Mental health and wellness is the state at which one feels, thinks, and behaves. Mental health can be viewed on a continuum, starting with an individual who is mentally well and free of any impairment in his or her daily life, while someone else might have mild concerns and distress, and another might have a severe mental illness.

Everyone has “stuff” that they keep contained in a tightly sealed plastic bag. There are some who occasionally can’t help but let the “stuff” leak, and there are those with the bag wide open.

However, in our society, we still tend to stigmatize those who let their “stuff” leak out instead of helping them, understanding them, or simply not judging them. Just as we all know someone with cancer, we all know someone with a mental health disorder.

Mental health is just as vital as physical health. In reality, the two coexist and should not be treated separately. There are many mental health disorders that exacerbate physical concerns or disorders, and vice versa.

For instance, someone who suffers from chronic migraines might also suffer from an anxiety disorder. Obesity contributes to the severity of symptoms of depression. Poor anger management is associated with high blood pressure. Behind every medical illness, it is possible to find a mental health concern as well.

It is also possible that a boost to mental health can alleviate symptoms of a medical condition. As an example, those who receive art therapy or pet therapy in hospitals are shown to have a speedier recovery than those without, as well as a decrease in severity of symptoms experienced.

A holistic approach for individuals needs to be the standard. Physicians, nurses, dentists, psychiatrists, psychologists, mental health counselors, and other mental health professionals need to collaborate to provide a complete treatment plan. A medical doctor who doles out prescriptions for irritable bowel syndrome also can refer the patient to a therapist for stress management. A dentist whose patient is suffering from extreme anxiety can have a mental health professional onsite or have one to whom to refer the patient. A psychologist can suggest that his patient see a specialist for any symptoms that can be contributing to his or her eating disorder.

As reported by the National Institute of Mental Health, more than 26 percent of the adult U.S. population has a mental health disorder, with over 22 percent of cases being considered “severe.” Mental health disorders include anxiety disorders, attention-deficit/hyperactivity disorder, autism, eating disorders, mood disorders, personality disorders, and schizophrenia.

Still, only 1 in 3 individuals will seek treatment for his or her disorder. It’s as if only 1 in 3 individuals who suffered from a high fever or a broken bone sought out a doctor.

We tend to view mental health as something that is an illusion, “all in one’s head,” or that certain disorders are overdiagnosed. Has anyone ever exclaimed that “cancer is overdiagnosed”? Yet, I have heard countless times that attention deficit hyperactivity disorder (ADHD) is being diagnosed too loosely in children and adolescents.

This month is to advocate for the awareness of mental health; however, it should be a consistent concern. Recent events have brought mental health awareness to the surface. We need to know what that means. This does not mean all catastrophic events are caused by those who are mentally ill and therefore we need better treatments. In fact, statistics show that those who are severely mentally ill are more likely to be victimized than to do harm.

It is easy to blame or stigmatize a certain group when events that cannot be understood occur and we grasp for any bit of reasoning we can. But it is neither accurate nor fair. This is the time that we educate ourselves and become properly informed, and develop compassion and understanding.

References

Brodie, S. J., Biley, F. C., & Shewring, M. (2002). An exploration of the potential risks associated with using pet therapy in healthcare settings. Journal of Clinical Nursing, 11(4), 444-456.

Demyttenaere, K., Bruffaerts, R., Posada-Villa, J., Gasquet, I., Kovess, V., Lepine, J. P., … & Chatterji, S. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA: The Journal of the American Medical Association ,291(21), 2581.

Monti, D. A., Peterson, C., Kunkel, E. J. S., Hauck, W. W., Pequignot, E., Rhodes, L., & Brainard, G. C. (2006). A randomized, controlled trial of mindfulness‐based art therapy (MBAT) for women with cancer. Psycho‐Oncology, 15(5), 363-373.

Some writers read a lot more into that statement than was actually there. Science 2.0 — a website that claims it houses “The world’s best scientists, the Internet’s smartest readers” — had this headline, “NIMH Delivers A Kill Shot To DSM-5.” Psychology Today made the claim, “The NIMH Withdraws Support for DSM-5.” (The DSM-5 is the new edition of the reference manual used to treatment mental disorders in the U.S.)

So is any of this true? In a word, no. This is “science” journalism at its worse.

NIMH’s Research Domain Criteria

For the past 18 months, the NIMH has been working on a different categorization system to classify mental disorders, to help further its research efforts (the NIMH is primarily a research-driven organization). It’s called the Research Domain Criteria project:

NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

The proposed classification system works under these assumptions:

• A diagnostic approach based on the biology as well as the symptoms must not be constrained by the current DSM categories,

• Mental disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior,
• Each level of analysis needs to be understood across a dimension of function,
• Mapping the cognitive, circuit, and genetic aspects of mental disorders will yield new and better targets for treatment.

In short, the NIMH is trying to find a new categorization system that takes into account more of the biology, genetics, brain circuitry and neurochemistry that we’ve discovered in the past three decades’ worth of research is becoming increasingly relevant to understanding mental disorders.

Does it Replace the DSM-5?

Will this replace the DSM-5? No, because as Dr. Insel notes, “This is a decade-long project that is just beginning.” If the NIMH effort ever replaces the DSM, it will be a long time from now.

Somehow, though, Science 2.0 and Psychology Today believe this letter suggests the NIMH has “withdrawn” support for the DSM-5, or has delivered a “kill shot” (whatever that is!). Are these kinds of characterizations accurate — or indeed, helpful?

We reached out to Bruce Cuthbert, Ph. D., the director of the Division of Adult Translational Research at the National Institute of Mental Health for clarification.

“As with most shifts in science, changes in research priorities require a transition,” said Dr. Cuthbert.

“Because almost all clinical researchers today grew up with the DSM system both clinically and in research, it will take some time to get a “feel” for the relationships between DSM disorders and various kinds of RDoC phenomena (both in terms of the types of symptoms, and in overall severity), learn how to write grant applications with the new criteria, and evolve new review criteria. So, there will be a period of some time while these crosswalks are worked out.

“I also should point out that these comments reflect [only] our translational research portfolios.

“Our Division of Services and Intervention Research mostly supports research conducted in clinical settings that is relevant to current clinical practice and services delivery. Thus, [...] grants in these areas will continue to be predominantly funded with DSM categories for some time.”

That’s a far cry from the entire NIMH withdrawing support for the DSM-5. The NIMH is simply saying (in my opinion), “Look, we’re unhappy with the validity of the DSM and its lack of support for biomedical markers for mental disorders. We’re working on a different schema, especially targeted at researchers. It may have greater relevance someday — that’s our hope and vision.”

Why a New Diagnostic System?

But then again, researchers in mental illness have been promising biomarkers for at least two decades as well — with little notable progress to show for their efforts.¹

Why is a new diagnostic system needed?

“For psychiatric disorders, we cannot effectively use very much of the knowledge we have gained about the brain and behavior over the last 30 years because of our symptom-based diagnostic system. In other words, the categories defined by symptoms simply do not map onto all the knowledge that we have gained about brain circuits, genetics, and behavior,” replied Dr. Cuthbert.

“We know that many different mechanisms are involved in any one DSM disorder (heterogeneity), while any one mechanism (fear, working memory, emotional regulation) is typically involved with many different disorders. [This] heterogeneity frustrates attempts to develop new treatments.”

Indeed, as John Horgan over at Scientific American wrote,

Ironically, some pharmaceutical companies that have enriched themselves by selling psychiatric drugs are now cutting back on further research on mental illness. The “withdrawal” of drug companies from psychiatry, Steven Hyman, a psychiatrist and neuroscientist at Harvard and former NIMH director, wrote last month, “reflects a widely shared view that the underlying science remains immature and that therapeutic development in psychiatry is simply too difficult and too risky.”

Pharmaceutical companies say that, on average, a marketed psychiatric drug is efficacious in approximately half of the patients who take it. Dr. Cuthbert from the NIMH suggests that, “One reason for this low response rate is the artificial grouping of heterogeneous syndromes with different pathophysiological mechanisms into one disorder.”

So the NIMH’s regrouping appears to be as much of an effort to spur new drug development as it is an effort to rethink the classification system of mental disorders. Which is a bit odd, if you think about it, since there is a rich research foundation showing that non-medication treatments — such as psychotherapy — work equally well (if not better) for the treatment of many mental disorders.

If these were pure medical diseases with clear and readily defined biomarkers, that shouldn’t be the case. After all, positive thinking can’t cure cancer.²

“Thus, mental disorders are an area where we must transcend the current symptom-based system if we are to advance,” concludes Dr. Cuthbert. “Among other things, if you have to wait until a full-blown set of symptoms is present before you can define a disorder (and there is no quantifiable data regarding risk states, as there is for, say blood pressure), then prevention is — by definition — impossible.”

This is simply untrue, in my opinion. There is a solid and growing research base already demonstrating that we can detect mental illness through a number of early screening and symptom measures and implement prevention measures. Other studies demonstrate significant correlations with certain characteristics — signs that can also be used to implement effective prevention.

“The research process will necessarily involve complex science to understand how we can relate more neuroscience-based measures to more specific and quantitatively-defined symptoms and clinical outcomes,” says Dr. Cuthbert from the NIMH. “This does not necessarily mean, however, that the diagnostic systems of the future will necessitate such a complex battery. As with biomarkers in other areas of medicine, a subsequent phase will be to find assessments that can be obtained feasibly in clinical settings (although this is unlikely to mean, as is the case now, that all disorders can be diagnosed simply sitting in a clinician’s office).”

Is It All About the Money?

Horgan suggests, perhaps, some ulterior motives for NIMH’s statement:

NIMH director Insel doesn’t mention it, but I bet his DSM decision is related to the big new Brain Initiative, to which Obama has pledged $100 million next year. Insel, I suspect, is hoping to form an alliance with neuroscience, which now seems to have more political clout than psychiatry. But as I pointed out in posts here and here on the Brain Initiative, neuroscience still lacks an overarching paradigm; it resembles genetics before the discovery of the double helix.

I’m not as skeptical as Horgan, but do believe the timing of Dr. Insel’s letter is a little curious — right before the launch of the DSM-5, and right after the public commitment of $100 million to brain research.

What is clear is that the NIMH is not withdrawing support for the use of the DSM-5 anytime soon. It is the reference manual all researchers and clinicians use today to speak the same language of mental illness. Without the same reference frame, research — and treatment — would become impossible.

Further Reading

Scientific American: Psychiatry in Crisis! Mental Health Director Rejects Psychiatric “Bible” and Replaces with… Nothing

Science 2.0′s article: NIMH Delivers A Kill Shot To DSM-5

1. David Kupfer, who chairs the DSM-5 Task Force, told Pharmalot: “The promise of the science of mental disorders is great. In the future, we hope to be able to identify disorders using biological and genetic markers that provide expreciseact diagnoses that can be delivered with complete reliability and validity. Yet this promise, which we have anticipated since the 1970s, remains disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”
2. Although, to be fair, positive thinking can definitely help in its overall treatment.

It remains a topic few health professionals want to discuss openly with their patients. It remains a topic avoided even by many mental health professionals. Policy makers see it as a black hole without an obvious solution.

And now grim new statistics confirm a disturbing trend — more people are taking their own lives than ever before in the U.S.

The U.S. Centers for Disease Control and Prevention released statistics yesterday showing that 33,687 people died in motor vehicle accidents, while nearly 5,000 more — 38,364 — died by suicide. Middle-aged Americans are making up the biggest leap in the suicide rate.

It’s data that should make us sit up and think.

The New York Times has the story:

From 1999 to 2010, the suicide rate among Americans ages 35 to 64 rose by nearly 30 percent, to 17.6 deaths per 100,000 people, up from 13.7. Although suicide rates are growing among both middle-aged men and women, far more men take their own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000.

The most pronounced increases were seen among men in their 50s, a group in which suicide rates jumped by nearly 50 percent, to about 30 per 100,000. For women, the largest increase was seen in those ages 60 to 64, among whom rates increased by nearly 60 percent, to 7.0 per 100,000.

What’s the cause of the rise in suicides in this country? Nobody can say for sure, but the CDC officials have some ideas:

But C.D.C. officials cited a number of possible explanations, including that as adolescents people in this generation also posted higher rates of suicide compared with other cohorts.

“It is the baby boomer group where we see the highest rates of suicide,” said the C.D.C.’s deputy director, Ileana Arias. “There may be something about that group, and how they think about life issues and their life choices that may make a difference.”

The rise in suicides may also stem from the economic downturn over the past decade. Historically, suicide rates rise during times of financial stress and economic setbacks. “The increase does coincide with a decrease in financial standing for a lot of families over the same time period,” Dr. Arias said.

Another factor may be the widespread availability of opioid drugs like OxyContin and oxycodone, which can be particularly deadly in large doses.

Men continue to prefer using a firearm to kill themselves at a rate far higher than all other methods combined (suffocation comes in a far second). Women prefer, instead, to poison themselves, followed by the use of a firearm. Suffocation (predominantly hanging) has risen as the new preferred method for committing suicide, rising 75 percent among men and 115 percent among women in the ten years studied.

Because the reasons for most people’s suicides are fairly complex, targeting new prevention methods and public educational campaigns to this problem is difficult. While suicide is most often the result of untreated or undertreated depression, getting more people who are suicidal to seek out treatment (or enhanced treatment) remains a challenge.

That does not mean we shouldn’t try, however. If anything, such reports point to the need of a redoubled effort to helping those in desperate need of intervention. Suicide is preventable, if only society put forward more effort to care and reach out to those in need. And not through the use of bandaid suicide crisis hotlines, but through the greater access of compassionate mental health treatment.

Read the article: Suicide Rate Rises Sharply in U.S.

Read the CDC Report: Suicide Among Adults Aged 35–64 Years — United States, 1999–2010

Then I was going to relate the story about how, in the summer of 2002, I chose to stop taking my medicine the way my doctor directed me to take it, and then I stopped taking my medicine at all.

This was a bad choice. As a result, my illness became an emergency.

Nine hours in the ICU, four days in a private room, and two more weeks of hospital care brought a bill that topped $95,000.

The cost of nine years of care was eaten up by just a few weeks of my irresponsibility. That was cost that the health care industry, including my insurance company, would not have had to bear if I had only taken my medicine as directed.

It then seemed easy for me to extend this argument to all patients with any chronic disease. Do what your doctor tells you and your condition should improve, or, at least, be far less likely to worsen. By patients only complying with their prescribed treatment regimens the cost of health care in the United States would go down.

How much? A lot. As a matter of fact, a New England Healthcare Institute study of health care costs in the United States pegged the added cost of care due to patient noncompliance at $290 billion. That’s 15 percent of the country’s total annual health care cost. And a Medco study found that only 50 to 65 percent of patients with chronic conditions adhere to the medication therapy prescribed for them.

It seemed clear. I am, for my lost summer, and everyone else who does not take responsibility for their own treatment, everyone who does not comply with their doctor’s orders, are responsible for the high cost of health care in the United States.

When noncompliant, a person does not take his or her medicine as directed. This often leads to their condition worsening and results in higher costs of doctor visits, emergency room visits, and hospitalizations. On the other hand, medication compliance can significantly reduce these costs.

According to Medco, for every dollar spent on diabetes medication medical cost savings are $7.00, for every dollar spent on high cholesterol medication medical cost savings are $5.10, and savings of $3.98 are found for every dollar spent on prescription medication for high blood pressure. Mental illness costs are surely similar.

So if simply taking one’s medicine can lead to lower total health care costs, why are so many patients not taking their medication as prescribed?

Reasons for noncompliance include side effects, lack of continuing symptoms, and, yes, irresponsibility. But cost may loom largest.

I have always had health insurance. The co-payment for my medicine is $49 per month when I’m stable (it was higher, but one drug went generic). It goes up during rough patches. I’m responsible. I pay it. I’m well. I thought, perhaps I adhere to my treatment regimen because I am so heavily invested in it.

Maybe if everyone paid a larger share of his own health care bill, compliance with treatment would increase. Maybe personal responsibility, sacrifice when necessary, and more participation by each individual in the cost of his or her care would improve compliance rates and reduce the overall cost of health care.

But the cost of medication to the individual must be considered. As costs increase, fewer can afford to pay them. A study from the National Bureau of Economic Research finds that an increase in medication co-payments from only $6 to $10 results in a 6.2 percent increase in noncompliance and a 9 percent reduction in the share of fully compliant persons. The same study finds that increases in coinsurance lead to even larger increases in noncompliance. As for the uninsured, the American Public Health Association has found that 89 percent have not filled a prescription due to cost.

What was lost on me was some very simple economics. If each individual pays less for his or her prescriptions, compliance increases and the nation and insurance companies pay less of a total health care bill. Unfortunately, the trend in health insurance is for each individual to pay higher co-pays or coinsurance. As these costs go up out-of-pocket expenses may exceed one’s ability to pay. The choice? Noncompliance or increased debt and possible bankruptcy.

So yes, compliance is a choice. And noncompliance greatly increases the nation’s health care bill. Every proposal on the table that makes an individual pay more for his medicine will increase noncompliance and add even more to the nation’s health care bill. High deductibles and higher co-payments charged by insurance companies against each individual will only make the problem worse. Paradoxically, as cost-driven noncompliance pushes total health care costs higher, these same insurance companies may find themselves less profitable over the long run as they face the higher cost of complications caused by medication noncompliance.

Perhaps if insurance companies lowered prescription co-payments more patients would take their medicine as directed and the insurance companies, with fewer complication-related charges against premiums, could actually increase profits. Pharmaceutical companies would benefit as well as more prescriptions would be filled. We should have no problem with health insurance and pharmaceutical companies making more money if the profits they earn come from lower total health care costs and healthier individuals.

As for my, and others’, idea that if people pay a larger percentage of their health care costs they will live healthier, more compliant, lives, the truth is that health and compliance can be expensive. Low-cost prescription benefits must be considered as we approach ideas to lower total healthcare costs. Higher costs to individuals for medication lead to higher rates of noncompliance, which lead to a higher national health care bill that, one way or another, we all must share.

References

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3326767/

http://www.hreonline.com/HRE/view/story.jhtml?id=5059249

http://www.nber.org/digest/apr05/w10738.html

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Jun/1408_Morgan_Prescription_drug_accessibility_US_intl_ib.pdf

Colleges and university are cutting back on their involvement with ADHD, primarily due to abuse of the psychiatric medications — stimulants like Ritalin — prescribed to treat the disorder. Students — whether they are malingering the symptoms or actually have it — are prescribed a drug to treat ADHD (sometimes from different providers in different states), then sell a few (or all the) pills on the side. Profit!

Now universities are becoming wise to the epidemic nature of the problem, as some studies have suggested up to a third of college students are illicitly taking ADHD stimulants.

This might help curb the abuse problem, but will it also make it harder for people with actual ADHD to receive treatment?

The short answer is, yes, of course. Students with a pre-existing diagnosis of attention deficit or attention deficit hyperactivity disorder will still often be able to get their prescriptions filled while at school. The university just doesn’t want to do the diagnosing of ADHD any longer.

I’ve long wondered at the wisdom of universities getting into the ADHD business in the first place. University counseling centers generally shrug off long-term treatment of serious mental illness. So it’s never been clear to me why they were comfortable prescribing medications for ADHD.

The New York Times notes — in a well-written take on this issue by Alan Schwarz — that the changes are sweeping campuses throughout the country:

Lisa Beach endured two months of testing and paperwork before the student health office at her college approved a diagnosis of attention deficit hyperactivity disorder. Then, to get a prescription for Vyvanse, a standard treatment for A.D.H.D., she had to sign a formal contract — promising to submit to drug testing, to see a mental health professional every month and to not share the pills. [...]

The University of Alabama and Marist College, like Fresno State, require students to sign contracts promising not to misuse pills or share them with classmates. Some schools, citing the rigor required to make a proper A.D.H.D. diagnosis, forbid their clinicians to make one (George Mason) or prescribe stimulants (William & Mary), and instead refer students to off-campus providers. Marquette requires students to sign releases allowing clinicians to phone their parents for full medical histories and to confirm the truth of the symptoms.

“We get complaints that you’re making it hard to get treatment,” said Dr. Jon Porter, director of medical, counseling and psychiatry services at the University of Vermont, which will not perform diagnostic evaluations for A.D.H.D. “There’s some truth to that. The counterweight is these prescriptions can be abused at a high rate, and we’re not willing to be a part of that and end up with kids sick or dead.”

Not everyone is convinced:

“If a university is very concerned about stimulant abuse, I would think the worst thing they could do is to relinquish this responsibility to unknown community practitioners,” Ms. Hughes [CEO of CHADD, an advocacy organization] said. “Nonprescribed use of stimulant medications on campus is a serious problem that can’t just be punted to someone else outside the school grounds.”

She has a point. The 2010 suicide death of Kyle Craig, who abused Adderall prescribed by his local physician at home and not by the university he attended, suggests the problem is more wide-ranging than perhaps some university officials understand.

However, this sort of effort on the part of Fresno State is amazing and should be applauded:

And in a rare policy among colleges, students receiving prescriptions to treat A.D.H.D. must see a Fresno State therapist regularly — not for a cursory five-minute “med check” but for at least one 50-minute session a month.

Psychotherapy required for ADHD treatment? Nice — finally an institution that listens to the research and understands that medications are, for most, not a life-long answer.

I think that, by and large, this is a measured response to a very serious problem of stimulant abuse among college students. Students have long enjoyed free healthcare on campus, with counseling an additional free service they receive. But student counseling centers mostly refer students with serious, ongoing mental health or mental illness to local providers in the community — they’re simply not well-equipped to treat people with such concerns. I see no reason why ADHD should be an exception.

What this does for the colleges that are mostly getting out of the ADHD business is to limit the overall amount of prescriptions floating around for these stimulant meds. That should drive down supply, drive up prices, and make it less attractive as a “study” option for students without ADHD.

As for the students who actually have attention deficit disorder? I think they will still be able to get the treatment they need. Having seen people at community mental health centers, I know that if there’s a will, people will find a way to pay for mental health services.

Read the full article: Colleges Tackle Illicit Use of A.D.H.D. Pills

People who are all about thinspiration engage in disordered eating in order to be as thin as possible — a common symptom of anorexia. But they don’t see it as a disorder or a problem, making this an insidious problem.

Nonetheless, such eating and self-image problems can result in health problems, even putting the individual’s life at risk.

Some people have sought to get common words or terms that people engaged in thinspiration use banned from social networking websites. One such woman is Torri Singer, a broadcast journalism major who has recently begun a petition to get such terms banned from Twitter.

Many social networks have already climbed aboard the bandwagon, including Tumblr, Instagram, Facebook and Pinterest. And while such policies have been implemented, thinspiration content is still easily found on many of these networks. I suspect that’s one of the challenges of implementing a policy like this — it’s extremely difficult to police, especially if people can just slightly alter the terms they use to talk about these issues.

But that hasn’t stopped Torri from putting Twitter on notice.

“[I want] to raise awareness about the harm of destructive thinspiration messages, and to prompt Twitter to make real change in order to stop the spread of this preventable growing trend,” Singer recently told me. Her inspiration for this campaign came from family:

My sister suffered on and off with eating disorders in her early adult life, so preventing other intelligent, strong, and beautiful girls from forming or elongating their disorders has always held a place of importance in my life. I know how difficult it is to be a girl and have constant exposure to beauty ideals, I don’t think we need any more pressure from self-generated pro-eating disordered “lifestyle” hashtags.

But when a website or social network changes its Terms of Use to remove such discussion from their networks, can it be an effective deterrent? “There is no doubt that other media sites such as Facebook, Instagram, Pinterest, and Tumblr have a long way to go before they are really safe and free of thinspiration triggers,” replied Singer.

“But they have made the first steps toward taking action and being responsible for the safety of their users.”

She also addressed people trying to change the spelling of terms they were using to get around the service’s policing efforts: “Instagram’s initial attempt to limit thinspiration led users to create new spellings (such as thynspo). Instead of giving up on the effort, Instagram revised the policy, stating it will disable “any account or hashtag found to be encouraging eating disorders.”

“The first step is ensuring that these messages are not readily available, and that is where policy change comes into play and really matters.”

Of course, trying to stamp out discussion of a topic on the Internet is impossible, given the hundreds of millions of websites, social networks, forums, and online communities. “By reducing the number of mainstream venues where these pro eating disorder messages are displayed,” Singer says, “we are reducing the exposure, and therefore the dangerous behavior that results (or continues) because of these online interactions.”

I agree — efforts such as Singer’s can make a perceivable impact on the popular, mainstream sites, reducing the likelihood of exposing this ideology to a new, naive audience. Especially when that site is a social network as large as Twitter.

“Banning thinspiration terminology means less accessibility to damaging phrases, encouragement, and images that propel disorders,” notes Singer. “It will prevent susceptible people from forming eating disorders, and people recovering/struggling with eating disorders from exposure to triggers.”

“In my mind, just getting people to have this conversation means that it has been some degree of successful. It is really amazing to see people who sign generating comments about their personal stories and their struggles. Many have said that thinspiration has been a big trigger in their lives and that they support any effort to ban it from impacting others like them.”

Efforts such as Singer’s are a good attempt at bringing attention to the problem and helping people understand that use of these kinds of keywords and hashtags only reinforce the disordered behavior — on a scale that wasn’t readily possible just five years ago. We applaud and support Singer’s petition and efforts to help reduce thinspiration messaging on mainstream social networks.

We encourage you to sign the petition:
Twitter: Restrict use of thinspiration language and hashtags

It then shows the man sitting in the cabin, waiting to die.

A few frames later, the garage lights come back on, and the man opens the garage door. The tag line is, “The New ix35 with 100% water emissions.”

Yes, very tasteful. Maybe if you were brain and dead and haven’t been alive for the past three decades. Nothing like making fun of people with mental illness, clinical depression, or a disability, is there Hyundai (and Innocean)??

Warning, we’ve included a copy of the video below. Do not continue on if you don’t wish to watch it.

I can imagine some of the other ideas that Hyundai and Innocean are also discussing right now:

• A cancer patient is shown dying in a hospital bed, and asks for one last drink of water. They wheel her out to the ix35′s exhaust pipe and instruct her to drink away.

• Lawn need watering? Just start up the ix35 and continually drive it around the yard, letting the water from the tailpipe drip onto the grass.
• A poor family is shown holding their cupped hands under the ix35′s tailpipe, dying for a drink of water.

Here’s the offensive video. You’ve been warned, so don’t view it if someone you know has died by suicide in this manner:

This ad has particular poignancy for me — and I suspect tens of thousands of other people around the world — as I knew someone who took their life via this method. Rob was my childhood best friend, and one of the primary motivations for me going into public education and advocacy as my career rather than providing individual psychotherapy to patients. He died November 8, 1990, and his death is a memory that I’m reminded of nearly every week as I work on the resources that go to make up this site.

Seeing such a vivid depiction of the end of a man’s life — to sell cars no less — is not just in poor taste. It is thoughtless, and even mean-spirited. As though human life is worth so little, we can demonstrate someone failing at taking their own life to help promote the attributes of this stupid pile of metal. A Hyundai.

Criticism of the Hyundai Video

The Hyundai ad is incomprehensible in an age where we are finally making inroads in the public understanding of mental illness… Of reducing the discrimination and prejudice against those who have one. A depiction of suicide in the media — even when reporting on a news item — can up the rate of suicides temporarily, referred to as suicide contagion. Did the ad agency who produced this ad even know that? Did they care?

Does it make a point? If one can get past the gruesome darkness of the ad, I suppose the point that you can’t kill yourself in this particular Hyundai is noted. But really? Out of all the options you have to demonstrate a car’s eco-friendliness, this is the one you go with?

Hyundai North America is distancing itself from its European counterparts with this statement:

We at Hyundai Motor America are shocked and saddened by the depiction of a suicide attempt in an inappropriate UK video featuring a Hyundai. Suicide merits thoughtful discussion, not this type of treatment.

Further criticism and commentary can be found over on this article by Matthew Herper, Update: Hyundai North America Disavows ‘Particularly Graphic And Dangerous’ Car Ad.

I just have to shake my head that this ad got through multiple levels of management review and approval in two different companies. Everybody probably was congratulating themselves on producing an “edgy” or “thought provoking” ad — while trying to sell pieces of steel on wheels.

A class-action lawsuit against the APA was thrown out earlier last year on technical grounds (but with prejudice, suggesting a new lawsuit has a harder road to climb).

Despite that, a new lawsuit was recently filed in federal court in California “accusing the group of misleading its members into paying a fee used to fund its lobbying arm as part of their annual dues.”

Law360 has the story:

To fund the [APAPO lobbying] group, the APA started assessing the so-called special fees, which were included on its annual membership dues statement with the instruction that any members who provide any health-related services “must pay” the fees, Grossman claims. These special fees were significant, ramping up to about $140 in 2011 — or about half of the APA dues themselves — according to the complaint.

This was backed by information on the group’s website and in a public statement, reiterating that the special fee was mandatory and that the only reason the fee was assessed separately was for tax reasons, due to APAPO’s separate tax status as a lobbying group, the suit alleges.

However, after a number of APA members discovered in 2010 that the special fee was only mandatory for membership in APAPO and began to spread the information to other members, the group had a turnaround, admitting its prior fee statements “[did] not make clear” that the fee was only for APAPO membership and that its 2011 dues statements would “be modified to clarify this point,” according to Grossman.

According to the APA, it continues to lose membership too, suffering an 8 percent decline in 2011 and nearly a 2 percent decline in 2012. Other professional organizations, including the Association for Psychological Science and the American Psychiatric Association, continue to see their membership ranks increase during the same period.

Given the APA’s confusing messaging and lack of apology about the issue, it’s not surprising to find that APA members have voted with their feet.¹ According to financial statements on the APAPO website, the special assessment fees received in 2011 dropped 14.5 percent — significantly more than the drop in overall APA membership for that year.

While we don’t want to see the APAPO go away, we do want to see the APA apologize for misrepresenting the fee for nearly a decade to its own members — and repay it to any member who felt misled.² An ethical and responsible organization shouldn’t need a lawsuit as a prod in order to do the right thing.

Read the full article: Psychologists Group Sued Over Misleading Membership Fees

1. Every time we and others asked the APA about the confusing messaging, spokespeople gave a canned response about the assessment being “mandatory” to be a member in the APAPO — one of those typical legal/PR answers that doesn’t answer the question.
2. The APA can afford to fund APAPO entirely on its own — without the “special” assessment. They clearly have the money, between the generous compensation packages they pay their top executives, the $11.4M profit reported in 2010, and the $9.3M profit reported in 2011. The APAPO’s annual budget is only $5M.

It doesn’t matter that I wake up most mornings to swim 160 laps, am borderline obsessed with eating salads and whole grains, and that I haven’t drank a drop of alcohol in 24 years; that I do yoga twice a week, keep a mood journal, engage in cognitive behavioral therapy, and have a rich spiritual life; that I take omega-3 fish oil capsules, vitamin D, calcium, and other supplements with my extra-pulp juice in the morning; or that I work really hard at communicating anger, frustration, and disappointment so that the repression of feelings doesn’t end up as a tumor somewhere inside my body.

I can’t get an individual or family plan short of signing up for a $10,000 deductible.

Because I have a history of depression.

My illness falls under the ABCs of the non-insurable, the “preventable” illnesses that solicit the red flag of “no way in hell” she’s getting coverage:

A – Asthma (and, hell, let’s throw in Arthritis)
B – High Blood Pressure
C – Cardiovascular Disease (and Cancer, sometimes classified – I know – “preventable,” but which is surely a insurance-killer)
Double D (think bra size) – Diabetes and OF COURSE Depression

Now I’m not so naïve that I dismiss the economic toll these illnesses take on an already fragile economy. Here’s the chronic disease price tag, estimated annual direct medical expenditure, according to the Center for Disease Control, which used different methodologies in calculating costs:

Cardiovascular disease and stroke: $313.8 billion in 2009
Cancer: $89 billion in 2007
Smoking: $96 billion in 2004
Diabetes: $116 billion in 2007
Arthritis: $80.8 billion in 2003
Obesity: $61 billion in 2000

Not mentioned here is clinical depression, which, left untreated, is as costly as heart disease or AIDS to the U.S. economy, according to Mental Health America. It costs over $51 billion in absenteeism from work and lost productivity and $26 billion in direct treatment costs.

Depression tends to affect people in their prime working years and may last a lifetime if untreated. According the MHA:

• Depression ranks among the top three workplace problems for employee assistance professionals, following only family crisis and stress.
• Three percent of total short-term disability days are due to depressive disorders and in 76 percent of those cases, the employee was female.
• In a study of First Chicago Corporations, depressive disorders accounted for more than half of all medical plan dollars paid for mental health problems. The amount for treatment of these claims was close to the amount spent on treatment for heart disease.
• The annual economic cost of depression in 1995 was $600 per depressed worker. Nearly one-third of these costs are for treatment and 72 percent are costs related to absenteeism and lost productivity at work.

That’s not to mention the human toll: seven out of ten deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50 percent of all deaths each year. Almost 15 percent of those suffering from severe depression will die by suicide.

And there is much we can do to prevent it. Four culprits are responsible for much of the illness, the suffering, the costs, and the early death associated with chronic diseases:

• Lack of physical activity
• Poor nutrition
• Tobacco use
• Excessive alcohol consumption

But allow me to climb back onto my soapbox. It’s still not fair. It’s not fair to those of us who go to great lengths to pursue healthy living and do everything in our day in the name of recovery – those of us who get up every morning with a pair of boxing gloves on, ready to fight for our health. It’s just not fair and it’s wrong.

I look forward to my meetings with health insurance brokers less than I do my yearly Pap. As much as I try to mentally prepare myself for the blow – “Repeat to yourself: You’re not going to like what you hear. It’s going to be unfair. You need to stay calm” – I still leave infuriated, which then, of course, has me checking off two of the ABCs: depression AND high blood pressure. That would probably bring my deductible up to $12,000, God forbid.

Originally published on PsychCentral.com

Ya have to admire psychologists who endlessly lobby state legislatures for the right to extend prescription privileges to their profession (with a little additional training). They won’t take repeated defeat as a sign that perhaps their efforts are… insane?

Illinois is the latest state to hand psychologists seeking prescription privileges a defeat, with NAMI Illinois siding on the side of not supporting the bills in front of the Illinois legislature. After intense lobbying by both sides of this issue, they concluded, “NAMI Illinois opposes SB 2187 and HB 3074 in its current form to expand prescriptions privileges to psychologists.”

When will psychologists learn?

The movement that is supported by some psychologists to gain prescription privileges is called RxP. The rationale behind the movement is that, in some communities in the U.S., psychiatrists are few and far between. With too few psychiatrists, patients often have little choice but to wait weeks or months for an appointment, or travel long distances to see another psychiatrist. Psychologists argue that their existing training prepares them to take an additional set of courses (which can be taken exclusively online) and training (supervision under a physician) that results in them being high-quality prescribers — equivalent to a medical doctor.

NAMI Illinois’ statement is worth a read, so we’ve posted a copy of it here. But here’s a highlight:

If we don’t fully address integrated health care needs, mental health needs become moot if people continue to die so early from physical causes. NAMI Illinois cannot advocate for the creation of more silos that hinder full integration of physical and mental health care needs.

Exactly. Instead of working with the profession of psychiatry to help address the shortage of psychiatrists, psychologists seek to circumvent that profession entirely by pushing for professionals with little medical background or knowledge to become medical prescribers.

This is a misguided, failure-ridden effort that has been going on now for more than three decades — with very little success to show for it. The bills are introduced into a number of state legislatures each and every year. Each and every year, they get defeated or never get voted out of committee.

And Illinois is not alone. Ohio’s legislators appear disinclined to keep reintroducing the same bills that keep failing, year after year, according to an update sent out by Janet Shaw, MBA, the executive director of the Ohio Psychiatric Physicians Association:

It appears Senators Burke and Seitz are no longer inclined to reintroduce last year’s bill in its current form.

Instead, Senator Burke suggested, and Senator Seitz agreed, that psychologists in Ohio who want to prescribe medications go the route of becoming a physician assistant since the training is similar and duration the same (approximately two years), to the psychopharmacology programs for psychologists, and since the scope of practice for a physician assistant already allows them to prescribe in Ohio.

I agree. Psychologists — like all mental health professionals who don’t hold a medical degree — already have a path to gaining prescription privileges. It’s called “go to medical school” and become a medical doctor, a registered nurse practitioner, or physician’s assistant. There is virtually nothing unique or special about a doctoral degree in philosophy (the Ph.D., which most psychologists hold) that gives them a leg up on the medical training necessary to prescribe.

Psychologists should be working with psychiatrists to understand how best to address the dearth of psychiatrists in certain geographical areas in the U.S., instead of trying to steal their profession away from them.

Psych Central remains steadfastly against psychologists gaining prescription privileges. It is a waste of psychologists’ time and efforts, and minimizes their specialized expertise and training in being uniquely qualified in the understanding of human behavior.

They end up in prison, usually for repeated petty crimes or drug abuse. And society, in its infinite wisdom, has decided that spending 4x to 5x the cost of keeping the person in prison is “better” than simply getting them into a drug abuse treatment program.

“When I went on the tour (of the prison), I didn’t see it in color; when I came back, I was trying to remember what it looked like, and I couldn’t remember any of the colors at all,” Jenn Ackerman told Slate. “I knew there was something so gritty and raw.”

“The system designed for security is now trapped with treating mental illness and the mentally ill are often trapped inside the system with nowhere else to go,” Ackerman notes on her website.

Indeed, that’s true. And perhaps such inspiring imagery can help remind all of us that these fellow human beings deserve dignity and treatment — not bars and discrimination.

The photos are well worth your time.

Check out the Slate article for the images and their stories: “Trapped” documents the line between mental illness and security in a Kentucky prison

See the photos: Trapped – The photo reportage by Jenn Ackerman

Yet, Kaiser Permanente’s health maintenance organization in the state — rather than abide by the regulation — regularly made patients wanting mental health care wait longer than the 10 business days. In fact, in one case from 2010, the California Department of Managed Health Care (DMHC) fined Kaiser $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months! The new report found that anywhere from 17 to 40 percent of patients waited longer than 14 days for an appointment.

Last week, the DMHC was again at Kaiser’s doorstep, finding that Kaiser kept two sets of appointment records to try and circumvent this regulation — a paper appointment calendar and an electronic health record calendar. The DMHC cited Kaiser for “serious” deficiencies in how it manages and provides mental health care services to its patients.

Kaiser Permanente is one of those enormous health care providers that seems to have lost the plot — providing reasonable and timely health care for its customers.

The latest Kaiser investigation by the DMHC was begun based upon a lengthy and detailed report (PDF) published in November 2011 by the National Union of Healthcare Workers — which represents 2,000+ health care employees at Kaiser. In other words, this is Kaiser’s own staff blowing the whistle on the horrible clinical practices they were forced to implement for their patients.

Here’s what the new DMHC report published last week concluded:

• Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.

• Kaiser’s internal record-keeping system contained numerous problems – including a parallel set of “paper” appointment records that differed from the HMO’s electronic records – that hid patients’ lengthy wait times from government inspectors.
• Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.
• Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.

This last point is particularly egregious because Kaiser — in multiple materials across multiple provider sites — suggested there were limits on mental health coverage visits. These limits haven’t been allowed — by law — since the federal mental health parity regulations went into effect in 2010. If you have a mental disorder diagnosis, your coverage is the same as it is for other health conditions. Yet in 2011, Kaiser was apparently still saying things like,

“We offer brief, problem solution focused individual counseling. Research shows many people improve in a single visit. For others, 3 to 6 visits can produce desired changes.”

and

“Health Plan contracts for up to 20 visits per calendar year with various copayments.”

If you read this, it may have dissuaded you from even seeking care, thinking your care would be arbitrarily limited by Kaiser (and not by what’s in your best treatment interests).

Of course, Kaiser claims that since the beginning of 2012, it has worked on fixing these problems. How convenient… yet this isn’t the first time Kaiser has been fined by the DMHC, so let’s just say that I’m a little skeptical of their “fixes.”

“The department feels these findings are really serious. Because of that, we are doing the immediate enforcement referral, which is unusual,” said Shelley Rouillard, chief deputy director of the Department of Managed Health Care.

Kaiser, get your act together. It’s shameful that you treat patients with mental health concerns as second-class citizens in California, and you don’t listen to your own employees. Instead, they have to turn to the regulatory agency in order to have their concerns addressed. In my opinion, that demonstrates a business organization that is clearly broken.

If you’re a patient of Kaiser’s HMO mental health system in California, I feel for you. The report linked above details practices that suggest Kaiser’s mental health patients are getting sub-standard care by overworked, underpaid, and unappreciated clinicians.

Read the full story: Kaiser mental health service reprimanded

Read the full DMHC Final Report: Routine Medical Survey of Kaiser Foundation Health Plan, Inc. Behavioral Health Services (PDF)

However, according to Dana Becker, Ph.D, author of the thought-provoking book One Nation Under Stress: The Trouble with Stress As An Idea, by focusing on how each person can manage stress, we’re obscuring the bigger picture and issues: the social, political and economic problems that spark and perpetuate our stress in the first place.

Today’s articles and rhetoric on stress imply that if we fix ourselves, we’ll fix everything. Instead of stress-reducing tips empowering us, according to Becker, “we’re being sold a bill of goods.” We’re buying into an illusion that “blames the victim.”

“The advice is targeted to help us achieve a sense of control in situations that aren’t really controllable except through some kind of economic, political or social level.” In other words, “having control over how well we eat isn’t the same as changing workplace policies.”

Instead of talking about poor workplace policies, spotty daycare and other hurdles for single parents or dual-career households, we’re talking about stress, said Becker, a psychotherapist and professor of social work at Bryn Mawr College. Instead of fixing the problem of a single parent with three kids having to work ‘til 8:30 p.m. every night, we’re talking about taking a bubble bath, she said.

Becker doesn’t dismiss the importance of self-care or healthy habits. She views this as a “both and.” “Nobody is saying that it’s a bad thing to take care of ourselves. [But] a lot of these problems won’t be solved unless we engage in a national discussion.”

History of Stress

So how did the concept of stress come to be? The term “stress” was used as early as 1914 by Harvard physiologist Walter Cannon. But his concept was different than ours today. As Becker notes in One Nation Under Stress, “Cannon described stress in terms of heat, hunger, oxygen deprivation and other phenomena that can cause predictable physiological responses.”

He concluded that in response to fear and fury, our bodies released adrenalin and our heartbeat and blood sugar increased. But our bodies would always return to “homeostasis,” or keep “on an even course.”  Remnants of this theory do live on today. According to Becker in her book:

“…it is generally agreed that, after Cannon, all stress theories were based at least in part on his ideas about homeostasis. Cannon’s work lives on in the popular idea that there is an ongoing battle between our out-of-date physiology and the demands of modern life. We make biological ‘adjustments’ that are no longer functional: we react to an angry boss the way our Stone Age counterparts reacted to a saber-tooth tiger, but we can’t run away…”

It was Czech-born endocrinologist Hans Selye who popularized the concept of stress. At first, Selye used the term “stress” much like Cannon did. But by 1950, Becker writes, “he was describing stress as a ‘response to a condition evoked by stressors.’” In his book The Stress of Life, which Selye penned for the public, he refers to stress as “the rate of wear and tear caused by life.” He also made the connection between stress and disease.

Selye was a master marketer of stress. According to Becker in her book, “A tireless promoter of the stress concept, Selye sold and resold it over the years in popular and professional venues – in his best-selling books The Story of the Adaptation Syndrome and The Stress of Life, in talks to doctors’ groups in Canada and the United States, and at meetings of the American Psychological Association.

But Selye was so good that while the public accepted stress as a prominent concept, his specific theories got lost. In fact, “…the ‘truth’ of the stress concept and the American embrace of it did not come about through scientific agreement or through medical cures for ‘stress-related’ diseases. It was stress’s popularity that made it ‘true,’” Becker writes.

Collective Movements

While it’s the American way to believe we can fix anything on our own, some problems require collective action, Becker said. Take discrimination, for instance. The only reason the brave behavior of Rosa Parks “worked is because there was a movement already afoot,” Becker said.  If a movement didn’t exist, her individual protest would’ve likely been an isolated one.

Today, there are many collective movements that aim to effect change. Becker mentioned a website called MomsRising, a place where moms can connect and pressure their representatives to make changes at the policy level.

Ultimately, Becker believes we’re asking the wrong questions about “stress.” Rather than solely asking how we can alleviate or reduce our own stress, we should be asking how our society – at the policy level – can address the bigger picture. The problems at the root of our stress are rarely individual issues; they’re social ones.

The study — published in the BMJ and conducted on data derived from the entire population of Sweden (can we say, “Big study!”) — found “After adjustment for sociodemographic confounders, any mental disorder was associated with a 4.9-fold risk of homicidal death, relative to people without mental disorders.”

In plain English — people with mental illness in Sweden were at nearly 5 times the risk of being murdered than citizens without a mental illness diagnosis.

Rather than wasting time passing laws to try and minimize outlier, tragic events (which, by their very definition, cannot be minimized by the passage of new laws), we instead should be putting more resources into protecting and helping treat people with mental illness.

The researchers examined the 615 homicidal deaths that occurred in Sweden from 2001 to 2008, in a population of over 7 million. Just to put that 615 into some perspective, that’s nearly the number of murders in just one year in New York City (ranging from 414 – 536/year in the past few years; NYC has a population of over 8 million).

The researchers looked at a wealth of demographic data and characteristics — such as gender, race and income — to ensure these variables might not be contributing to the relationship the researchers found.

They found that the risk of being murdered was highest, at nine-fold, for people with substance use disorders, a number that may of course be subject to confounding lifestyle variables. But it was also increased for people with other mental illnesses in a way that couldn’t be explained by substance use.

Those with diagnosed personality disorders, for example, had a 3.2 times increased risk of being a victim of murder. For depression, the risk was increased by a factor of 2.6, for anxiety disorders, 2.2, and for schizophrenia, 1.8.

Some were at even greater risk than others. “Unmarried males with low socioeconomic status were particularly likely to be victimized; they were also at a heightened risk for suicide or accidental death, as previous studies have already established.”

The researchers concluded,

In this large [...] study, people with mental disorders, including those with substance use disorders, personality disorders, depression, anxiety disorders, or schizophrenia, had greatly increased risks of homicidal death. Interventions to reduce violent death among people with mental disorders should tackle victimization and homicidal death in addition to suicide and accidents, which share common risk factors.

And yet has any lawmaker in the U.S. suggested a law to better help and protect the population most at risk for becoming a victim of violence?

Not a one.

Read the full article: Study: People With Mental Illness Are Five Times More Likely to Be Murdered

Reference

Crump et al. (2013). Mental disorders and vulnerability to homicidal death: Swedish nationwide cohort study. BMJ, 346. doi: http://dx.doi.org/10.1136/bmj.f557

And sometimes that public health care is a little… how shall we say? Lacking.

So last week it shouldn’t have been much of a surprise when Nevada was accused of patient dumping. A psychiatric hospital in Las Vegas, Rawson-Neal, apparently discharged a patient to a bus station to catch a bus to Sacramento, California with a one-way ticket. The patient was under the care of the Southern Nevada Adult Mental Health Services.

The only problem? The patient had no contacts or family in Sacramento, California. He knew absolutely no one there.

While it’ll be a few weeks before we know the full story (after a hastily-called state investigation into the practice), we do know this. The patient, James F.C. Brown, arrived Feb. 12 in Sacramento after a being given a one-way ticket to take a 15-hour bus ride from Las Vegas:

He told social workers he was forced to go to Sacramento, where he had never been and knew no one. [...]

In Brown’s case, the discharge paperwork from Southern Nevada Adult Mental Services had no detail about who or what organization might help him in Sacramento. The paperwork, signed by Brown and a discharge nurse on Feb. 11, lists his address on discharge as “Greyhound bus station to California.”

“Discharge to Greyhound bus station by taxi, with 3 day supply of medication,” the handwritten instructions said. “Follow up with mental health, NA (Narcotics Anonymous) meeting in California. Follow up with medical doctor in California for any medical concerns.”

Somebody clearly dropped the ball here. Brown was staying at Rawson-Neal psychiatric hospital in Las Vegas, a 190-bed acute-care psychiatric hospital. It apparently has a 30-bed observation unit which Brown was staying on, after being thrown out of his group home in Las Vegas, due to the group home’s closure. Annie’s Place was a 10-person assisted living home.

According to KLAS-TV Las Vegas, since July of last year, some two percent of patients with Southern Nevada Adult Mental Health Services were discharged to California — most of them by bus. An internal review by the Nevada Division of Mental Health Services is under way, along with external reviews by both the state Division of Healthcare Quality and Compliance, and the U.S. federal Centers for Medicare and Medicaid Services.

The real question is — is this a one-time accident, a situation where a lone patient fell through the cracks? Or is this a symptom of a more serious and chronic practice in Nevada that has been, perhaps, going on for years?

Hey, it’s one way to improve the mental illness statistics in your state — ship people with mental illness to a neighboring state. And hope they don’t come back (or don’t talk to a concerned social worker who takes their story public).

Read the coverage

Sacramento Bee: Federal probe sought of alleged ‘dumping’ of mental patient in Sacramento

Las Vegas Review-Journal: State to investigate report of mentally ill man dumped in California