Research Funding Cuts Described as “Devastating” by APA President

From Psychiatric News Alert: In Monday’s edition of his video series addressing key issues in mental health and its treatment, APA President Jeffrey Lieberman, M.D., discusses important scientific advances in understanding mental illness over the last several decades and how cuts in research funding are likely to stall future advances. At a time when talented researchers are devoting their careers to uncovering more of the brain’s mysteries and should be attracting increased funding, “Federal investment in research through the National Institutes of Health is currently $4 billion lower than the peak year of 2003 and at the lowest level since 2001. These deep cuts have forced hard choices,” Lieberman emphasized, “destructive choices amounting to wide-scale de-emphasis of clinically oriented, disease-relevant research.”

He called described th funding cuts as “devastating” since their effect could be to delay crucial discoveries and erode the cadre of researchers working in this field.

“It’s time that our government aligns its policies with our national interests and scientific opportunities. We need to prioritize the health of the nation to protect and to support biomedical research.”

View the video or others in the series below or by clicking here. For previous Psychiatric News Alerts, click here.

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Judges and Psychiatrists Discuss Mental Health Treatment in the Judicial System

Speaking at the institute, from left, Leifman, Osher, and former Ohio Supreme Court Justice Evelyn Stratton, J.D.

It is common knowledge that the judicial system sees a disproportionate number of mentally ill persons and that jails are crowded with inmates needing mental health services. The problem has many aspects, including the economic burden it places on the corrections systems within the United States and the ineffectiveness of common criminal penalties and sentences in circumstances where medication, therapy and support services are needed.

Fortunately, change may come. At the recent APA Institute on Psychiatric Services, in Philadelphia, fifty leading judges and psychiatrists from across the country met to begin developing strategies to improve outcomes for individuals with mental health needs in the criminal justice system.

As part of an ongoing collaboration, the Judicial-Psychiatric Leadership Forum was convened by the Judges’ Leadership Initiative for Criminal Justice and Behavioral Health and the Psychiatric Leadership Group for Criminal Justice and was coordinated by the American Psychiatric Foundation and the Council of State Governments Justice Center.

According to Miami-Dade County Judge Steve Leifman, cochair of the Judges Leadership Initiative:

“The progress made at this forum is an important step forward in addressing the needs of people with mental illnesses who become entangled in the criminal justice system. The cost of incarcerating rather than treating people with mental illness both in financial and human terms is exorbitant and unnecessary.”

Psychiatrist Fred Osher, M.D., director of the Center for Health Systems and Services Policy for the Council of State Governments Justice Center, added:

“It is critical that psychiatrists engage judges in a dialogue to identify effective strategies that result in improved public health and safety outcomes. It is a shared set of concerns that require a shared vision and collaboration to have the largest impact.”

An estimated 17% of people admitted to jail have serious mental disorders—more than three times the rate in the general population, and nearly 70% of adults in jails and prisons have a substance use disorder. For more information on this topic, see the Psychiatric News articles “Combined Effort Needed to Prevent Incarceration of Mentally Ill People” and “Judges Get Help Handling Mentally Ill Defendants.”

Study Suggests Racial Disparity Persists in Mental Health Services

Based on data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, racial disparities in receipt of outpatient mental health services have continued to be large and have not shown improvement over a 15-year period. Researchers from Columbia University and Brown University estimated annual visit prevalence for three racial-ethnic groups—non-Hispanic whites, non-Hispanic blacks, and Hispanics—as the number of visits divided by the group’s U.S. population size. Analyses were stratified by diagnosis, physician type, patient characteristics, and year.

Total annual prevalence rates for mental-health-related physician visits were 197 visits per 1,000 population for non-Hispanic whites, 118 for non-Hispanic blacks, 114 for Hispanics, and 90 for non-Hispanic others. Non-Hispanic blacks were treated markedly less frequently than whites for obsessive-compulsive, generalized anxiety, attention-deficit/hyperactivity, personality, panic, and nicotine use disorders but more frequently for psychotic disorders. Hispanics were treated far less frequently than whites for bipolar I, impulse control, autism spectrum, personality, obsessive-compulsive, and nicotine use disorders but more frequently for drug use disorders.

For more information about mental health and minority groups, see the Psychiatric News article, “To Understand Mental Health Disparities, Look to R.I.C.E. not Race.”

Study of Suicide Motivations to Advance Prevention

From UBC News: A University of British Columbia study sheds important new light on why people attempt suicide and provides the first scientifically tested measure for evaluating the motivations for suicide.

Published in the official journal of the American Association of Suicidology, the work gives doctors and researchers important new resources to advance suicide prevention, improve treatments, and reduce the likelihood of further attempts.

The study finds that suicide attempts influenced by social factors – such as efforts to elicit help or influence others – generally exhibited a less pronounced intnet to die, and were carried out with a greater chance of rescue. In contrast, suicide attempts motivated by internal factors – such as hopelessness and unbearable pain – were preformed with the greatest desire to die.

Prof. David Klonsky

“It may be surprising to some, but focsing on motivations is a new approach in the field of sucide research – and urgently needed, says Prof. David Klonsky”. “Until now, the focus has been largely on the types of people attempting suicide, their demographics, their genetics, without actually exploring the motivations. Ours is the first work to do this in a systematic and comprenhensive way.

The study’s 120 participants were outpatients and undergraduate students who had attempted suicide with “intnet to die” within the past three years.

Lead author Alexis May, UBC Psychology

For the study, participants completed a questionaire related to 10 different motivations for attempted suicide. The resulting questionaire is now available for clinical use. The Inventory of Motivations for Suicide Attempts (IMSA) is the most accurate and first scientifically tested tool for evaluating a person’s motivation for suicide.

Despite massive prevention efforts, suciide rates have increased globally over the past 50 years, with almost one million people taking their lives, annually.

Early Violent Behavior Increases Chance of Post-Diagnosis Violence

From Psychiatric News Alert: Individuals who engage in antisocial behavior before showing symptoms of schizophrenia are more likely to be violent when a first schizophrenia episode occurs, according to a new prospective study reported in JAMA Psychiatry. The study was conducted by Catherine Winsper, Ph.D., and psychiatrist Swaran Singh, M.D., of the University of Warwick in England and colleagues.

The study included 670 young adults being treated for a first episode of psychosis. The subjects were divided into four groups depending on whether they had engaged in antisocial behavior before their first psychotic episode or not, and if so, to what degree. The researchers then followed up to see which subjects committed violence and  compared the four groups regarding their antisocial behavior histories. Subjects who had engaged in moderate or high levels of antisocial behavior on a regular basis before their first psychotic episode were four times as likely to engage in violence as were subjects who had engaged in little or no antisocial behavior before experiencing their first psychotic episode.

Said Paul Appelbaum, M.D., former APA president, the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University, and chair of the APA Committee on Judicial Action, to Psychiatric News:

“These data have implications for violence prediction and treatment in patients with schizophrenia [and] suggest that treatment targeting psychotic symptoms in higher-risk patients may not be enough to prevent violent behavior—interventions aimed specifically at propensities for violence may be needed as well.”

According to Thomas McGlashan, M.D., professor of psychiatry at Yale University and an expert on the prodromal phase of schuzophrenia:

“Simply put, these data point out that youth with a history of delinquent behaviors and a vulnerability for psychosis are clearly at risk for behaving violently once that vulnerability becomes expressed as a first episode of schizophrenia. For this sub-sample of young people, early detection and intervention at the pre-onset of prodromal phase of the disorder may be doubly protective by preventing not only the onset of psychosis, but also the perpetration of any associated…antisocial behaviors.”

More information about the link between antisocial behavior, violence, and psychosis can be found in the Psychiatric News articles “High Rates of Mental Illness Associated With Gang Membership” and “Threat Delusions Linked to Violence in First Episode Psychosis.”

What is Psychotherapy?

Psychotherapy, or “talk therapy”, is a way to treat people with a mental disorder by helping them understand their illness. It teaches people strategies and gives them tools to deal with stress and unhealthy thoughts and behaviors.

Psychotherapy helps patients manage their symptoms better and function at their best in everyday life.

Psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan.

There are many kinds of psychotherapies. There is no “one size fits all.”

Caring and Sharing Support Group at Beach Cities Health District

On November 26, 2013, and on subsequent fourth Tuesdays of the month, provided a room remains available, at 7:00 p.m., a Caring and Sharing support group meets at the BCHD at 514 N. Prospect Avenue, Redondo Beach, California. The support-group meetings will hopefully occur in the Coast Room on the Third Floor  but please check the room posting as the room may be changed.

BCHD is the largest preventive health agency in the nation, and has served the communities of Hermosa Beach, Manhattan Beach and Redondo Beach since 1955. It offers an extensive range of dynamic health and wellness programs. The BCHD Center for Health Connection (CHC) provides medical, dental and counseling services for qualified children and adults in the South Bay who are uninsured or underinsured. The center pre-screens individuals and connects those who qualify with fee-based and need-based health services.