Serious Mental Illness Blog

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Mental illness is our most pressing health problemBy Martin Wolf
Given the considerable economic costs to society, treatment would pay for itself
Depression and anxiety cause more misery than physical illness, poverty or unemployment. They also impose huge economic costs. Yet they are amenable to effective and relatively cheap treatments. In the UK, however, fewer than a third of adult sufferers are treated, compared with 90 per cent of those with diabetes. Only a quarter of children with these mental illnesses receive effective treatment. This undertreatment is unjust and hugely inefficient. It is largely due to continued prejudice and a lack of awareness of the existence of effective treatments. This terrible failure must end now.
This, in sum, is the argument of a compelling new book, Thrive: The Power of Evidence-Based Psychological Therapies, by Professor Richard Layard of the London School of Economics and Professor David Clark of Oxford. The former is a well-known economist. The latter is a psychologist and one of the world’s leading experts on cognitive behavioural therapies. While I am able to assess the economic arguments, I cannot judge the claims made for CBT. But, the authors note, the National Institute for Health and Care Excellence, which is responsible for assessing the effectiveness of treatments for the National Health Service, recommends its use. That makes the undersupply of these services remarkable, if not shocking.
In Britain one in six adults suffers from depression or crippling anxiety disorders. The same is true in the US and continental Europe. These conditions can be disabling. Indeed, their impact on a person’s ability to function in society is on average 50 per cent more disabling than that of angina, asthma, arthritis or diabetes. For sufferers, mental illness is the “enemy within” – an assault on the self more agonising than most physical ailments. Moreover, according to the World Health Organisation, mental illnesses account for 38 per cent of all ill health in high-income countries. Heart disease, stroke, cancer, lung disease and diabetes together account for only 22 per cent in these countries. Yet, perhaps because of the stigma of mental illnesses, health systems and employers largely ignore the severity of these effects.
Above all, mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age. As the impact of infectious diseases has largely vanished, physical illness predominantly affects the elderly. This means that the economic consequences of mental illness are vastly greater than those of physical illness, not to mention the life-long damage done by mental illness in childhood. An extraordinarily high proportion of those in prison, for example, suffer from mental illness. About 90 per cent of those who kill themselves also suffer from mental illness. Suicide is a silent plague: “As many people in the world die from suicide as from homicide and warfare combined.” In 2000, 815,000 people killed themselves.
Moreover, the authors stress, mental illness makes it far more difficult to treat physical illnesses. People with mental illnesses find it hard to stick to their treatment plans. In addition, the consequences of mental illness contribute significantly to physical maladies.
In all, the case for treating mental illness at least as energetically as physical illness is overwhelming. The question, though, is whether that is possible. The book argues that today drugs and, even more, CBT have been proved in rigorous clinical trials to be effective. This is a matter of a properly scientific approach to development and testing treatments.
Mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age
“For some conditions,” argue the authors – citing depression, anxiety disorders, post-traumatic stress disorder, and bulimia – “we have treatments that lead to sustained recovery in half or more people, with many others seeing worthwhile improvements.” This is not perfect. But it is immensely better than nothing. Moreover, such treatments can also be effective in treating children as young as eight. The most encouraging aspect of all is that, it turns out, we are the captains of our souls. It is possible, it seems, to help people in agony regain lost control.
Given the economic costs to society, including those caused by unemployment, disability, poor performance at work and imprisonment, the costs of treatment would pay for themselves. The cost of therapy is also not high: about the same as six months’ treatment of diabetes routinely supplied by health systems today. Yet the commitment of most high-income countries to provide universal healthcare is grossly violated in the case of mental illnesses for no good reason and at vast economic, social and personal cost. This, argue the authors persuasively, is a scandal.
Most of us know people afflicted by mental illness. All know its devastating consequences. Indeed, the authors argue that the failure to tackle mental illness is one of the reasons unhappiness is so prevalent in societies that are so rich by historical standards. If the claims made for these treatments are correct, our failure to provide them is not just a crime but a blunder. We must not let outworn prejudice stop us from taking needed action.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

Mental illness is our most pressing health problem
By Martin Wolf

Given the considerable economic costs to society, treatment would pay for itself

Depression and anxiety cause more misery than physical illness, poverty or unemployment. They also impose huge economic costs. Yet they are amenable to effective and relatively cheap treatments. In the UK, however, fewer than a third of adult sufferers are treated, compared with 90 per cent of those with diabetes. Only a quarter of children with these mental illnesses receive effective treatment. This undertreatment is unjust and hugely inefficient. It is largely due to continued prejudice and a lack of awareness of the existence of effective treatments. This terrible failure must end now.

This, in sum, is the argument of a compelling new book, Thrive: The Power of Evidence-Based Psychological Therapies, by Professor Richard Layard of the London School of Economics and Professor David Clark of Oxford. The former is a well-known economist. The latter is a psychologist and one of the world’s leading experts on cognitive behavioural therapies. While I am able to assess the economic arguments, I cannot judge the claims made for CBT. But, the authors note, the National Institute for Health and Care Excellence, which is responsible for assessing the effectiveness of treatments for the National Health Service, recommends its use. That makes the undersupply of these services remarkable, if not shocking.

In Britain one in six adults suffers from depression or crippling anxiety disorders. The same is true in the US and continental Europe. These conditions can be disabling. Indeed, their impact on a person’s ability to function in society is on average 50 per cent more disabling than that of angina, asthma, arthritis or diabetes. For sufferers, mental illness is the “enemy within” – an assault on the self more agonising than most physical ailments. Moreover, according to the World Health Organisation, mental illnesses account for 38 per cent of all ill health in high-income countries. Heart disease, stroke, cancer, lung disease and diabetes together account for only 22 per cent in these countries. Yet, perhaps because of the stigma of mental illnesses, health systems and employers largely ignore the severity of these effects.

Above all, mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age. As the impact of infectious diseases has largely vanished, physical illness predominantly affects the elderly. This means that the economic consequences of mental illness are vastly greater than those of physical illness, not to mention the life-long damage done by mental illness in childhood. An extraordinarily high proportion of those in prison, for example, suffer from mental illness. About 90 per cent of those who kill themselves also suffer from mental illness. Suicide is a silent plague: “As many people in the world die from suicide as from homicide and warfare combined.” In 2000, 815,000 people killed themselves.

Moreover, the authors stress, mental illness makes it far more difficult to treat physical illnesses. People with mental illnesses find it hard to stick to their treatment plans. In addition, the consequences of mental illness contribute significantly to physical maladies.

In all, the case for treating mental illness at least as energetically as physical illness is overwhelming. The question, though, is whether that is possible. The book argues that today drugs and, even more, CBT have been proved in rigorous clinical trials to be effective. This is a matter of a properly scientific approach to development and testing treatments.

Mental ill health is today overwhelmingly the most important form of sickness affecting children and adults of working age

“For some conditions,” argue the authors – citing depression, anxiety disorders, post-traumatic stress disorder, and bulimia – “we have treatments that lead to sustained recovery in half or more people, with many others seeing worthwhile improvements.” This is not perfect. But it is immensely better than nothing. Moreover, such treatments can also be effective in treating children as young as eight. The most encouraging aspect of all is that, it turns out, we are the captains of our souls. It is possible, it seems, to help people in agony regain lost control.

Given the economic costs to society, including those caused by unemployment, disability, poor performance at work and imprisonment, the costs of treatment would pay for themselves. The cost of therapy is also not high: about the same as six months’ treatment of diabetes routinely supplied by health systems today. Yet the commitment of most high-income countries to provide universal healthcare is grossly violated in the case of mental illnesses for no good reason and at vast economic, social and personal cost. This, argue the authors persuasively, is a scandal.

Most of us know people afflicted by mental illness. All know its devastating consequences. Indeed, the authors argue that the failure to tackle mental illness is one of the reasons unhappiness is so prevalent in societies that are so rich by historical standards. If the claims made for these treatments are correct, our failure to provide them is not just a crime but a blunder. We must not let outworn prejudice stop us from taking needed action.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Filed under economics economic finances depression depressed anxiety anxious treatment recovery mind body brain wellness mental health health healthy mental illness illness diagnosis disorder psychology psychiatry counseling social work uk united kingdom news us united states america

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Drug Abuse: Antipsychotics in Nursing HomesBy Jan Goodwin, AARP Bulletin, 
These dangerous medications are prescribed at an alarming rate without the patient’s consent
When Patricia Thomas, 79, went into a Ventura, Calif.,nursing home with a broken pelvis, the only prescriptions she used were for blood pressure and cholesterol, and an inhaler for her pulmonary disease. By the time she was discharged 18 days later, she “wasn’t my mother anymore,” says Kathi Levine, 57, of Carpinteria, Calif. “She was withdrawn, slumped in a wheelchair with her head down, chewing on her hand, her speech garbled.” Within weeks, she was dead.
Thomas, a former executive assistant, had been given so many heavy-duty medications, including illegally administered antipsychotics, by the Ventura Convalescent Hospital in November of 2010 that she could no longer function. If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.
"Yes, my mom had Alzheimer’s, but she wasn’t out of it when she went into the nursing home. She could dress and feed herself, walk on her own. You could have a conversation with her,” says Levine. “My mother went into Ventura for physical therapy. Instead, she was drugged up to make her submissive. I believe that my mother died because profit and greed were more important than people.”
A Ventura County Superior Court judge agreed that Levine had a legitimate complaint against the nursing home. In May, attorneys from the law firm Johnson Moore in Thousand Oaks, Calif., joined by lawyers from AARP Foundation, agreed to a settlement in an unprecedented class-action suit against the facility for using powerful and dangerous drugs without the informed consent of residents or family members. “It is the first case of its kind in the country, and hopefully we can replicate this nationwide,” says attorney Kelly Bagby, senior counsel for AARP Foundation Litigation.
A national problem
Tragically, what happened to Patricia Thomas is not an isolated incident. According to Charlene Harrington, professor of nursing and sociology at the University of California, San Francisco, as many as 1 in 5 patients in the nation’s 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients. The problem, experts say, stems from inadequate training and chronic understaffing, as well as an aggressive push by pharmaceutical companies to market their products.
"The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today," says Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C. "When nursing facilities divert funds from the care of residents to corporate overhead and profits, the human toll is enormous."
Kickbacks to doctors
Last November, in what the U.S. Department of Justice called “one of the largest health care fraud settlements in U.S. history,” Johnson & Johnson and its subsidiaries were fined more than $2.2 billion to resolve criminal and civil charges because of their aggressive marketing of drugs, including antipsychotics, to nursing homes, when they knew the drugs had not been approved by the U.S. Food and Drug Administration (FDA) as safe and effective for a general elderly population. The corporation also allegedly paid kickbacks to physicians, as well as to Omnicare, the nation’s largest long-term-care pharmacy provider. Omnicare pharmacists were recommending Johnson & Johnson’s drugs, including the antipsychotic Risperdal, for use by nursing home residents.
Back in 2009, Eli Lilly did the same thing with its antipsychotic Zyprexa, marketing to older people in nursing homes and assisted living facilities, federal prosecutors charged. In a settlement, the company agreed to pay $1.4 billion. “This case should serve as still another warning to all those who break the law in order to improve their profits,” Patrick Doyle, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services in Philadelphia, said at the time.A report released in March by the inspector general of Health and Human Services charged that one-third of Medicare patients in nursing homes suffered harm, much of which was preventable. “Too many nursing homes fail to comply with federal regulations designed to prevent overmedication, giving patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use,” Inspector General Daniel Levinson said. “Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions.”Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia or bipolar disorder. As such, they carry the FDA’s black-box warning that they are not intended for frail older people or patients with Alzheimer’s or dementia. In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death. “They can dull a patient’s memory, sap their personalities and crush their spirits,” according to a report from the California Advocates for Nursing Home Reform.
Kept in the dark
What’s more, the law requires “informed consent” by a patient or, if that is no longer possible, by his or her family before such drugs are administered. Yet advocates say that, all too frequently, this doesn’t happen. Levine, for example, says she didn’t know about all her mother’s medications until she transferred her mom to another facility. “When I saw the list of what she’d been given, I freaked out. I was upset and angry, in tears,” she recalls.
How can such things happen? One explanation is that many facilities don’t have enough properly trained staff: Most of the patient care in nursing homes falls to certified nursing assistants (CNAs) who need as little as 75 hours of on-the-job training to get certified. “Yet if you want a license to be a hairdresser, you need 1,500 hours of training,” Harrington points out.What’s more, CNAs are paid low wages so many of them work long hours. “They are totally exhausted, with extremely heavy workloads,” she says. That leads to high employee turnover and caregivers who don’t know their patients well enough to recognize their needs.Compounding the problem, many nursing home patients require a high level of care. Some are incontinent, and an estimated 60 to 70 percent have some form of dementia. There should be one CNA for every seven patients, but in some cases, the ratio is 1 to 15 — or even more, Harrington says. There also tend to be too few physicians actually present in nursing homes. “These facilities are highly medicalized, but doctors are rarely there,” says Tony Chicotel, staff attorney for California Advocates for Nursing Home Reform. He says that because of their low rate of reimbursement from Medicare, nursing homes are too often seen as a place where few top doctors practice.The result of all this can be so-called behavior problems among patients — which is the explanation nursing homes cite for giving patients unnecessary antipsychotic drugs, according to the U.S. Centers for Medicare and Medicaid Services (CMS). And pharmaceutical companies have been aggressively marketing their products as an easy and effective way to control these issues.
"There was a push by drug manufacturers, claiming these medications work for seniors when they knew, in fact, that it doubled their risk of death," Chicotel says.
CMS, which oversees the nursing homes that receive funding from federal programs, says it has been working to correct deficiencies in nursing facilities, including the inappropriate use of medications. The agency achieved the goal of reducing the inappropriate use of antipsychotic drugs by 15 percent over a recent two-year period, and hopes to get to a 30 percent reduction in the next few years, according to spokesman Thomas Hamilton. But Edelman points out that initial goal was reached more than a year late, and some 300,000 patients are still receiving the drugs inappropriately. Hamilton acknowledges that more needs to be done, but lack of funding from Congress is making even the most preliminary work difficult.
A better way
Fortunately, a growing number of nursing homes have begun to look for more effective — and more humane — ways to care for patients. Better training for caregivers is key: According to Cheryl Phillips, M.D., a geriatrician at LeadingAge, an organization representing nonprofit services for older people, nursing home staff can be trained to deal with behavior issues thoughtfully and creatively, without resorting to drugs.
She cites an example of a male patient who was spending his days in a noisy nursing home activity room. One day, he grew more and more agitated and tripped an aide with his cane. To calm him down, the staff took him to his private quarters. Over the following days, his behavior in the activity room became increasingly aggressive; he began randomly hitting caregivers and fellow patients. Each time, he was taken away to spend time in his room.
"The staff initially thought he had become violent and needed an antipsychotic," Phillips recalls. "But they ultimately realized that the cacophony in the activity room was stressing him out. Caregivers inadvertently rewarded him by giving him quiet time in his room, which is what he wanted. When they did it repetitively, they reinforced his aggressive behavior." Once the staff discussed the problem and began finding peaceful activities for the patient, the problem was solved — no drugs needed.
Putting patients first
Another success story is the Beatitudes facility in Phoenix, which dramatically changed its way of handling patients with dementia based on Tom Kitwood’s book Dementia Care Reconsidered: The Person Comes First. “What happens here is not for our systems, our convenience, but for the people we care for,” says Tena Alonzo, the director of education and research at Beatitudes. “People with dementia have disturbances in their sleep/wake cycle, so we let them be comfortable and decide when they want to sleep or eat, or not. Or how they want to spend their time,” she says. As a result, patients stop resisting care, and the facility runs more smoothly.
The Beatitudes’ philosophy is now being taught to a growing number of nursing homes around the country. “We’ve created a softer, gentler approach, acknowledging that we are not in charge of a person’s life — they are. In allowing them to retain their dignity, and adopt a comfort level of care, we’ve had better outcomes,” says Alonzo. That paradigm shift has not increased operating expenses, or required a higher staff-to-resident ratio. “We discovered that better care was better business,” Alonzo says.
For Kathi Levine and her mother, these encouraging developments are coming too late. “I want our lawsuits to impact nursing homes all over the country,” Levine says. “We need to protect our family members. They don’t have a voice, they can’t speak for themselves. So we need to speak out for them and help other people know what to look for. I want to make sure that what happened to my family doesn’t happen to anyone else.”
Jan Goodwin is an award-winning author and investigative journalist for national publications.
For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

Drug Abuse: Antipsychotics in Nursing Homes
By Jan Goodwin, AARP Bulletin

These dangerous medications are prescribed at an alarming rate without the patient’s consent

When Patricia Thomas, 79, went into a Ventura, Calif.,nursing home with a broken pelvis, the only prescriptions she used were for blood pressure and cholesterol, and an inhaler for her pulmonary disease. By the time she was discharged 18 days later, she “wasn’t my mother anymore,” says Kathi Levine, 57, of Carpinteria, Calif. “She was withdrawn, slumped in a wheelchair with her head down, chewing on her hand, her speech garbled.” Within weeks, she was dead.

Thomas, a former executive assistant, had been given so many heavy-duty medications, including illegally administered antipsychotics, by the Ventura Convalescent Hospital in November of 2010 that she could no longer function. If one drug caused sleeplessness and anxiety, she was given a different medication to counteract those side effects. If yet another drug induced agitation or the urge to constantly move, she was medicated again for that.

"Yes, my mom had Alzheimer’s, but she wasn’t out of it when she went into the nursing home. She could dress and feed herself, walk on her own. You could have a conversation with her,” says Levine. “My mother went into Ventura for physical therapy. Instead, she was drugged up to make her submissive. I believe that my mother died because profit and greed were more important than people.”

A Ventura County Superior Court judge agreed that Levine had a legitimate complaint against the nursing home. In May, attorneys from the law firm Johnson Moore in Thousand Oaks, Calif., joined by lawyers from AARP Foundation, agreed to a settlement in an unprecedented class-action suit against the facility for using powerful and dangerous drugs without the informed consent of residents or family members. “It is the first case of its kind in the country, and hopefully we can replicate this nationwide,” says attorney Kelly Bagby, senior counsel for AARP Foundation Litigation.

A national problem

Tragically, what happened to Patricia Thomas is not an isolated incident. According to Charlene Harrington, professor of nursing and sociology at the University of California, San Francisco, as many as 1 in 5 patients in the nation’s 15,500 nursing homes are given antipsychotic drugs that are not only unnecessary, but also extremely dangerous for older patients. The problem, experts say, stems from inadequate training and chronic understaffing, as well as an aggressive push by pharmaceutical companies to market their products.

"The misuse of antipsychotic drugs as chemical restraints is one of the most common and long-standing, but preventable, practices causing serious harm to nursing home residents today," says Toby Edelman, an attorney at the Center for Medicare Advocacy in Washington, D.C. "When nursing facilities divert funds from the care of residents to corporate overhead and profits, the human toll is enormous."

Kickbacks to doctors

Last November, in what the U.S. Department of Justice called “one of the largest health care fraud settlements in U.S. history,” Johnson & Johnson and its subsidiaries were fined more than $2.2 billion to resolve criminal and civil charges because of their aggressive marketing of drugs, including antipsychotics, to nursing homes, when they knew the drugs had not been approved by the U.S. Food and Drug Administration (FDA) as safe and effective for a general elderly population. The corporation also allegedly paid kickbacks to physicians, as well as to Omnicare, the nation’s largest long-term-care pharmacy provider. Omnicare pharmacists were recommending Johnson & Johnson’s drugs, including the antipsychotic Risperdal, for use by nursing home residents.

Back in 2009, Eli Lilly did the same thing with its antipsychotic Zyprexa, marketing to older people in nursing homes and assisted living facilities, federal prosecutors charged. In a settlement, the company agreed to pay $1.4 billion. “This case should serve as still another warning to all those who break the law in order to improve their profits,” Patrick Doyle, special agent in charge of the Office of Inspector General for the U.S. Department of Health and Human Services in Philadelphia, said at the time.A report released in March by the inspector general of Health and Human Services charged that one-third of Medicare patients in nursing homes suffered harm, much of which was preventable. “Too many nursing homes fail to comply with federal regulations designed to prevent overmedication, giving patients antipsychotic drugs in ways that violate federal standards for unnecessary drug use,” Inspector General Daniel Levinson said. “Government, taxpayers, nursing home residents, as well as their families and caregivers, should be outraged — and seek solutions.”Antipsychotic drugs are intended for people with severe mental illness, such as patients with schizophrenia or bipolar disorder. As such, they carry the FDA’s black-box warning that they are not intended for frail older people or patients with Alzheimer’s or dementia. In those populations, these drugs can trigger agitation, anxiety, confusion, disorientation and even death. “They can dull a patient’s memory, sap their personalities and crush their spirits,” according to a report from the California Advocates for Nursing Home Reform.

Kept in the dark

What’s more, the law requires “informed consent” by a patient or, if that is no longer possible, by his or her family before such drugs are administered. Yet advocates say that, all too frequently, this doesn’t happen. Levine, for example, says she didn’t know about all her mother’s medications until she transferred her mom to another facility. “When I saw the list of what she’d been given, I freaked out. I was upset and angry, in tears,” she recalls.

How can such things happen? One explanation is that many facilities don’t have enough properly trained staff: Most of the patient care in nursing homes falls to certified nursing assistants (CNAs) who need as little as 75 hours of on-the-job training to get certified. “Yet if you want a license to be a hairdresser, you need 1,500 hours of training,” Harrington points out.What’s more, CNAs are paid low wages so many of them work long hours. “They are totally exhausted, with extremely heavy workloads,” she says. That leads to high employee turnover and caregivers who don’t know their patients well enough to recognize their needs.Compounding the problem, many nursing home patients require a high level of care. Some are incontinent, and an estimated 60 to 70 percent have some form of dementia. There should be one CNA for every seven patients, but in some cases, the ratio is 1 to 15 — or even more, Harrington says. There also tend to be too few physicians actually present in nursing homes. “These facilities are highly medicalized, but doctors are rarely there,” says Tony Chicotel, staff attorney for California Advocates for Nursing Home Reform. He says that because of their low rate of reimbursement from Medicare, nursing homes are too often seen as a place where few top doctors practice.The result of all this can be so-called behavior problems among patients — which is the explanation nursing homes cite for giving patients unnecessary antipsychotic drugs, according to the U.S. Centers for Medicare and Medicaid Services (CMS). And pharmaceutical companies have been aggressively marketing their products as an easy and effective way to control these issues.

"There was a push by drug manufacturers, claiming these medications work for seniors when they knew, in fact, that it doubled their risk of death," Chicotel says.

CMS, which oversees the nursing homes that receive funding from federal programs, says it has been working to correct deficiencies in nursing facilities, including the inappropriate use of medications. The agency achieved the goal of reducing the inappropriate use of antipsychotic drugs by 15 percent over a recent two-year period, and hopes to get to a 30 percent reduction in the next few years, according to spokesman Thomas Hamilton. But Edelman points out that initial goal was reached more than a year late, and some 300,000 patients are still receiving the drugs inappropriately. Hamilton acknowledges that more needs to be done, but lack of funding from Congress is making even the most preliminary work difficult.

A better way

Fortunately, a growing number of nursing homes have begun to look for more effective — and more humane — ways to care for patients. Better training for caregivers is key: According to Cheryl Phillips, M.D., a geriatrician at LeadingAge, an organization representing nonprofit services for older people, nursing home staff can be trained to deal with behavior issues thoughtfully and creatively, without resorting to drugs.

She cites an example of a male patient who was spending his days in a noisy nursing home activity room. One day, he grew more and more agitated and tripped an aide with his cane. To calm him down, the staff took him to his private quarters. Over the following days, his behavior in the activity room became increasingly aggressive; he began randomly hitting caregivers and fellow patients. Each time, he was taken away to spend time in his room.

"The staff initially thought he had become violent and needed an antipsychotic," Phillips recalls. "But they ultimately realized that the cacophony in the activity room was stressing him out. Caregivers inadvertently rewarded him by giving him quiet time in his room, which is what he wanted. When they did it repetitively, they reinforced his aggressive behavior." Once the staff discussed the problem and began finding peaceful activities for the patient, the problem was solved — no drugs needed.

Putting patients first

Another success story is the Beatitudes facility in Phoenix, which dramatically changed its way of handling patients with dementia based on Tom Kitwood’s book Dementia Care Reconsidered: The Person Comes First. “What happens here is not for our systems, our convenience, but for the people we care for,” says Tena Alonzo, the director of education and research at Beatitudes. “People with dementia have disturbances in their sleep/wake cycle, so we let them be comfortable and decide when they want to sleep or eat, or not. Or how they want to spend their time,” she says. As a result, patients stop resisting care, and the facility runs more smoothly.

The Beatitudes’ philosophy is now being taught to a growing number of nursing homes around the country. “We’ve created a softer, gentler approach, acknowledging that we are not in charge of a person’s life — they are. In allowing them to retain their dignity, and adopt a comfort level of care, we’ve had better outcomes,” says Alonzo. That paradigm shift has not increased operating expenses, or required a higher staff-to-resident ratio. “We discovered that better care was better business,” Alonzo says.

For Kathi Levine and her mother, these encouraging developments are coming too late. “I want our lawsuits to impact nursing homes all over the country,” Levine says. “We need to protect our family members. They don’t have a voice, they can’t speak for themselves. So we need to speak out for them and help other people know what to look for. I want to make sure that what happened to my family doesn’t happen to anyone else.”

Jan Goodwin is an award-winning author and investigative journalist for national publications.

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Filed under drug drugs med meds medication medications antipsychotic psychosis psychotic schizophrenia schizophrenic abilify psychiatry psychology counseling social work mental health mental illness mental health illness recovery healthy wellness mind body brain treat treatment therapy

15 notes

Rikers: Where Mental Illness Meets Brutality in JailBy Michael Winerip and Michael Schwirtz, The New York Times
Just a few weeks earlier, Andre Lane was locked in solitary confinement in a Rikers cellblock reserved for inmates with mental illnesses when he became angry at the guards for not giving him his dinner and splashed them with either water or urine. Correction officers handcuffed him to a gurney and transported him to a clinic examination room beyond the range of video cameras where, witnesses say, several guards beat him as members of the medical staff begged for them to stop. The next morning, the walls and cabinets of the examination room were still stained with Mr. Lane’s blood.
The assaults on Mr. Bautista and Mr. Lane were not isolated episodes. Brutal attacks by correction officers on inmates — particularly those with mental health issues — are common occurrences inside Rikers, the country’s second-largest jail, a four-month investigation by The New York Times found.
Reports of such abuses have seldom reached the outside world, even as alarm has grown this year over conditions at the sprawling jail complex. A dearth of whistle-blowers, coupled with the reluctance of the city’s Department of Correction to acknowledge the problem and the fact that guards are rarely punished, has kept the full extent of the violence hidden from public view.
But The Times uncovered details on scores of assaults through interviews with current and former inmates, correction officers and mental health clinicians at the jail, and by reviewing hundreds of pages of legal, investigative and jail records. Among the documents obtained by The Times was a secret internal study completed this year by the city’s Department of Health and Mental Hygiene, which handles medical care at Rikers, on violence by officers. The report helps lay bare the culture of brutality on the island and makes clear that it is inmates with mental illnesses who absorb the overwhelming brunt of the violence.
The study, which the health department refused to release under the state’s Freedom of Information Law, found that over an 11-month period last year, 129 inmates suffered “serious injuries” — ones beyond the capacity of doctors at the jail’s clinics to treat — in altercations with correction department staff members.
The report cataloged in exacting detail the severity of injuries suffered by inmates: fractures, wounds requiring stitches, head injuries and the like. But it also explored who the victims were. Most significantly, 77 percent of the seriously injured inmates had received a mental illness diagnosis.
Covering Jan. 1, 2013, to Nov. 30, 2013, the report included no names and had little by way of details about specific cases. But The Times was able to obtain specific information on all 129 cases and used it to take an in-depth look at 24 of the most serious incidents, including Mr. Bautista’s and Mr. Lane’s. The Times also examined numerous other attacks on inmates by jail employees uncovered independently of the report.
Continue reading the main story


For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

Rikers: Where Mental Illness Meets Brutality in Jail
By Michael Winerip and Michael Schwirtz, The New York Times

Just a few weeks earlier, Andre Lane was locked in solitary confinement in a Rikers cellblock reserved for inmates with mental illnesses when he became angry at the guards for not giving him his dinner and splashed them with either water or urine. Correction officers handcuffed him to a gurney and transported him to a clinic examination room beyond the range of video cameras where, witnesses say, several guards beat him as members of the medical staff begged for them to stop. The next morning, the walls and cabinets of the examination room were still stained with Mr. Lane’s blood.

The assaults on Mr. Bautista and Mr. Lane were not isolated episodes. Brutal attacks by correction officers on inmates — particularly those with mental health issues — are common occurrences inside Rikers, the country’s second-largest jail, a four-month investigation by The New York Times found.

Reports of such abuses have seldom reached the outside world, even as alarm has grown this year over conditions at the sprawling jail complex. A dearth of whistle-blowers, coupled with the reluctance of the city’s Department of Correction to acknowledge the problem and the fact that guards are rarely punished, has kept the full extent of the violence hidden from public view.

But The Times uncovered details on scores of assaults through interviews with current and former inmates, correction officers and mental health clinicians at the jail, and by reviewing hundreds of pages of legal, investigative and jail records. Among the documents obtained by The Times was a secret internal study completed this year by the city’s Department of Health and Mental Hygiene, which handles medical care at Rikers, on violence by officers. The report helps lay bare the culture of brutality on the island and makes clear that it is inmates with mental illnesses who absorb the overwhelming brunt of the violence.

The study, which the health department refused to release under the state’s Freedom of Information Law, found that over an 11-month period last year, 129 inmates suffered “serious injuries” — ones beyond the capacity of doctors at the jail’s clinics to treat — in altercations with correction department staff members.

The report cataloged in exacting detail the severity of injuries suffered by inmates: fractures, wounds requiring stitches, head injuries and the like. But it also explored who the victims were. Most significantly, 77 percent of the seriously injured inmates had received a mental illness diagnosis.

Covering Jan. 1, 2013, to Nov. 30, 2013, the report included no names and had little by way of details about specific cases. But The Times was able to obtain specific information on all 129 cases and used it to take an in-depth look at 24 of the most serious incidents, including Mr. Bautista’s and Mr. Lane’s. The Times also examined numerous other attacks on inmates by jail employees uncovered independently of the report.

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31 notes

Two Icelandic Stories: Recovery from Schizophrenia/Depression without Medication in Iceland
By Daniel Mackler

Author’s description: Here are the stories of two people, Rósa and Hrannar, who were in the Icelandic mental health system. Both found alternative ways of finding health, getting out of psychiatry, and getting and staying off psychiatric medication. I filmed them on a beach an hour from the capital, Reykjavik, while I was visiting Iceland — on the Solstice, June 21, a day in which it stays light out for 24 hours a day. What better day to make a film of hope!

(P.S. The “plumes of smoke” in the background at certain points in the film — such as at 4:08 and 5:39 — are actually steam vents from natural hot springs which occur all over Iceland.)

Here are links to two Icelandic organizations the struggle for the rights of people in the mental health system:
http://www.gedhjalp.is/
http://www.hugarafl.is/

Author’s website: http://www.wildtruth.net

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

Filed under recovery hope recover treatment schizophrenia schizophrenic depression depressed sad sadness mood emotion emotions feeling feelings thought thoughts mental health healthy health mind body brain wellness daniel mackler story stories film documentary video

33 notes

Mentally ill people need to be helped, not houndedBy Polly Toynbee, The Guardian
Ministers promise ‘parity of esteem’ for mental and physical health services. Instead the reality is scandalous cruelty
Once upon a time, David Cameron said that general wellbeing matters as much GDP. What’s it all for if a country grows richer but its people feel no better? A genuine attempt at prioritizing wellbeing would be revolutionary, because the happiest people live in more equal societies, are less ridden by anxiety, enjoy good employment, are well housed and more trusting. Yet in Britain all those fundamentals indices of wellbeing are in retreat.
If aiming for happiness is beyond this government, minimizing extreme pain could be within reach, if it began by prioritizing scarce NHS resources entirely according to suffering. If pain was measured in a Benthamite way – the relief of the greatest suffering for the greatest number of patients – mental illness would trump most other conditions. One sufferer describes getting his broken leg slammed in a door as less excruciating than the agony caused by his depression. Yet an ingrowing toenail gets treated within a mandatory 18 weeks, while there is no waiting limit at all for treating mental illness. More than half of those referred by GPs never get any treatment, and of those who do, some wait for over a year in the deepest despair. It’s even more shocking that so often children get no help.
Professors Richard Layard, an economist, and David Clark, a clinical psychologist, ratchet up their campaign for better mental treatment with their new book, Thrive. These champions of cognitive behavioral therapy have done more to turn mental health into practical politics than anyone before, though progress is slow. Their skill has been to produce evidence that a course of CBT, costing £650, can permanently rescue half of those who take the course from disabling mental illnesses. For politicians, their evidence shows that a highly systemized treatment with specifically trained therapists saves lives and money. Nice guidelines say everyone with depression and anxiety should referred for CBT – but that’s not binding, so most are not. The mechanized approach invites criticism, but this strictly evidence-based therapy has the best chance of gaining political traction.
The coalition promised that mental health would get “parity of esteem" with physical health, but so far there is little sign of it. Instead the government has just cut the tariff paid for mental healthcare by more than it cut the tariff for physical treatments. Norman Lamb spoke at the launch of the Layard and Clark campaign in the Commons, protesting that mental health "was first to be cut and isn’t getting a fair share of attention". Had he forgotten that he is himself a health minister who could say no?
On some other planet, Nick Clegg made an eye-catching announcement in December that all mental patients could choose where they go for treatment – NHS or private – but most wait for anything, anywhere, and many get nothing. A shortage of beds means in-patients are now often sent hundreds of miles from home, certainly not by choice. NHS England’s website claims “parity of esteem” but only promises that 15% will get CBT by 2015.
As it is, cancer and heart disease rule the roost, surgeons are king and psychiatry is low in the pecking order. Politicians are not entirely to blame; they know that mental and community services, where 90% of patients are treated, should get priority, but NHS politics is governed by front-page demands for every new drug, and for intensive care to prolong the miserable last six months of life. Oppositions protest at rising waiting lists or ambulance waiting times. Jeremy Hunt doesn’t call community mental services to ask who they’re neglecting, he calls A&E to bellow at them for overstepping a four-hour wait. Can mental health be made as politically sensitive?
Neglect of the mentally ill is bad enough, but now consider how the Department for Work and Pensions deliberately torments them. I just met a job center manager. It had to be in secret, in a Midlands hotel, several train stops away from where she works. She told me how the sick are treated and what harsh targets she is under to push them off benefits. A high proportion on employment and support allowance have mental illnesses or learning difficulties. The department denies there are targets, but she showed me a printed sheet of what are called “spinning plates”, red for missed, green for hit. They just missed their 50.5% target for “off flows”, getting people off ESA. They have been told to “disrupt and upset” them – in other words, bullying. That’s officially described, in Orwellian fashion, as “offering further support”. As all ESA claimants approach the target deadline of 65 weeks on benefits – advisers are told to report them all to the fraud department for maximum pressure. In this manager’s area 16% are “sanctioned” or cut off benefits.
Of course it’s not written down anywhere, but it’s in the development plans of individual advisers or “work coaches”. Managers repeatedly question them on why more people haven’t been sanctioned. Letters are sent to the vulnerable who don’t legally have to come in, but in such ambiguous wording that they look like an order to attend. Tricks are played: those ending their contributory entitlement to a year on ESA need to fill in a form for income-based ESA. But job centers are forbidden to stock those forms. These ill people’s benefits are suddenly stopped without explanation: if they call, they’re told to collect a form from the job centers, which doesn’t stock them either. If someone calls to query an appointment they are told they will be sanctioned if they don’t turn up, whatever. She said: “The DWP’s hope is they won’t pursue the claim.”
Good advisers genuinely try to help the mentally ill left marooned on sickness benefit for years. The manager spoke of a woman with acute agoraphobia who hadn’t left home for 20 years: “With tiny steps, we were getting her out, helping her see how her life could be better – a long process.” But here’s another perversity: if someone passes the 65-week deadline, they are abandoned. All further help is a dead loss to “spinning plates” success rates. That woman was sent back to her life of isolation: she certainly wasn’t referred for CBT. For all this bullying, the work program finds few jobs for those on ESA.
Failing to treat the mentally ill is bad enough, but this is maltreatment. There has been much outrage about lack of kindness and care in hospitals. Neglect of mental patients is every bit as bad, but deliberate cruelty by the DWP defies any concern for the wellbeing for the most vulnerable, let alone “parity of esteem”.
Picture credit: seasidestudiosblog.blogspot.com
For more mental health resources, Click Here to access the Serious Mental Illness Blog.
Click Here to access original SMI Blog content

Mentally ill people need to be helped, not hounded
By Polly Toynbee, The Guardian

Ministers promise ‘parity of esteem’ for mental and physical health services. Instead the reality is scandalous cruelty

Once upon a time, David Cameron said that general wellbeing matters as much GDP. What’s it all for if a country grows richer but its people feel no better? A genuine attempt at prioritizing wellbeing would be revolutionary, because the happiest people live in more equal societies, are less ridden by anxiety, enjoy good employment, are well housed and more trusting. Yet in Britain all those fundamentals indices of wellbeing are in retreat.

If aiming for happiness is beyond this government, minimizing extreme pain could be within reach, if it began by prioritizing scarce NHS resources entirely according to suffering. If pain was measured in a Benthamite way – the relief of the greatest suffering for the greatest number of patients – mental illness would trump most other conditions. One sufferer describes getting his broken leg slammed in a door as less excruciating than the agony caused by his depression. Yet an ingrowing toenail gets treated within a mandatory 18 weeks, while there is no waiting limit at all for treating mental illness. More than half of those referred by GPs never get any treatment, and of those who do, some wait for over a year in the deepest despair. It’s even more shocking that so often children get no help.

Professors Richard Layard, an economist, and David Clark, a clinical psychologist, ratchet up their campaign for better mental treatment with their new book, Thrive. These champions of cognitive behavioral therapy have done more to turn mental health into practical politics than anyone before, though progress is slow. Their skill has been to produce evidence that a course of CBT, costing £650, can permanently rescue half of those who take the course from disabling mental illnesses. For politicians, their evidence shows that a highly systemized treatment with specifically trained therapists saves lives and money. Nice guidelines say everyone with depression and anxiety should referred for CBT – but that’s not binding, so most are not. The mechanized approach invites criticism, but this strictly evidence-based therapy has the best chance of gaining political traction.

The coalition promised that mental health would get “parity of esteem" with physical health, but so far there is little sign of it. Instead the government has just cut the tariff paid for mental healthcare by more than it cut the tariff for physical treatments. Norman Lamb spoke at the launch of the Layard and Clark campaign in the Commons, protesting that mental health "was first to be cut and isn’t getting a fair share of attention". Had he forgotten that he is himself a health minister who could say no?

On some other planet, Nick Clegg made an eye-catching announcement in December that all mental patients could choose where they go for treatment – NHS or private – but most wait for anything, anywhere, and many get nothing. A shortage of beds means in-patients are now often sent hundreds of miles from home, certainly not by choice. NHS England’s website claims “parity of esteem” but only promises that 15% will get CBT by 2015.

As it is, cancer and heart disease rule the roost, surgeons are king and psychiatry is low in the pecking order. Politicians are not entirely to blame; they know that mental and community services, where 90% of patients are treated, should get priority, but NHS politics is governed by front-page demands for every new drug, and for intensive care to prolong the miserable last six months of life. Oppositions protest at rising waiting lists or ambulance waiting times. Jeremy Hunt doesn’t call community mental services to ask who they’re neglecting, he calls A&E to bellow at them for overstepping a four-hour wait. Can mental health be made as politically sensitive?

Neglect of the mentally ill is bad enough, but now consider how the Department for Work and Pensions deliberately torments them. I just met a job center manager. It had to be in secret, in a Midlands hotel, several train stops away from where she works. She told me how the sick are treated and what harsh targets she is under to push them off benefits. A high proportion on employment and support allowance have mental illnesses or learning difficulties. The department denies there are targets, but she showed me a printed sheet of what are called “spinning plates”, red for missed, green for hit. They just missed their 50.5% target for “off flows”, getting people off ESA. They have been told to “disrupt and upset” them – in other words, bullying. That’s officially described, in Orwellian fashion, as “offering further support”. As all ESA claimants approach the target deadline of 65 weeks on benefits – advisers are told to report them all to the fraud department for maximum pressure. In this manager’s area 16% are “sanctioned” or cut off benefits.

Of course it’s not written down anywhere, but it’s in the development plans of individual advisers or “work coaches”. Managers repeatedly question them on why more people haven’t been sanctioned. Letters are sent to the vulnerable who don’t legally have to come in, but in such ambiguous wording that they look like an order to attend. Tricks are played: those ending their contributory entitlement to a year on ESA need to fill in a form for income-based ESA. But job centers are forbidden to stock those forms. These ill people’s benefits are suddenly stopped without explanation: if they call, they’re told to collect a form from the job centers, which doesn’t stock them either. If someone calls to query an appointment they are told they will be sanctioned if they don’t turn up, whatever. She said: “The DWP’s hope is they won’t pursue the claim.”

Good advisers genuinely try to help the mentally ill left marooned on sickness benefit for years. The manager spoke of a woman with acute agoraphobia who hadn’t left home for 20 years: “With tiny steps, we were getting her out, helping her see how her life could be better – a long process.” But here’s another perversity: if someone passes the 65-week deadline, they are abandoned. All further help is a dead loss to “spinning plates” success rates. That woman was sent back to her life of isolation: she certainly wasn’t referred for CBT. For all this bullying, the work program finds few jobs for those on ESA.

Failing to treat the mentally ill is bad enough, but this is maltreatment. There has been much outrage about lack of kindness and care in hospitals. Neglect of mental patients is every bit as bad, but deliberate cruelty by the DWP defies any concern for the wellbeing for the most vulnerable, let alone “parity of esteem”.

Picture credit: seasidestudiosblog.blogspot.com

For more mental health resources, Click Here to access the Serious Mental Illness Blog.

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