Mental Health Association of Nebraska

Evolving Definitions of Mental Illness and Wellness

From the US National Library of Medicine comes an interesting study on the changing perceptions and understanding of mental illness and wellness.  The authors provide a historical update on the definitions of illness and wellness, and state that there has been movement "from a diagnosis-focused to a person-focused definition of mental illness, and from an 'absence of disease' model to one that stresses positive psychological function for mental health." Wellness is defined as "the degree to which one feels positive and enthusiastic about oneself and life, whereas illness refers to the presence of disease."

Along with the evolving definition of mental health and illness, the authors also considered social determinants of mental health and illness including income, housing, stress, early childhood experience, social exclusion, occupation, education level, sanitation, social support, discrimination and lack of access to resources.  In their conclusion they state that "mental health is frequently intertwined with physical health and social conditions; attempts to understand different diseases, develop interventions, and design health promotion strategies will be more effective if rooted in a dynamic and complex biopsychosocial model of disease and health."  To read more . . .

One area that was not considered, or at least specifically identified, is the impact of prevailing social norms in defining acceptable or normal behavior v. abnormal or anti-social behavior. For an interesting discussion on the social impact on diagnosis of mental illness, read The Americanization of Mental Illness.

New Iowa law requires hospitals to notify police before releasing “mental patients”

Closer to home, Iowa Governor Chet Culver signed into law a measure that forces hospitals to notify the police before releasing "mental patients" that either have been arrested or subject to arrest (Iowa gov. signs bill sparked by h.s. coach killing, The Washington Post, March 24, 2010).  The new law came about after a popular high school coach was shot and killed by a former student/player who had recently been released from a local hospital.  Prior to the shooting, the former student had been arrested by police and taken to the hospital for a psych evaluation.  The "law lets police demand that someone taken into custody be evaluated by mental health professionals and possibly hospitalized.  If there is a warrant pending or police plan to make an arrest, a judge or officer may require that police be notified before the patient is released."  To read more . . .

Ensuring Integrity in Industry-Sponsored Research

In an article in the latest edition of the Journal of the American Medical Association (JAMA), questions were raised concerning "the most fundamental principle of medicine, primum non nocere" [First, do no harm], holds "that for every physician, whether functioning as a clinician providing direct patient care; as a researcher, reviewer, or editor involved in medical publishing; or as an administrator overseeing an academic institution, health care organization, or pharmaceutical company research program.  In all situations affecting patients, physicians must do no harm."  The authors found "disturbing example[s] of inappropriate conduct surrounding . . .industry-sponsored clinical trial[s]" that created "a situation in which concerns about preserving market share apparently trumped concerns about the potential for causing harm."

In questioning the integrity of industry-sponsored research, the authors asked:

• Why would a peer reviewer for a medical journal violate ethical standards and provide a confidential manuscript to a for-profit company?
• Why would physician managers in a company misuse that confidential information in attempts to counter research findings suggesting that a company's product was harmful?
• Why would any physician in a for-profit company participate in, tolerate, or condone deceptive or unethical conduct or lack sufficient ability to stop such conduct?
• Why would any physician-researcher agree to report findings from an unscheduled interim analysis of a clinical trial, potentially undermining the statistical validity and credibility of the overall results?
• Why would any physician serving on a steering committee and realizing that patients were at risk remain silent when a drug is shown to be potentially harmful?
• Why would studies be published without complete assurance that the data management was appropriate and the statistical analysis was accurate and ethically conducted?

To read more . . .

Pfizer found guilty of racketeering

In a followup to last week's post When drug maker' profits outweigh penalties, the federal court in Boston found Pfizer guilty of racketeering for marketing its epilepsy drug Neurontin for unapproved use in treating aliments including bipolar disorder and migraines. Under federal racketeering law, the $47 million penalty automatically triples to $141 million (US jury's Neurontin ruling cost Pfizer $141 million, Reuters, March 25, 2010).  The suit was brought to court by HMO Kaiser Permanente, who claimed they were "wrongfully manipulated" into spending "more that one hundred million dollars on a very expensive drug that we now know is no more effective than a placebo for pain, bipolar. and many other conditions it was promoted to relieve" (Kaiser Pernanente Statement on Verdict in Neurontin Case, FierceBiotech.com, March 26, 2010).

To learn more about the prescription medications you are taking, and whether they are approved for the uses they were approved for, check out:

MedWatch

DailyMed

MedLine Plus

Health Reform Fact Sheets For People Living With Mental Illness

Thanks to UPenn Collaborative there 2 new documents to help people living with psychiatric disabilities learn more about how the health care bills passed by Congress in 2009 might affect consumers.  specific elements might be different from the version just passed by Congress, but the majority of the information should be of value. 

"Will health reform help people with mental lllness?"  examines the health reform bills and their impact on opportunities for community integration.

"If I have a psychiatric disability, will health reform help me?" is a complementary fact sheet that further describes some changes the law could make in care and treatment.

For more information and access to other papers and reports available, please visit UPenn Collaborative.

Nebraska Board of Psychology votes to not change ethics language

On Friday, March 19, 2010, the Nebraska Board of Psychology heard testimony, both for and against, on proposed language changes within the state's Regulations Defining Unprofessional Conduct by a Psychologist. The initial language change would have allowed a psychologist, for personal religious or moral reasons, to stop providing therapy and refuse to provide the person with any referral to other services.  DHHS lawyers re-crafted a compromise that still would allow the therapist to drop their patient for moral reasons, but would require referral that "may be for the initial presenting problem, or the newly identified problem, or both." The Regulation now states that a therapist's "failure to consider a client as an individual and imposing on the client any stereotype of behavior, values or roles related to age, gender, religion, race, disability, nationality or sexual orientation which would unreasonably interfere with the objectivity provision of psychological services to the client," would be considered as unprofessional conduct.  

MHA-NE provided testimony against any language change to the regulations, stated that the "conscience conviction policy only addresses the needs of the provider, not the needs of the consumer," and "that the whole purpose of your profession is to provide needed care to people, not in fulfilling your individual need to serve yourself." MHA-NE also quoted archbishop emeritus and Nobel Peace Prize recipient Desmond Tutu's recently published article regarding the increasing discrimination based solely on sexual orientation:

"No one should be excluded from our love, our compassion or our concern because of race or gender, faith or ethnicity, or because of their sexual orientation.  Nor should anyone be excluded from health care on any of these grounds."  To read Desmond Tutu's article in, click here.

Stating that the primary obligation that the therapist has is to their patients, the Board said that the patient was the vulnerable party, and that decision to terminate service because of the individual's "immoral lifestyle" could cause trauma to the patient.  The Board voted unanimously to reject any language changes.

When drug makers' profits outweigh penalties

In an article that received the 2010 Society of American Business Editors and Writers Award for Enterprise Reporting, David Evans reports that many major pharmaceutical companies weigh the costs and benefits when deciding to purposefully advise physicians to prescribe approved medications for non-approved uses (Washington Post, March 21, 2010). According to the author, prior to receiving the "largest criminal fine in U.S. history," pharma giant Pfizer had a marketing plan that "offered doctors $1,000 a day" for all day access so their sales staff could  "mentor" the doctor on their products. "Under the fragmented system of U.S. medical regulation, it's legal for a doctor to prescribe FDA approved drugs for any use.  The FDA has no authority over doctors, only over drug companies."  When caught and prosecuted, the companies view the penalties an just another "cost of doing business," and seem to be "willing to pay hundreds of millions on dollars in fines as a cost of generating billions in revenue."  To read more . . .

DSM-V: Medicalization of Grief

According to Dr. Allen Frances, MD, small changes in the in the Draft DSM-V could have profound impact on how people dealing with grief are diagnosed and treated (Psychiatric Times, March 16, 2010).  Dr. Francis, who served as the chair of the DSM-IV Task Force, believes that although some people would benefit from quick access to necessary treatment,"others, an inaccurate and unnecessary psychiatric diagnosis could have many harmful effects. Medicalizing normal grief stigmatizes and reduces the normalcy and dignity of the pain, shortcircuits the expected existential processing of the loss, reduces reliance on the many well established cultural rituals for consoling grief, and would subject many people to unnecessary and potentially harmful medication treatment." To read more . . . 

Dr. Francis also hosts a web blog on the proposed changes to the so-called "Psychiatrist' Bible."  to check it out, visit DSM5 in Distress.

Mental Illness: Both over-treated and under-treated

Shirley Wang of the Wall Street Journal writes that “more Americans are being prescribed multiple psychiatric medications for use at the same time, but most people diagnosed with recent depression don't get adequate treatment.”  Citing 2 recently released studies, Wang states that 8.3 % of the people studied met the criteria for major depression but only half received some form of treatment for the condition. 

In another study, researchers found that “psychiatrists are increasingly prescribing more than one psychotropic drug for patients during a single office visit” and that up to 60% of office visits resulted in the prescribing of “two or more psychotropic medications.”  To read more . . .

Vision and behavior

Judith Warner of the New York Times reports that vision therapy can be useful in treating children with

“reading problems, learning problems, spelling problems, attention problems, hyperactivity, coordination problems; it can also treat a child who experiences “trouble in sports,” who “frustrates easily,” displays “poor motivation,” and “does not work well on his own.”  To read Warner’s article, click here.  To learn more about behavioral optometry, visit Visionandlearning.org.