I have always viewed as circumspect the interest of certain medical specialty societies which take stands that could be viewed by some as political. The need for these groups to make some sort of societal statement applied to medical corollary without the acknowledgement of the majority of its members implies ever so slightly of a kind of elitism better served by organizations more overtly deemed “political”.

Consider the statement by the APA on the recent effects of the oil spill on the incidence of mental illness diagnoses and subsequent insurance claims for treatment.

Mental illnesses brought on by difficult situations surrounding the BP oil spill may be less visible than other injuries, but they are real. An entire way of life has been destroyed, and this is causing anxiety, depression, [PTSD], substance use disorders, thoughts of suicide and other problems,” said APA President Carol A Bernstein, M.D.

The position –  the result of a response to BP’s chief claims administrator essentially denying payment equity with physical ailments payable with the government’s escrow relief funds — sounds more like a pitch to the feds and Big Insurance for more action guaranteeing accessible mental health care under reform. Since the biggest oil fiasco in this country’s history won’t be fading in importance anytime soon, the drive is on for greater awareness of the need for improved access to mental healthcare services.

While there is nothing wrong in actively lobbying the federal government for goals like this — the timing of this announcement, the association with a prominent DC-area mental health lobby, and the strong interest in this particular tragedy (as opposed to other numerous, less newsworthy ones) — should remind healthcare providers of the blurred line between political activism and healthcare advocacy.

Often referred to as the “bible” for the medical discipline of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, still in its fourth edition overall, is preparing for a makeover — its first since 1994. This was the reference that was the handbook for getting through psychiatric rotations in medical school and residency. Its focus is to provide criteria for diagnosing mental disorders. Incorrectly referred to as a “cookbook” by many, the manual actually stands as complementary to the myriad postulates and patient presentations often part of the challenging workup toward a clinical psychiatric diagnosis.

Scheduled for release in 2013, the fifth edition is now in its final stages of preparation. Starting today, a task force commissioned with proposals for the upcoming edition is now soliciting public comment on proposed changes — which include everything from the proper nomenclature for substance abuse to the increasingly necessary strict determination of the diagnosis of autism. | LINK

The movie The Soloist, starring Oscar winner Jamie Foxx and Oscar nominee Robert Downey, Jr., may have finished behind the Beyoncé flick Obesessed this past weekend in terms of box office, but it is being mentioned in this post for another reason: highlighting a call to action of sorts regarding adult mental illness in this country.

The Soloist is based on the true story of the unlikely friendship between Nathaniel Ayers, a street musician living in Skid Row, and Steve Lopez, a columnist with the Los Angeles Times. In a series of columns, Lopez reports on Ayers’s journey as a gifted student from the Julliard School of Music to the streets of Los Angeles, living with schizophrenia. 

Schizophrenia is a mental illness that affects about 2 million Americans — twice the number living with HIV/AIDS. | LINK

This has to be the absolute sanest thing the FDA has done in quite a while: reject a drug (for an indication to treat depression) which appears in the same class as drugs used to treat acute psychosis and chronic schizophrenia (!)

A committee of Food and Drug Administration advisers said Seroquel XR was safe enough for treating some patients with depression but opposed use of the drug for fighting anxiety given the serious side effects.

The panel voted 6-3 that Seroquel XR had acceptable risks if it was added to other medicines to find a workable combination to alleviate depression. Several panel members stressed that doctors should try other treatments for depression first before deciding to add Seroquel XR.

Okay, so the FDA’s stance was not exactly prohibitive on the use of Seroquel to treat depressed mood; it was more conciliatory (almost as if its pharma company requested it)…

The panel split 4-4, with one abstention, when asked if it was safe enough to use Seroquel XR as the only treatment for depression in some cases. Panelists said there were safer medicines that should be tried if only one medicine was going to be used.

Does that mean that physicians **won’t** prescribe it for depression as a first-line? Heck, they already give the stuff for sleep. | LINK

Let’s start this post by harkening back to the dawn of the managed medical care era, just after Medicare and Medicaid programs were about to initially cry insolvency amid a new Nixon administration ready to try anything to put those social programs out of their misery. Back then, the words “doctor” and “trust” were interchangable entities among patients who could come to appreciate their care and expect a (reasonably) long and healthy relationship.

Fast forward a good forty years, and those government programs are still churning, albeit with major financial baggage gumming up the works; and patients no longer expect primary care with a singular provider from cradle to grave. As a Broken Health Care Nation, patients as consumers have come to expect nothing less.

But can the same thing be said about primary mental healthcare? What is probably seen as a boundary-busting dysfunctionally enabling relationship among client and provider by anonymous bean counting third parties is a closely guarded dyad steeped in trust and sanctimony by those same patients and their committed mental health treatment team.

It’s precisely this issue of trust which is at the center of the fight between a District of Columbia’s city council decision to close publicly funded mental healthcare clinics in favor of private contracts for those patients whose trust in that care delivery model is solid. To say that they have to deal with the alternative is laughable, and they came out in full force to protest the proposed action. | LINK

Conventional widsom always posited that the farther you went in your formal schooling or generally kept your mind sharp during graceful aging, you stood a pretty good chance of maintaining sound cognitive functioning in those Golden Years. Okay. But what to make of new data in the journal Neurology? Suggesting that doctors have to watch all patients closely for signs of mental deterioration, a study of 6500 people in Chicago, found no link between a person’s educational level and their rate of decline to Alzheimer’s and other forms of dementia. While it is unlikely that this bit of fresh information will cause geriatricians and primary care practitioners completely to abandon previously established anecdote, the results of this trial do place the importance of sound preventive medicine as a reimbursible healthcare intervention. Hear that, policymakers? | LINK

Healthcare advocates in favor of privatizing^[1] services to the mentally ill in the District of Columbia are doing so because the move will save money. Union reps for the District’s public municipal services disagree, citing the potential for undertreatment and outright negligence of DC’s most vulnerable of the lot.

Union leaders who represent some employees said the transition is risky. They said city counselors provide care to the most difficult cases, people with deep psychiatric troubles. Those patients have developed a trust with their counselors and are less likely to make the transition to a private care provider, they said.

In addition, union leaders said, about 200 workers would lose their jobs in the midst of a recession. They probably would seek work in the private sector, where pay is lower and job turnover is higher, the leaders said. 

LINK

1. Privatizing may have unintended consequences. It could lead to the fragmentation of treatment services by eliminating interdisciplinary teams and interagency programs, for example. [↩]