Obamacare and Mental Health: Good News and Bad News

An article was published by US News and World Report yesterday, and it has mixed news about the Affordable Care Act and mental health treatment: the number of people with mental health conditions who are uninsured decreased in 2015, but the number of people who received mental health services using insurance plans obtained on the exchanges also decreased, when it should have increased. That’s very concerning, since it’s been shown consistently over time that “talk therapy” is the most cost-effective way to help people with disorders like depression and anxiety to improve their well-being and functioning.

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Predicting and Preventing Workplace Violence: An EAP’s Worst Nightmare

The recent tragedy involving the murders of a news reporter and camera operator on the air in Roanoke, Virginia is a reminder that workplace grievances and grudges can erupt into violence very easily, and that terminating a person’s employment can be the trigger that causes a marginally disturbed person to become violent. Taking away a person’s job not only threatens his or her sense of survival (because a job is the means we have to provide ourselves with food, clothing, and shelter), but also threatens a person’s self-image and self-worth, when being fired is equivalent to a rejection. One of the most difficult aspects of such a situation is that the breaking point may not occur when the employer and co-workers might expect it and can prepare. Often, as in this case, it simmers for months or even years before a violent incident occurs.Continue Reading Predicting and Preventing Workplace Violence: An EAP’s Worst Nightmare

Blogging for Mental Health – Reducing Stigma and Supporting Treatment

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On May 14, the American Psychological Asociation is encouraging members to blog on subjects related to mental health and mental illness. This is an opportune time for me to reflect on what has been accomplished in the nearly forty years I’ve been working in this field, and what still needs to be done.Continue Reading Blogging for Mental Health – Reducing Stigma and Supporting Treatment

A Tough Uncle: On “Being Losers”

In the latest example of what are becoming all-too-frequent acts of unspeakable horror, homemade bombs killed three people and seriously wounded dozens more at the beloved Boston Marathon this week. The act itself seems to fit the definition of terrorism perfectly: an indiscriminate strike at ordinary, innocent people in a moment of national celebration, forever tainting the memory of the event, and forever changing the lives of thousands or millions of people who had to witness it, even apart from those directly impacted.

Now that (as of the moment) one of the suspected bombers has been killed, and another is still at large, the media have seized upon any story they can find. In doing so, they spoke to the uncle of the suspected bombers, who gave the reporters his unvarnished opinion about the crime (this from an Associated Press story):

Asked what he thought provoked the bombings, Tsarni said: “Being losers, hatred to those who were able to settle themselves. These are the only reasons I can imagine of. Anything else, anything else to do with religion, with Islam, it’s a fraud, it’s a fake.”

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Unspeakable Horror

In the aftermath of the horrific shootings in Sandy Hook Elementary School, we see (as we do after each of these increasingly common incidents) many pieces in news media and from mental health experts (including the American Psychological Association) on how to talk to children about such tragedies. Unfortunately, we adults also need help in figuring out how to talk to each other – and ourselves – about such events.Continue Reading Unspeakable Horror

Synthetic Cannabinoids – A Scary Brew

I attended a conference today on synthetic cannabinoid drugs, such as “Spice,” K-2, and “bath salts.” These are drugs made by altering the chemical properties of an existing drugs, primarily THC (cannabis, or marijuana). Although their popularity seems to have followed from the popularity of “club drugs” such as ecstasy, they are not chemically based on stimulants as ecstasy was. They were originally touted as a “legal high,” but more of them are being made illegal, and with good reason.Continue Reading Synthetic Cannabinoids – A Scary Brew

Professor Sir Michael Marmot at Local Conference on Urban Mental Health

Today’s keynote speaker at the Adler School of Professional Psychology’s conference on urban mental health was Professor Sir Michael Marmot, a researcher at University College London who specializes in studying health inequities around the world. He made a number of excellent points.

One of his points was that disparities in income and wealth have been associated with poor health outcomes in the US and Britain more than in other countries (for example, the Scandinavian countries). He pointed out that Britons have universal access to health care, but lower income Britons, like lower income Americans, still don’t have the health enjoyed by similar income people from some other countries.

The take-away from all this is that neither more money nor wider availability of “health care” (actually, the system of paying for medical treatment services. about which we argue so much in this country, and which other countries provide free) can ensure good health for large groups of people. Of course, if a person is diagnosed with cancer and has no insurance, he or she may die. But prevention is also important, as is managing the traumatic stress that goes with poverty. Nutrition, exercise, attitudes, and avoiding risky behaviors such as smoking and heavy drinking, need to be combined with better access to health care, to produce healthier communities.

Another point he made is that some decisions made by public policy makers, economists, and politicians – such as a decision to let unemployment rise in order to avoid inflation -may be expected to cause some people to die, because unemployment is correlated with higher rates of suicide, homicide, and illness. Although “correlation is not causation,” his point was that some evidence cannot be ignored without dehumanizing the people who experience problems of poor physical and mental health. We should be looking at the processes that lead to these outcomes, rather than characterizing the people who suffer from them as less worthy than ourselves and excluding them from access to the resources that could help them.

Our current conversation about whether people are “entitled” when they need help from the rest of us – with getting food, health care, and safe places to live – was obviously in the background of all he was saying. Race is an obvious issue when discussing this, and he described his research with the castes of India to illustrate that marginalization has real effects on people’s health, even with financial and service resources being equal.

Professor Marmot’s work is available at the “Marmot Review” of the Institute for Health Equity at UCL. The conference link is here and the Twitter hashtag is #ISE2012.

Suicide shouldn’t be politicized, but…

I don’t ordinarily like to bring my political views into this blog, but there are some examples (like the Florida law that makes it illegal for a doctor to ask if there are guns in a house with young children) that seem to cross from politics into ethical dilemmas. This blog post on Mother Jones’ website, about the disturbing trend of teen suicides in Minnesota – taking place a climate of bullying and intolerance of homosexuality, and politically-pressured silence on the part of school officials – has serious implications for mental health professionals.Continue Reading Suicide shouldn’t be politicized, but…