Mental Health Association of Nebraska

NE HHS: Psychiatric Regional Center Readmission Rate Low

According to Regional Center Discharge Follow-up Services Project Report, 1,225 adults have been discharged from selected units of the State Regional Centers between January 1, 2005 and December 31, 2008.  Nebraska began behavioral health reform in 2004 with the passage of LB 1083, which called for the closure of adult mental health services at 2 of the 3 state hospitals.  According to the report, 78 percent of those discharged have not been readmitted to any state mental health facilities.  Unfortunately, 28 former patients (2.3%) who were discharged during that time have since died, and with an average age of 47 years at the time of death (state average: 75 years), reflects the national trend that has found that people living with severe mental illness die 25 years sooner than the general population.

The report also includes community and emergency services use by former patients, as well as Medicaid, Social Security and other forms of economic assistance use.  For a copy of the report, click here.

To read Nancy Hicks' article in the Lincoln Journal Star, click here.

Ed Thomas Act: Preventing Crimes by the Mentally Ill

Building on the ignorance and fear of his fellow Iowan's, Representative Bruce Braley (D) is working on a federal version of Iowa's "Ed Thomas Act," which, following the murder of a popular football coach, promises to stop crime committed by people living with mental illness by allowing hospitals to notify police when they discharge patients who have received services within their mental wards.  H.R. 5733 would allow sharing of "officially protected health information" about people who have been "accompanied by law enforcement at the time such individual seeks care" from, presumably, a mental health unit.  According to Braley, the new legislation would help "ensure the future safety of schools and communities not just here in Iowa, but across America."  To read more . . .

Short on Empathy

TIME Magazine's Alice Park reports that college students seem to care more about the environment and animal welfare that for their fellow humans.  Citing 72 studies conducted between 1979 and 2009, she states that researchers found that "today's students are 40 percent less empathetic than their counterparts from the 1970's."  Questions asked study participants included "I often have tender, concerned feelings for people less fortunate than me," and "I sometimes try to understand my friends better by imagining how things look to them."  According to Park, members of "Generation Me . . . highlighted their tendency toward narcissistic and selfish behavior - a trait that some blame on their over-indulgent baby boomer parents."  To read more . . .

Bazelon Center for Mental Health Law on Electronic Medical Records

In acknowledging the importance of effective communication between medical care providers and consumers, especially given the co-morbidity of mental illness and physical illnesses like diabetes and cancer, the Bazelon Center believes that mental health consumers need to have access to and control of their medical records.  "The Bazelon Center . . .strongly believes that consumers with mental illness should  be able to access all of their health and mental health information.  Access to this information is not only fundamental to a person's sense of autonomy, it is also critical to health care improvement efforts that focus on involving patients in their own care and their learning to self-manage aspects of their health. Also, for consent to be fully informed, the consumer must have confidence that the information is accurate and complete and thus may want to know exactly what is being shared."  To learn more, visit the Bazelon Center for Mental Health Law.

Hospital fined for patient suicide

Omaha's Immanuel Medical Center was placed on probationary status by the Nebraska Department of Health and received a $10,000 fine for failing to protect a suicidal patient who, after being admitted, hung himself.  According to the Omaha World Herald, John Bighia, 41. was taken by ambulance to the Omaha hospital's emergency room on May 11, 2010, at 8:08 pm after he cut his wrists at work.  He was admitted to the psych ward at 10:12 pm, and was found dead in his room at 10:40 pm.

Immanuel was cited for "multiple failures" including:

• failure to protect Bighia's right to safe care which resulted in . . .death
• failure to inspect his room before putting him in it, thus leaving open an interior door from which Bighia suspended a sheet and hanged himself
• failure to monitor him every 10 minutes, although a staffer falsified records indicating such monitoring had occurred
• failed to inform the state within 24 hours of his death

In their report, the Department of Health also stated that after completing staff re-education sessions after the incident, psych ward staff failed to monitor another suicidal patient and then falsified records to show that they had monitored him.  This time the patient didn't harm himself.  To read more . . .

New federal rules on hospital visitation

Last April, President Obama called on the US Department of Health and Human Services to develop new rules that "would ensure that hopsitals that participate in Medicare and Medicaid respect the rights of patients to designate visitors, regardless of whether the visitors are legally related to the patient," and that hospitals do not deny visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability."

The new rules will be included in the Medicare Hospital and Critical Access Hospital Conditions of Participation, 42 CFR Parts 482 and 485 subpart F, respectively, and are expected to be published later this fall.  To read more . . .

Given the Nebraska Catholic Conference's belief that any form of therapeutic aid to people who are morally objectionable is, at the very least, tacit approval of immorality; and given the therapeutic benefits for a patient who has visitors; I can't help but wonder if they are working on a "compromise" here too.

Psychiatric Fads

In Normality Is an Endangered Species:  Psychiatric Fads and Overdiagnosis, Dr. Allen Frances, M. D., Professor of Psychiatry and former chairman of the Department of Psychiatry and Behavioral Sciences at Duke University, states that "fads in psychiatric diagnosis come and go and have been with us for as long as there has been psychiatry."  Frances believes that we are currently experiencing at least 3 "false epidemics" including autism, attention deficit and childhood bipolar disorder.  And when the DSM5 finally comes out, there will be more.

Frances believes that "epidemics in psychiatry are caused by changing fashions - the people don't change, the labels do."  Since there are no objective tests for mental illness, "what is diagnosed as mental disorders is very sensitive to professional and social context," including the readily available Diagnostic and Statistical Manual (DSM), which gave "non-clinicians" a tool for good as well as bad.  In addition, Frances identifies other forces contributing to overdiagnosis including pharmaceutical companies, an overly "perfectionistic" society, the internet, and even "patient and family advocacy groups."  The article is an interesting read and Frances places the blame on all within our society.  To read his article, click here.

How things you touch influence the way you think

In a study recently published in the journal Science, researchers from MIT found that "people's tactile sensibilities affect their social and decisions," and that "a person's exposure to objects of different weight, texture and hardness sends unconscious but powerful cues to the brain."

In one experiment, participants were given clipboards of different weight and asked to review employment resumes.  People whose resume was attached to the heavier clipboards were rated better qualified than those attached to the lighter clipboards, and when asked to rate the accuracy of their judgments, those with the heavier clipboards rated themselves higher than the participants with the lighter ones.

According to the authors, "first impressions are liable to be influenced by one's tactile environment," and suggested that "manipulation of touch could come in handy for negotiators, pollsters, marketers and anyone else with a stake in interpersonal evaluation."  To read more . . .

NE Board of Mental Health Practice Rejects “Compromise” Ethics Language

On Thursday, July 1, 2010, the Board of Mental Health Practice became the third state board to reject NEHHS / Nebraska Catholic Conference desire to allow mental health service providers to drop a client "for any reason" and then refuse to make an appropriate referral to another professional that will help the client.

On June 21, 2010, the NE Board of Health refused to follow Dr. Joann Schaefer's recommendation to reject the Board of Psychology's recently approved rules and regulations, and instead voted unanimously to approve them.

The next state board to consider the issue is the Board of Alcohol and Drug Counselors.  Their next meeting is scheduled for Thursday, July 8, 2010, with the open meeting beginning at 11:00 am, in the State Office Building, First Floor Room Z, in Lincoln.  Discussion on their rules and regulations, 172 NAC 15, is on the agenda.

Dr. Schaefer stated earlier that she would refuse to let the new rules advance without the so-called compromise language.  If you would like to contact Dr. Schaefer and let her know how you feel about the issue, her phone number is 402-471-8566, and her email address is joann.schaefer@nebraska.gov.  Her boss is Kerry Winterer, and his number is 402-471-9433, email address kerry.winterer@nebraska.gov,  and his boss, Governor Dave Heineman, can be reached at 402-471-2244, email dave.heineman@nebraska.gov. 

To read Nancy Hicks' article in the July 2, 2010, Lincoln Journal Star, click here.  Don't forget to check out the discussion section.

Elyn Saks on Forced Treatment, Seclusion and Restraint

Elyn Saks, Associated Dean and Orrin B. Evans Professor of Law, Psychology, Psychiatry and Behavioral Health Sciences at the University of Southern California Gould Law School, is considered an expert in mental health law.  In 2009, Saks was awarded the MacArthur Fellowship for her work as a "mental health lawyer expanding the options for those suffering from severe mental illness through scholarship, practice, and policy informed by a life that adds uncommon depth and insight." 

Saks was recently interviewed by Alysa Solomon, Ph.D, of the Los Angles County Department of Mental Health, where she speaks about her experiences growing up with mental illness, including in-patient psychiatric care and the use of restraints.To hear her interview, click here.

In the Introduction of Refusing Care: Forced Treatment and the Rights of the Mentally Ill, Saks writes that "it has been said that how a society treats its least well-off members says a lot about its humanity.  Our treatment of the mentally ill says that American society is inhumane." 

In her book she asks, "when should we treat those who don't want treatment, and when should we respect their choices?"  According to Saks, determining competence is an exercise in "value choices," where societal norms dominate when defining competence.  Saks believes that the standard for competence should be the same for those living with mental health issues as for the healthy, thus in determining incompetence, as in requiring forced medication or seclusion and restraint, standards should be the same for those living with and/or living without mental illness.  "Nobody would dream of authorizing, say a doctor, to force treatment of some kind on a perfectly competent, unimpaired person solely because that would be in his best interests."  Although the book isn't in our city library, you can read excerpts and order it through Amazon.com.