive disorders and will host clinical programs that bring this knowledge to patients.  Like the cancer centers created decades ago, the centers of excellence for depression will provide people across the country with access to high quality treatment, and will hopefully reduce the stigma of these disorders.

Depression centers based on the cancer center model

Pilots now allowed to take antidepressants after 1 year "adjustment" period

 Pilots taking antidepressants  

Fascinating - I didn't know until I read this that, until now, pilots haven't been allowed to fly when taking antidepressants, but it makes sense that we watch pilots' health closely. I'm not sure what the FAA's policy with regard to drugs for "physical" illnesses is, but I suspect it's similar.

I'm glad pilots can now use these four medications for treatment of depression, and I'm confident that these are four of the safest antidepressants on the market. Generally, SSRIs like Prozac don't cause side effects like sleepiness, and will, in most instances, make pilots more fit to fly--especially if the pilot has been suffering from severe vegetative symptoms such as insomnia or an inability to eat. The waiting period is a good precaution because patients can have severe and unexpected reactions to almost any drug. 

One whole year seems like a very long time, though. That's longer than the entire course of treatment for many patients. I hope the FAA has sound science backing up its decision to make the monitoring period so long, otherwise requiring a hiatus of this length may be discrimination. 

Phoebe Price's Death - Bullying and Suicide

Nine teens have been charged with harassment in the death of Phoebe Price, a Massachusetts high school student who killed herself last fall after suffering from intense bullying at school.

The Death of Phoebe Prince - Bullying and Suicide

Observers in the case have largely concluded that the bullying drove Price to suicide. However, a defense attorney will no doubt claim that Price's death is due to a pre-existing mood disorder. Which side is right? What "caused" Phoebe Price's suicide? 

Unfortunately, when it comes to human behavior, cause and effect are rarely straightforward. Not all children would have reacted to Price's situation by committing suicide. Some people are simply more susceptible to emotional dysregulation. In this case, Price may have been predisposed to extreme sadness and depression, and the toxic environment at her school may have accelerated an inevitable descent into depression. On the other hand, even the most psychologically resilient children can be driven to despair in a difficult enough environment. 

Some combination of "nature and nurture" probably made Price vulnerable to suicide. After all, human environments and human temperaments exist on a continuum, and a child on the losing end of both faces an unenviable challenge. What can we do, then, to strengthen both the emotional resiliency of a child and the supportiveness of her environment?

One approach would teach both bullies and the bullied to identify and regulate their emotions more effectively. Just as Price was unable to regulate her sadness, the bullies who tormented her may have had trouble curbing their anger and hostility. Both would have benefited from programs that teach school-age children and adolescents how to manage their feelings and develop empathy for others. 

Groups like Project Happiness provide this sort of emotional education for children. It's time we put these programs in every school to foster children's compassion and resiliency. (More on Project Happiness another day). 

Healthcare Reform - Some Background on Mental Health Parity

Love it or hate it, healthcare reform is here to stay. The Patient Protection and Affordable Care Act (H.R. 3590) was signed into law by President Obama one week ago today. Over the next few weeks, I plan to highlight sections of the bill that are particularly relevant to people living with a mental illness. 

Before I delve into the current legislation, I want to mention a 2008 Act which provides for greater parity in the treatment of mental and physical illnesses.

As part of the 2008 economic bailout, Congress passed the Mental Health Parity and Addiction Equity Act. This law requires large group plans that provide mental health benefits to provide these benefits on par with traditional medical benefits. That is, the same deductibles, caps, limits, and out-of-pocket expenses must apply.

The bill was championed for twelve years by senator Pete Domenici (R-AZ) and the late senator Paul Wellstone (R-Minn). Below is a link to a 2008 Time magazine interview in which Domencici discusses passage of the bill. 

When Bush signed the bill into law in 2008 I doubt anyone realized just how significant parity would become in light of healthcare reform. Now, not only will millions more Americans soon have health insurance, but they will have insurance that provides adequate coverage for mental illness.

Senator Pete Domenici on the Mental Health Parity Bill of 2008