Monday, August 25, 2014

Depressing thoughts

The US and Canada differ on many aspects of health care delivery, but one area in which they have a common approach is inadequate care for mental health.  I was reminded of this when I met with a colleague who works at the British Columbia Division of the Canadian Mental Health Association.  She related several stories about slow and inappropriate treatment of patients--both in crisis and in chronic states--in the provincial health system.

Meanwhile, Modern Healthcare reported that south of the border a court ruled that, "hospitals in Washington state will be prohibited from boarding psychiatric patients in emergency departments while they wait for inpatient beds to open up."

This creates a terrible Catch-22:

“While we respect the state court's decision, federal law still prevents hospital emergency departments from discharging unstable patients, for example, suicidal or homicidal patients, back into environments where they could cause harm to themselves or to others,” Dr. Alex Rosenau, president of the American College of Emergency Physicians, said in a statement. “This ruling does not provide guidance for hospitals and physicians regarding resolution of the conflicts among federal law, this state ruling, and the medical liability risk of discharging patients based on a time limit rather than based on reaching a stable condition.”

These debates often focus on funding, but the human costs are high.  Marijke takes the recent death of Robin Williams to note on her blog:

Williams's death hit too close to home to many and it opened up a conversation that many people are afraid to have. Williams graced us with his humour and his talent, and seemed to have it all. Yet he didn't. He missed something incredibly important - good mental health. It reminds us that we are all vulnerable.

Virtually every family in these two countries has had or will have a member with mental illness.  I'd love to see some politicians who bravely break through the stereotypes and force political action that raises diseases of the brain to the level of diseases of the kidney, lungs, and liver.


Anonymous said...

I appreciate your compassion for those suffering. But as a health care professional and member of the growing movement to promote options and informed consent in mental health treatment, it's important to note that 'brain disease' is a blanket term, and inaccurate. We have yet to identify the biological underpinnings of what gets diagnosed as mental illness. (On the other hand, we have seen the neurodegenerative effects of antipsychotics, for example). More Tx isn't always better.

We diagnose and treat symptoms, which says nothing about why, or how to cure. Medications can help relieve suffering temporarily in some, but also come with serious adverse effects, which, for many, result in disability.

Yes, distress has a biological correlation, but it is also rooted in environment, culture, poverty, oppression and trauma. LGBTQ youth and veterans of war, for example, are at 3xs at risk of suicide. Does this mean they have inferior brains? No. The data show that the low serotonin theory of depression was disproven in the early 80s, though marketed as fact since then. Very problematic.

It's time we address the real problems with the DSM, our treatments, and poor outcomes in this country. We need alternatives, a more cautious approach to medications, and non-pharma funded information.

Paul Levy said...

Thanks for the helpful expanded view.

Barry Carol said...

Since I’ve had some experience with mental health conditions in both my immediate and extended family, I’ll offer my layman’s perspective.

In comparing mental health and physical health conditions, one challenge is that mental health issues are often considerably more difficult to diagnose and then to determine an effective course of treatment.

There are more drug treatment options available for mental health conditions today than several decades ago but many have significant side effects and it can be a challenge to get the dosage right. While insurers are willing to pay for long term drug treatment, they are generally not willing to pay for unlimited sessions with a psychiatrist or other mental health professional because it’s hard to measure progress. Moreover, most psychiatrists, at least in this area, don’t accept insurance because reimbursement rates are too low and documentation requirements are too onerous.

I think the bottom line is that there is a heck of a lot we still don’t know about how to effectively treat mental health conditions as compared to physical conditions like heart disease, diabetes and cancer. Regarding what, if anything, we should be doing differently in treating mental health issues and how to pay for them, I don’t know.

Anonymous said...

So much more needs to be done. Thank you for this post.