Mental Health Services Act Audit Report

The California State Auditor released the Mental Health Services Act Audit Report. At the following links you will find an Executive Summary as well as a full copy of the findings, and an Audit Advisory.

NAMI California praises the thorough review of the programs. It has reviewed the findings internally and states that it agrees with the importance of evaluation in determining program outcomes. NAMI California believes in the use of measurement and evaluation to ensure fidelity with the intention of the original Mental Health Services Act (MHSA).

NAMI California has advocated for years for strengthening state oversight of county MHSA programs. This report affirms its efforts. NAMI California also supports its recommendations for the Mental Health Services Oversight and Accountability Commission (OAC), the Department of Health Care Services (DHCS) and the Mental Health Planning Council as well as the four counties it reviewed (Sacramento, Santa Clara, Los Angeles and San Bernardino). It hopes those counties who were not the subject of review will use the recommendations and findings to ensure their programs are serving the members of their county appropriately and encourages counties to use their families, those with lived experience and other stakeholders to inform their process to safeguard taxpayer resources.

Next week, NAMI California will release its annual list of all California County MHSA funded programs. Programs ranging from Prevention and Early intervention to Full Service Partnership. This can be a useful tool in determining which programs your county funds utilizing MHSA monies. While also, giving the opportunity to create open dialogue about the resources in your area.

Early Detection of Schizophrenia–The Time Is Now

A message from APA President Jeffrey Lieberman, M.D., also appearing in  Psychiatric News Alert to all interested persons. Please send your comments to pnupdate@psych.org

“I believe that we are at another game-changing moment in psychiatry with the rise of the early detection and intervention strategy (EDIS). This new therapeutic strategy and model of care could have a significant effect on our ability to treat and limit the morbidity of mental illness beginning with schizophrenia and related psychotic disorders.

“While schizophrenia has been historically associated with a therapeutic nihilism due to its devastating and often irreversible consequences, research over the last two decades has changed attitudes and inspired optimism. Studies show that the earlier patients are diagnosed and treated, the better their responses to treatment. This leads to improved outcomes and higher chances of full recovery. The corollary to this is continued engagement of patients in treatment following their recovery and relapse prevention.

“Among the reasons for this are findings from neuroimaging studies showing that the hallmark clinical deterioration of schizophrenia is associated with cortical gray matter atrophy, reflecting the loss of cell processes and synaptic connections. Unlike Alzheimer’s disease though, for which there currently is no “disease-modifying” treatment, early intervention and relapse prevention methods for schizophrenia coupled with antipsychotic medication may prevent illness progression.

“Moreover, additional research and first-person reports indicate that resilience, coping skills, and peer and family support can substantially contribute to favorable outcomes and recovery. Collectively, these findings have suggested the value of early detection, intervention, and sustained engagement with treatment to enhance recovery and prevent disability.

“Unfortunately, these encouraging research findings have been slow to translate into clinical practice in the United States. It will not come as a surprise that an important reason for the slow implementation of the EDIS model of care is a lack of adequate financing. Many individuals in the earliest stages of psychosis do not have health insurance, and even if they do, their plans do not cover comprehensive psychosocial and rehabilitative services. And while the public mental health system is designed to serve individuals without health insurance and to provide services not covered by insurance, the system favors individuals who have already become disabled by mental illness, limiting the availability of services for patients in the early stages of psychotic disorders.”

For Dr. Lieberman’s full message and call to action, CLICK HERE.

Common Genetic Variation May Underlie Different Mental Health Conditions

An international research group has identified a 15% overlap between inherited schizophrenia and bipolar-disorder attributable to common genetic variation. The Cross Disorders Group of the Psychiatric Genomics Consortium published the study online in Nature Genetics August 11.

The group used genomewide-genotype data from thousands of people and compared them with control subjects. Besides the relationship between schizophrenia and bipolar disorder, there was a 10% inheritability overlap between bipolar disorder and depression, a 9% overlap between schizophrenia and depression, and a 3% overlap between schizophrenia and autism. The common genetic variants with small effects revealed in this and related studies will eventually be supplemented by other research on other variations. Study co-leader Naomi Wray, Ph.D., of the University of Queensland in Australia, said in a statement accompanying the study:

“Shared variants with smaller effects, rare variants, mutations, duplications, deletions, and gene-environment interactions also contribute to these illnesses. Since our study only looked at common gene variants, the total genetic overlap between the disorders is likely higher.” 

The study was funded in part by the National Institute of Mental Health. Read more about the work of the Psychiatric Genomics Consortium in Psychiatric News.

Psychotic Symptoms Linked to Adolescent Suicide Risk

From Psychiatric News Alert (8/12/13): According to a recent study, psychotic symptoms alone (as distinguished from diagnosed psychotic disorders) are a striking marker of suicide danger in adolescents, especially in those adolescents who demonstrate other types of psychiatric pathology.

“This is a very interesting study,” said child and adolescent psychiatrist Kayla Pope, M.D., of Boys Town National Research Hospital in Nebraska. “We need better markers for assessing suicide risk, and the finding in this study is an important step in that direction.”

The finding, from a team of European researchers in JAMA Psychiatry, came as a surprise to the lead researcher, Ian Kelleher, M.D., Ph.D.

“While we knew that people with psychotic disorders are at high risk of suicidal behavior, we did not know that there was such a strong relationship between psychotic experiences (which are much more common than psychotic disorders) and suicidal behavior in the population.”

More information about suicide risks can be found in Psychiatric News herehere, andhere. Information about suicide is also available in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

Countdown: NAMIWalks on October 5, 2013

In 59 Days
Changing Minds One Step at a Time

Every journey begins with that first step! As NAMIWalks celebrates its 11th Anniversary in 2013, it is proud to be the largest and most successful mental-health awareness and fundraising event in America. Through the NAMIWalks active, public display of support for people affected by mental illness, America is changing how it views persons with mental illness.

For the Los Angeles Area, the event begins with checkin at 8:00 a.m. at the Third Street Promenade, Santa Monica, California, for a 5K walk. The walk begins at 9:30 a.m. For more information about the Los Angeles NAMIWalks, please contact the Walk Manager, Shelley Hoffman, (310) 571-5256.

If you are not in the Los Angeles Area, you can find a walk near you by clicking on THIS NATIONAL LINK.

NAMIWalks helps raise awareness, helping assure that help and hope are available for those in need. Please join to help improve our lives and our communities one step at a time.

Psychotic Symptoms, Rather than Antipsychotic Meds, Linked to Alzheimer Patient Death & Institutionalization

It is the presence of psychiatric symptoms, including psychosis and agitation, not the use of antipsychotic medications that appears to raise the risk for institutionalization or death among patients with Alzheimer’s disease (AD), according to a new study published in AJP in Advance.

Researchers at several institutions, led by Oscar Lopez, M.D., of the University of Pittsburgh, examined time to nursing home admission and time to death in nearly 1,000 patients with a diagnosis of probable AD, taking into account a range of variables, including dementia severity, physical illnesses, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use. A total of 241 patients (25 percent) were exposed to antipsychotics at some time during follow-up. A higher proportion of patients exposed to antipsychotic medications, especially conventional antipsychotics, were admitted to a nursing home or died compared with those who never took these medications, but the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.

“This observational study does not support the association between mortality and antipsychotic use that has been reported in institutionalized elderly patients,” the researchers stated.

Geriatric psychiatrist and immediate past APA President Dilip Jeste, M.D., who reviewed the study, called it “an important contribution to the literature on mortality related to psychosis and antipsychotics in persons with Alzheimer’s disease.”

“The results from various published studies have often been at variance with one another. The present study’s finding that psychosis itself is associated with increased mortality is consistent with several other reports, suggesting the need to treat these symptoms. Although there are no FDA-approved safe and effective treatments for psychosis in dementia, a number of pharmacological and psychosocial approaches are available. The treating clinician needs to take into account the risk-benefit ratios for various treatments as well as no specific treatment.”

For more information about AD, see American Psychiatric Publishing’s Clinical Manual of Alzheimer Disease and Other Dementias here and Psychiatric News here.

Caution: Parent Talking Weight with Child May Increase Risk of Eating Disorder

Study Suggests Talking About “Eating Healthy Foods” is Safer.

From Psychiatric News Alert (8/5/13): When parents discuss weight issues with their adolescents, it may encourage them to develop eating disorders, a large community-based study reported in JAMA Pediatrics suggests. The study found, for example, that youngsters were more likely to engage in unhealthy eating behaviors such as extreme dieting, laxative use, and binge eating when their parents talked about weight than when they talked about eating healthy foods. This was the case for overweight youth as well as for those who were not overweight. In addition, binge eating was found to be more prevalent among adolescents whose mothers discussed weight than among adolescents whose mothers didn’t.

“I think these are important findings,” Michael Devlin, M.D., co-director of eating disorders research at the New York State Psychiatric Institute, told Psychiatric News. “They support the idea that, despite our concerns about obesity and its comorbidities, the most useful health promotion messages relate to lifestyle and not weight, and that weight-related messaging, particularly messages that evoke shame or contribute to stigma, can be counterproductive.”

Body dissatisfaction is another major factor that has been linked with the development of eating disorders in young people. Read more about that issue in Psychiatric News here, and read about research on binge-eating disorder here.