I’m conflicted about the announcement of Project ECHO’s expansion last week. The ECHO Institute was founded by the Robert Wood Johnson Foundation, the GE Foundation and the University of New Mexico Health Sciences Center to help primary care physicians do a better job with common, chronic condition diagnosis and treatment via Project ECHO.

On Friday, they announced a new initiative focusing on mental health treatment. The new effort will involve having academics train primary-care physicians to strengthen and better coordinate their mental health care.

It’s the right focus, because family doctors and general practitioners prescribe the majority of antidepressants in this country, and are often the first-line professional to see a patient who may have a mental health concern.

But then the director of Project ECHO, Sanjeev Arora, spoke.

Disappointing to some professionals, I’m sure, is the fact that two disorders didn’t make it into the DSM-5 at all — not even in the chapter “Conditions for Further Study.”

Those two lonely disorders? “Internet addiction” and parental alienation disorder.

This is a nice respite from the hype surrounding both these concerns and reaffirms what we’ve been saying here for years — these are not mental disorders. Do some people have a usually-temporary and almost-always transitory problem with figuring out how much time to spend on the Internet? Sure they do — it’s just not a disorder-level concern.

And the evidence is simply too sparse for “parental alienation disorder,” which I believe has propagated more for legal than clinical reasons.

This guest article from YourTango was written by Jamie (Simkins) Rogers.

I’ve been feeling nostalgic since the recent death of Dr. Joyce Brothers the other week. I grew up watching Brothers on shows like Donahue and The Tonight Show Starring Johnny Carson while my grandmother crocheted afghans beside me.

I knew I wanted to be a therapist from a very young age, having analyzed my own familial relationships ad nauseum (I was a weird kid). Back then, I loved Dr. Brothers’ wit, grace, class and charm.

Today, I respect her as the rarity she was during her prime: an accomplished female in the field of psychology.

The DSM-5 was officially released today. We will be covering it in the weeks to come here on the blog and over at Psych Central Professional in a series of upcoming articles detailing the major changes.

In the meantime, here is an overview of the big changes. We sat in on a conference call that the American Psychiatric Association (APA) had in order to introduce the new version of the diagnostic reference manual used primarily by clinicians in the U.S. to diagnose mental disorders. It is called the Diagnostic and Statistical Manual of Mental Disorders and is now in its fifth major revision (DSM-5).

James Scully, Jr., MD, CEO of the APA, kicked off the call by remarking that the DSM-5 will be a “critical guidebook for clinicians” — a theme echoed by the other speakers on the call.

In the past week, I’ve seen some incredibly sensationalistic articles published about the upcoming DSM-5 and a letter recently released by the National Institute of Mental Health (NIMH). In the letter by Dr. Thomas Insel, director of the NIMH, wrote in part, “That is why NIMH will be re-orienting its research away from DSM categories.”

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.

Nearly three years ago, we reported on the kerfuffle over psychologists who were upset to find that the “mandatory assessment” fee they thought was, well, mandatory turned out to be entirely optional. The fee was being paid to the American Psychological Association (APA), the professional guild association for psychologists, to fund a legally separate organization, the APAPO, tasked with lobbying (mostly at the state level — not the federal level).

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.”

“Insanity is doing the same thing over and over again but expecting different results.”
~ Rita Mae Brown

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?

California has some patient-friendly regulations on its books, meant to help patients get the care they need in a reasonable amount of time. One of those regulations is that patients shouldn’t have to wait more than 10 business days for a regular appointment with their health or mental health care provider.

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.

My first introduction to the Diagnostic Statistical Manual (DSM), published by the American Psychiatric Association (APA), was standing in the kitchen of my parents’ home and witnessing my father in full rant.

My dad was a psychiatrist/ psychoanalyst of the old school. Which is to say he was brilliant, but also a man of his particular age. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership in the APA. My dad loved being a psychoanalyst and he loved being a physician but he wasn’t that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn’t idle. But it wasn’t like he was giving up his beloved couch.

Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.

Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.

So here’s a list of the major updates…

Do you tend to be touchy-feely?  Are you comfortable with a pat on the back, a gentle hold on an elbow or a high-five?

When we touch, how often we touch and how we respond to touch is influenced by a wide variety of factors.  Each culture has varying norms about what is acceptable social touch. Families and social groups within a culture have their own norms. A 2012 study in the Journal of Personality and Social Psychology, for example, found that men are more likely to touch women than vice versa.

And each individual has a personality style that may influence their comfort level with touch in social situations.

Social touching (for example, a pat on the shoulder)  is an important part of our interactions with others.  It can be calming, create bonds, express concern and solidarity, reduce anxiety and provide reassurance.

While attending the 28th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center last week, it occurred to me that mental health professionals are some of the worst when it comes to discriminating against people with mental illness.

They do this in insidious and subtle ways, suggesting a patient can’t do the things others without mental illness can do. Like hold down a job, get into independent housing, interact in social situations or even just go back to school and get a degree.

They also do this in more direct ways, by suggesting to their patients applying for a job or going back to school that, “If they don’t ask about mental illness, don’t volunteer that information.” Why not?

Why are mental health professionals helping to contribute to discrimination and stigma about mental illness by making these suggestions?