Monday, October 27, 2003

Achieving Remission in Depression: Raising the Standard of Care
Article in Medscape Psychiatry & Mental Health - "...Despite the widespread use of the SSRIs, it has become increasingly evident that these agents are often less effective in treating depression compared with some dual-acting agents that affect serotonergic and noradrenergic systems. Early studies that reported similar efficacy rates of all the antidepressant classes tended to use response rather than remission rates as the criterion for improvement. Response is generally defined as a 50% decrease in scores on depression scales, such as the Hamilton Depression Rating Scale (HAMD) or the Montgomery Asberg Depression Rating Scale. Yet significant depressive symptoms are often present after a 50% improvement rate is attained. The patient may therefore have symptomatically improved but still not feel well by the response criterion. Alternatively, remission is an indicator of wellness. When remission is achieved, the patient experiences few, if any, symptoms of depression." [Viewing Medscape resources requires registration, which is free].  
  

Insured Americans Drive Surge in Emergency Department Visits
An Issue Brief from the Center for Studying Health System Change - "isits to hospital emergency departments (EDs) have increased greatly in recent years, contributing to crowded conditions and ambulance diversions. Contrary to the popular belief that uninsured people are the major cause of increased emergency department use, insured Americans accounted for most of the 16 percent increase in visits between 1996-97 and 2000-01, according to a study by the Center for Studying Health System Change (HSC). This Issue Brief examines trends in emergency department and other ambulatory care use, focusing on differences among insurance groups. Although insured people accounted for most of the increase in emergency department visits, uninsured Americans increasingly rely on emergency departments because of decreased access to other sources of primary medical care. Emergency department waiting times also have increased substantially, which may lower both insured and uninsured patients’ perceptions of the quality of their care." See also the related press release.  
  

Prisons as Mental Institutions: The Mass Incarceration of the Mentally Ill
Feature article at FindLaw by Joanne Mariner, a lawyer with Human Rights Watch - "...Despite good reasons to limit the incarceration of the mentally ill, the number of mentally ill people behind bars continues to grow. Over the past few decades, the country's prisons and jails have become its default mental health system. Somewhere between two and four hundred thousand mentally ill people are incarcerated, several times more than the number of people living in mental institutions. The results, from a therapeutic, humanitarian, and human rights perspective, are appalling." See also the item posted here last week on the related report by the Human Rights Watch.  
  

Hundreds to Lose Mental Health Coverage (Washington)
Brief KXLY story - "Letters are going out Thursday telling about 900 Spokane County residents that they will be losing their mental health coverage. Those who are already registered for Medicaid will continue getting mental health care, but other low income and elderly residents are out of luck."  
  

City unifies agencies for mental health (Pennsylvania)
Philadelphia Enquirer story - " The years-long drive to create a unified city system for delivering mental-health and substance-abuse treatment culminated yesterday as Mayor Street signed an order establishing the Office of Behavioral Health and Mental Retardation Services, with a budget larger than that of any other city department. The biggest change for the more than 100,000 men, women and children who receive treatment is 'they won't be referred from agency to agency to get different services,' said Estelle Richman, Pennsylvania Secretary of Public Welfare, who pushed for the consolidation when she was city health commissioner and who has supported it as a member of Gov. Rendell's cabinet."  
  

State to develop mental health crisis plan (Indiana)
Story in the Indianapolis Star - "Indiana officials announced Thursday they have launched an effort to create a statewide plan that ultimately will help people cope in times of crises. The plan will be based on a recent assessment by the state and Brian W. Flynn, a former assistant surgeon general of the United States and an expert in the effects of disasters on mental health. The assessment of Indiana's 30 community mental health centers was the first of its kind in the nation. It found that 22 centers felt they needed technical assistance to develop an adequate disaster response. The survey also revealed that 67 percent of the centers did not have a clear idea of how to go about meeting needs in emergencies, while 76 percent did not understand the roles of other agencies."  
  

Mental health care 'a maze' (Canada)
Toronto Star story - "The mental health care system in Toronto and the Peel region is 'egregiously under-funded, hard to understand, severely fragmented and difficult to access,' says a stinging report commissioned by Ontario's former Tory government but never released. The system 'is plagued by shortages of qualified staff and by insufficient use of evidence-based practices ... the current level of investment in this non-system is insufficient.' This situation 'is a crying shame,' the report concludes. ... The report was compiled by the 30-member Toronto-Peel task force, one of nine the Tories appointed across the province in January, 2000 to develop a mental health action plan. More than 10,000 Ontarians were consulted. The task forces delivered their reports to then Minister of Health Tony Clement in December, 2002, but he did not release any of them, angering task force members."  
  

Democrats push mental health bill as tribute to Wellstone
AP story in USA Today - "Marking the one-year anniversary of Paul Wellstone's death, Democratic senators failed Friday to win passage of one of the late senator's top crusades: legislation to mandate equal health insurance coverage for mental illnesses. Although the bill has the support of two-thirds of the Senate, Republicans blocked an effort to pass the legislation by unanimous consent, a provision generally used for non-controversial legislation..."  
  

Law eases intervention in mental health cases (Maryland)
Baltimore Sun story - "...Mental health advocates hope that a new Maryland law that relaxes the standards for involuntary emergency psychiatric evaluations will make it easier for families and others to obtain the proper treatment before a crisis becomes a tragedy. The aim of the legislation, which went into effect Oct. 1, is to get a mentally ill person assessed, stabilized and treated as soon as possible, to avoid relapses and long-term hospitalizations, according to members of the Maryland chapter of the National Alliance for the Mentally Ill, which organized the effort to change the law."