Articles Posted in Mental Illness

Medicaid-300x225Republicans have long fumed about the federal government’s role in health care, ever since Medicare for the elderly and Medicaid for the poor were both passed in 1965. Now, though, we’re at a crossroads, where a frontal assault on Medicaid could cause big damage to both programs.

The temptation for too many Americans, as I’ve written before, may be to skip over the Medicaid-related parts of the GOP proposals to repeal and replace the Affordable Care Act, aka Obamacare. That would be wrong because those parts of the American Health Care Act, aka Trumpcare, may be the most radical and will be detrimental to the poor, working poor, children, sick, disabled, and seniors. They will hit many millions more middle-class Americans than might be thought.

Opponents also say that Trumpcare and its Medicaid and health insurance changes will harm Medicare, the linchpin of health care coverage for seniors.

price-portrait-300x253The Republican-controlled Senate has launched itself in a late-night session on the path to its long-pledged repeal and replacement of the Affordable Care Act, aka Obamacare. The GOP-controlled House on  Friday the 13th followed close behind.

Lawmakers have chosen a complex parliamentary path. GOP members are expressing confusion about their way forward, even as doubts are being voiced by GOP governors in states where the ACA has expanded health care for the poor through Medicaid. The president-elect has called for swift action — insisting on not just Obamacare’s repeal but also its replacement with an undefined plan that he says will provide health care coverage that’s better than what exists now and for more Americans.

With big, many, and byzantine legislative steps needing to be taken even beyond “repeal,” can the ACA be replaced, too — and with what?

Carrie_Fisher_memorial_star-225x300Although advocates ended 2016 cheered by new legislation that increased funding and raised the priority of mental health in the nation’s health policy, the year also closed with stark reminders of how far the United States has lagged in this vital area.

Two separate news investigations have painted dire portraits of how the lack of mental health care has led to criminal violence and killings, while another media probe found disturbing signs that a major hospital chain was too quick to question patients’ mental competency and then to hold them against their will. The deaths of two of Hollywood’s elites—a mother and daughter—also brought to fore the stigma that many still bear due to mental disorders.

Neglect’s huge toll

VPJoeBiden_PresidentObamaPresident Obama is expected to sign the $6.3 billion 21st Century Cures Act, capping a rare, multi-year, bipartisan push to significantly improve the nation’s health care. The Senate, with Vice President Biden presiding and winning salutes from political colleagues and patient advocacy groupsapproved the act 94-5.

Proponents say it has many benefits to go around, as I’ve written, providing:

  • a $4.8 billion boost to the National Institutes of Health to support an array of innovative research in its facilities, as well as at universities, medical schools, academic medical centers, and major hospitals;

mdmaMental health experts aren’t suffering Sixties flashbacks. But they are seeing a new day for Molly (aka MDMA, Ecstasy, or 3,4-Methylenedioxymethamphetamine) and magic mushrooms (psilocybin). These hallucinogenic drugs are getting serious consideration in helping those with post-traumatic stress disorder (PTSD) and depression and anxiety due to cancer.

The federal Food and Drug Administration, which won’t comment on the matter, has approved Phase 3 clinical trials (large-scale human research) of MDMA for treatment of PTSD, according to  Multidisciplinary Association for Psychedelic Studies (MAPS).  

MAPS is a nonprofit research and educational organization that “develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.”

US_Congress_02It’s almost 1,000 pages,   culminates at least three years of work, and provides a $6.3 billion boost for an array of health-related agencies and initiatives. Will the U.S. Senate join the House in bipartisan passage of the 21st Century Cures Act, a sweeping measure that some say could affect American health care as much as the Affordable Care Act aka Obamacare?

After the bitterly divisive presidential campaign, House members surprised many with their swift consideration of the health funding bill, which passed 392-26. Congressional leaders then crowed about how they can work together and how the legislation will help. The act now has moved to the Senate for consideration. Senators, notably Massachusetts Democrat Elizabeth Warren, have been far more critical of components of the measure, particularly how Big Pharma and device-makers may benefit.

I’ve written how Congress, around this time last year, provided holiday cheer by approving the framework of the 21st Century Cures Act, an omnibus bill that took a year for funding details to get worked out. Because the legislation covers so many health areas and still must be acted on by the Senate and signed by the president, it still needs wary watching. Lobbyists for many different causes already have had a field day on this bill, and they will continue to do so.

commty care ncHospitals and health systems are making stark choices between offering models to assist their communities and reduce medical costs−or raking in profits, no matter how outrageous and shame-provoking their charges might be. Evidence of the extremes came this week in reports about alternative realities.

Let’s start with the positive view, recognizing exemplary efforts in the Charlotte, N.C.-area to both help patients and to sharply cut medical costs. Forward-looking health policy experts decided to dive into the highest Medicaid users of emergency services, discovering, for example, that just one patient, a homeless alcoholic man, visited the ER 223 times in 15 months and had undergone 150 redundant and needless X-rays or other scans. Many of the top 100 “frequent flyers,” poor and repeat ER patients, took an exceedingly costly route to fill prescriptions or to seek pregnancy or other routine tests; 86 of these individuals were known to have behavioral woes, including depression or bipolar disease. The experts found that these individuals visited multiple ERs on the same day, sometimes crossing a street or two to do so. They appeared on hot or cold days, suggesting their real need might not be medical but for shelter.

Community Care North Carolina — an umbrella group, with cooperation and support from hospitals, social workers, nurses, and social service agencies — searched out the heaviest using Medicaid-ER patients. They needed to comb the streets, jails, and even a strip club. They helped the patients find responsive primary care doctors, and other assistance, for example, in managing chronic illnesses and conditions. They connected them with social service agencies for assistance with existing housing, nutrition, jobs, and transportation programs. As the Charlotte Observer reports:

elexDutiful sons and daughters may need to see their parents, uncles and aunts, and grandparents, if nothing else to shut off their cable television news, turn off the talk radio, yank them off social media, and put down their newspapers and magazines. That’s because the American Psychological Association warns that an onslaught of media coverage, in a 2016 U.S. presidential campaign remarkable for its ugliness, is contributing to unhealthy stress for us all, especially older folks.

The association bases this claim on its annual survey, conducted by Harris Poll, of more than 3,500 adults older than 18 and living in the United States, with 52 percent of respondents saying the Hillary Clinton vs. Donald J. Trump race is a “very or somewhat significant source of stress.”

The dark campaign stresses Democrats and Republicans almost equally, and Americans’ discomfort is “exacerbated by arguments, stories, images and video on social media that can heighten concern and frustration, particularly with thousands of comments that can range from factual to hostile or even inflammatory,” the association reports.

Barry_Goldwater_photo1962muskieThey’re crazy, right? Or maybe they have a “personality disorder.” Our current political season is raising the issue about how wise it is for commentators and the rest of us to put labels on politicians we don’t like  in terms of their mental health.

Susan Molchan, a psychiatrist in the Washington, D.C.-area, provides a thought-provoking commentary on this topic at Healthnewsreview.org, the excellent watchdog site for hype and misinformation about health-related matters. She argues that, barring a careful, expert, and actual diagnosis of a patient, it can be destructive to the public dialogue and stigmatizing to those with true mental health afflictions, for the media, in particular, to speculate about public figures’ mental disorder.

Many of these pieces, of course, focus on a polarizing current candidate−and she provides examples of his coverage with commentators’ theorizing. Others could be added, such as: this column in which its author analogizes her own negative health experiences on to the candidate; or this piece−which drew attention because its author also happens to be a psychiatrist.

risperdalA Tennessee teen-ager suffered such emotional distress after growing enlarged breasts as an undisclosed side-effect of an anti-psychotic medication that the drug’s maker should pay him $70 million in damages, a Philadelphia jury has decided.

That verdict, only for compensatory damages, was the latest rebuke to Johnson & Johnson over its drug Risperdal. Jurors found that J&J “intentionally falsified, destroyed, or concealed records,” that warned that the medication could cause gynecomastia, the abnormal enlargement of the breasts in men.

J&J has lost a half dozen similar cases already, and it faces more than 1,500 damage lawsuits in Pennsylvania court. In one previous decision, a jury in 2015 awarded an autistic Alabaman $2.5 million after he developed 46DD sized breasts after taking Risperdal.

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