Suicide Prevention Day Resources

The International Association for Suicide Prevention (IASP) and the World Health Organization (WHO) are co-sponsoring World Suicide Prevention Day on September 10th. The theme of this 11th anniversary event is “Stigma: A Major Barrier for Suicide Prevention.”

World Suicide Prevention DayAccording to the WHO and the latest Burden of Disease Estimation, suicide is a major public health problem in high-income countries and is an emerging problem in low- and middle-income countries. Suicide is one of the leading causes of death in the world, especially among young people. Nearly one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds. The number of lives lost each year through suicide exceeds the number of deaths due to homicide and war combined. These staggering figures do not include nonfatal suicide attempts which occur much more frequently than deaths by suicide.

A large proportion of people who die by suicide suffer from mental illness. Recent estimates suggest that the disease burden caused by mental illnesses will account for 25% of the total disease burden in the world in the next two decades, making it the most important category of ill-health (more important than cancer or heart diseases). Yet a significant number of those with mental illnesses who die by suicide do not contact health or social services near the time of their death. In many instances there are insufficient services available to assist those in need at times of crisis.

This lack of access to appropriate care is one of the many factors that magnify the stigma associated with mental illness and with suicidal ideation and behaviour. This type of stigma, which is deeply rooted in most societies, can arise for different reasons. One of the causes of stigma is a simple lack of knowledge – that is, ignorance. This type of stigma can be directly addressed by providing a range of community-based educational programs that are targeted to specific subgroups within the society (that is, by age, educational level, religious affiliation, and so forth). The goal of such programs is to increase public awareness of the characteristics and treatment of people with mental illnesses and/or suicidal behaviour, and of the available treatment resources to help individuals with these problems.

But knowledge is not enough to combat stigma. Negative attitudes about individuals with mental illnesses and/or suicidal ideation or impulses – prejudice – is common in many communities. These negative attitudes often do not change with education about mental illnesses and suicidal behaviour. Indeed, many health professionals who feel uncomfortable dealing with persons struggling with mental illnesses or suicidal ideation often hold negative, prejudicial attitudes about such patients. This can result in a failure to provide optimal care and support for persons in crisis. Changing such prejudicial attitudes requires a long-term effort to change the underlying cultural values of the community and a parallel effort to alter the treatment norms of health care professionals.

Stigma is also the underlying motive for discrimination – inappropriate or unlawful restrictions on the freedoms of individuals with mental illnesses or suicidal behaviour. Such restrictions can occur at a personal, community or institutional level. One extreme example is the criminalization of suicidal behaviour, which still occurs in many countries. Discrimination can prevent or discourage people affected by mental illnesses and/or suicidal ideation or behaviour from seeking professional help or from returning to their normal social roles after receiving treatment for an episode of illness or crisis. Clearly, criminalization of suicidal behaviour can be a powerful deterrent on the care-seeking of individuals in crisis who desperately need to be able to access care and support, without being judged or penalized.

At a government or administrative level, stigma can have an impact on resource allocation. In both high-income and low- and middle-income countries stigmatized conditions such as mental illnesses and suicidal behaviour receive a much smaller proportion of health and welfare budgets than is appropriate, given their huge impact on the overall health of the community. Furthermore, fund-raising efforts to support public health initiatives in this area often fall flat because of lack of interest among communities, governments, and international funding agencies; that is, because of stigma.

Attempts to fight stigma, by undertaking massive public education programs, have been of limited effectiveness in reducing the stigma associated with mental illness and suicide. New, innovative methods that are more target-group specific or that creatively use the emerging social media need to be developed and tested. Despite the difficulty and complexity of fighting stigma, persons, organizations and governments committed to the dual goals of improving the quality of life of individuals suffering from mental illnesses and suicidal ideation and of reducing the huge burden of suicide on families and communities don’t have an option. Unless stigma is confronted and challenged, it will continue to be a major barrier to the treatment of mental illnesses and to the prevention of suicide.

World Suicide Prevention Day provides a special opportunity to refocus our collective energies on addressing this fundamental problem. Changing cultural attitudes about mental illness and suicidal behaviour requires a scientific awareness of the many forces that influence community norms and the concerted effort of a wide range of community stakeholders over a prolonged period of time. World Suicide Prevention Day is an ideal time to inspire people to work towards the goal of developing creative new methods for eradicating stigma. Comprehensive local or national plans for the prevention of suicide will not reach their full potential until the problem of stigma is effectively addressed.

On this year’s World Suicide Prevention Day, IASP is hosting its first core activity, which will be to undertake a collective Cycle Around the World, with the aim to globally raise awareness of suicide and its prevention, and to reduce the stigma associated with it. Further details of this activity will be published on the IASP website on a regular basis over the coming months.

WHAT YOU CAN DO TO SUPPORT WORLD SUICIDE PREVENTION DAY

Become a Facebook Fan of the International Association for Suicide Prevention (IASP) www.facebook.com/IASPinfo

WORLD SUICIDE PREVENTION DAY is an opportunity for all sectors of the community – the public, charitable organizations, communities, researchers, clinicians, practitioners, politicians and policy makers, volunteers, those bereaved by suicide, other interested groups and individuals – to join with the International Association for Suicide Prevention and the WHO to focus public attention on the unacceptable burden and costs of suicidal behaviours with diverse activities to promote understanding about suicide and highlight effective prevention activities.

Those activities may call attention to the global burden of suicidal behaviour, and discuss local, regional and national strategies for suicide prevention, highlighting cultural initiatives and emphasizing how specific prevention initiatives are shaped to address local cultural conditions.

Initiatives which actively educate and involve people are likely to be most effective in helping people learn new information about suicide and suicide prevention.

Source: http://www.iasp.info/wspd/index.php

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Cognitive Behavioral Therapy Effective for Bipolar Disorder

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Cognitive Behavioral Therapy Effective for Bipolar DisorderWhen someone begins treatment for bipolar disorder, I always recommend therapy along with medication because we know from studies that the combination of the two treatments works better than either alone.

However, most people think about psychotherapy (talk-therapy) when the word therapy is mentioned. That is not a bad thing. Psychotherapy has helped many people with and without bipolar disorder lead fuller, happier lives.

But another option that is effective for many people is cognitive behavioral therapy. This therapy has only been applied to bipolar disorder in the last decade, but it has been used to treat depression even longer. Studies on its effectiveness in bipolar disorder are preliminary, but so far the evidence suggests it is effective.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is different than traditional therapy in that it is short-term and doesn’t involve delving into historic issues. Cognitive behavioral therapy is about the here and now and is about giving you tools to deal with the symptoms of bipolar disorder that you are experiencing today.

Cognitive behavioral therapy is an analytical process that encourages people to look at their behavior, feelings, and motivations to learn what triggers these situations and what can be done to handle them.

For example, in cognitive behavioral therapy:

  • The patient is asked to explore their distorted thinking such as “I am god” when manic or “I am worthless” when depressed.
  • Patients are encouraged to develop interpersonal routines such as sleeping and waking at the same time each day.
  • Patients work to understand the warning signs of oncoming mood episodes and learn how to cope with these symptoms to avoid episodes where possible (relapse prevention).
  • Patients are aided in exploring what triggers episodes or specific emotions.

Cognitive behavioral therapy may be delivered one-on-one or in groups.

For Whom Does Cognitive Behavioral Therapy Work?

It is my belief that anyone can benefit from cognitive behavioral therapy in some way; however, statistically, people with fewer than six mood episodes have been shown to have greater success with this therapy. Also, people who are in the midst of a crisis—either mania or depression—may not be in a place emotionally or intellectually to optimally benefit from cognitive behavioral therapy. Some degree of stability should be attained before attempting this therapy (medication and traditional psychotherapy may help achieve this).

It is recommended that specialists in cognitive behavioral therapy deliver the treatment for greatest success. If therapy is not available in your area, workbooks are available to walk you through the therapy although this likely won’t be as beneficial as a live therapist (and likely won’t be bipolar-specific).

Cognitive Behavioral Therapy Is About Tools

Cognitive behavioral therapy is not a magic bullet for mental illness but it is an assortment of tools that can help you battle the illness every day. It helps you deal with the symptoms that may linger in spite of treatment with medication or while searching for the right medication.

Find out more about cognitive behavioral therapy from Simon Fraser University’s Core Information Document on Cognitive Behavioral Therapy or visiting Healthline’s page on cognitive behavioral therapy.

Source: http://www.healthline.com/health-blogs/bipolar-bites/cognitive-behavioral-therapy-effective-bipolar-disorder

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Free Webinar on the Proposed DSM-V

DSM-IV-TR vs. Proposed DSM-5: Comparison, Implications and Impact

Join NAADAC on February 29, 2012 from 3-4 p.m. EST and earn one continuing education credit. A revised edition of the Diagnostic and Statistical Manual of Mental Disorders will be released in May 2013. This webinar will examine the proposal and let professionals know what to prepare for.

More info: http://www.naadac.org/component/content/article/45-knowledge-center/625-february-2012-dsm-v-webinar

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Grief is a Mental Illness…Really?

By LAUREN PAXMAN

A controversial decision to reclassify grief as a mental illness has been criticised by medical experts.

Should grief be treated like depression?The change in classification was intended to add flexibility to how early people can be treated for depression following the death of a loved one. But it has led to worries that bereaved people will be treated with pills rather than empathy.

An editorial in influential medical journal, The Lancet, argues that grief does not require psychiatrists and that ‘legitimizing’ the treatment of grief with antidepressants ‘is not only dangerously simplistic, but also flawed.’

The unsigned lead editorial reads: ‘Grief is not an illness; it is more usefully thought of as part of being human and a normal response to the death of a loved one.’

The Lancet’s comments follow the American Psychiatric Association’s decision to add grief reactions to their list of mental illnesses in their fifth edition of the psychiatry ‘bible’, Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), which is due out in 2013.

But The Lancet, along with many psychiatrists and psychologists have called for the changes to be halted – saying they would lead to a ‘tick box’ system that did not consider the wider needs of patients but labelled them as ‘mentally ill’.

They agree that in rare cases, bereavement will develop into prolonged grief or major depression that may merit medical treatment. However, they suggested that for the majority of the bereaved, ‘doctors would do better to offer time, compassion, remembrance and empathy, than pills.’

The DSM-5 proposal – which has been opposed by The Lancet’s editorial writers – would eliminate the so-called ‘grief exclusion.’

This ‘exclusion’ means that anyone who has experienced bereavement cannot be diagnosed as depressed for a certain period of time.

In a previous edition, DSM-III, that period of time was set at one year.

The DSM-IV reduced that period to two months and DSM-5 plans to reduce the period to just two weeks.

Although the proposed changes to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) would not directly affect clinical practice here, where doctors tend to use different international guidelines, experts say it would eventually influence research and thinking in the field.

Defending the change in timeframe, Dr. Kenneth S. Kendler, a member of the DSM-5 Mood Disorder Working Group, said it would allow for an earlier diagnosis but would by no means force it.

Simon Wessely, of the Institute of Psychiatry, King’s College, London, said ‘We need to be very careful before further broadening the boundaries of illness and disorder.’

‘Back in 1840 the Census of the United States included just one category for mental disorder.

‘By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.’

Whereas people who are bereaved are currently given help where necessary, in future they might find themselves labelled as having a depressive disorder if their symptoms lasted longer than a certain period of time, he added.

Peter Kinderman, Professor of Clinical Psychology and Head of Institute of Psychology, University of Liverpool, said ‘It will exacerbate the problems that result from trying to fit a medical, diagnostic, system to problems that just don’t fit nicely into those boxes.

‘Perhaps most seriously, it will pathologise a wide range of problems which should never be thought of as mental illnesses. Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labelled as ‘mentally ill’.

Dr. Arthur Kleinman, a Harvard psychiatrist, social anthropologist and global health expert, says that the main problem is the lack of ‘conclusive scientific evidence to show what a normal length of bereavement is.’

According to the Lancet writers, ‘it is often not until 6 months, or the first anniversary of the death, that grieving can move into a less intense phase.’

They added that grieving is individual, shaped by age, gender, religious beliefs and the strength of the relationship with the lost loved one.

Source: http://www.dailymail.co.uk/health/article-2102618/Lancet-urges-doctors-treat-grief-empathy-pills.html#ixzz1mfIHkK3A

Should grief be treated like depression?

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Possible DSM Changes Spark Controversy

By Rick Nauert, PhD – PHD Senior News Editor

Possible DSM Changes Spark ControversyProposed revisions to the Diagnostic and Statistical Manual of Mental Disorders (DSM), the fat text used to help identify and categorize mental illness, are not sitting well with many mental health professionals and the public.

Suggested changes to the definitions of autism spectrum disorders and depression, among others, are eliciting great concerns. And experts say there are larger concerns about the DSM as a whole.

“Almost no one likes the DSM, but no one knows what to do about it,” said University of Michigan psychiatrist Dr. Randolph Nesse.

The current round of revisions is the fifth since the DSM was originally published by the American Psychiatric Association in 1952.

Nesse and University of Cape Town psychiatrist Dr. Dan Stein combined for an article in the current issue of BMC Medicine titled “Towards a genuinely medical model for psychiatric nosology.”

The article provides a candid appraisal of the difficulty of categorizing mental disorders that the authors expect will not make a lot of their colleagues happy.

“The problem is not the DSM criteria,” Nesse said. “The problem is that the untidy nature of mental disorders is at odds with our wish for a neat, clean classification system.”

The proposed abolition of the grief exclusion, for example, in diagnosing major depression is just one example of a push to define psychiatric disorders according to their causes and brain pathology.

“A huge debate over when depression is abnormal seems likely to be resolved by removing the so-called ‘grief exclusion,’” Nesse said. “At the moment, depression is not diagnosed in the two months after loss of a loved one.

“The result of this proposed change would be that people experiencing normal grief will receive a diagnosis of major depression. Doing this would increase consistency in diagnosing depression, but at the cost of common sense. It’s clear that bereavement is not a mental disorder.”

Nesse and Stein point out that the rest of medicine recognizes many disorders that do not have specific causes.

“Conditions such as congestive heart failure can have many causes,” Nesse said. “This doesn’t bother physicians because they understand what the heart is for, and how it works to circulate blood.”

Furthermore, he said, physicians recognize symptoms such as fever and pain as useful responses, not diseases.

“These symptoms can be pathological when they’re expressed for no good reason, but before considering that possibility, physicians look carefully for some abnormality arousing such symptoms,” Nesse said. “Likewise, the utility of anxiety is recognized, but its disorders are defined by the number and intensity of symptoms, irrespective of the cause.

“It’s vital to recognize that emotions serve functions in the same way that pain, cough and fever do, and that strong negative emotions can be normal responses to challenging or anxiety-provoking situations.”

Instead of specific diseases with specific causes, many mental problems are “somewhat heterogeneous overlapping syndromes that can have multiple causes,” Nesse said.

“Most are not distinct species like birds or flowers. They are more like different plant communities, each with a typical collection of species. Distinguishing tundra from alpine meadow, arboreal forest and Sonoran desert is useful, even though the categories are not entirely homogenous and distinct.”

Source: http://psychcentral.com/news/2012/02/16/possible-dsm-changes-spark-controversy/34909.html

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DSM-5 May List Internet Addiction Among Illnesses

By Rheana Murray / NEW YORK DAILY NEWS

Surf the web too much? That might soon land you on a psychiatrist’s couch.

The American Psychiatric Association (APA) is catching heat over proposed amendments to its newest Diagnostic and Statistical Manual of Mental Disorders (DSM) — widely considered the “bible” of psychiatric symptoms in the mental-health industry.

Opponents say the new version would label millions more people as “mentally ill” for conditions such as extreme shyness — and qualify them for psychiatric drugs they don’t need.

“[It’s] hard to avoid the conclusion that DSM-5 will help the interests of the drug companies,” said Allen Frances of Duke University, according to Reuters.

DSM-5, the new mental illness ‘bible,’ may list Internet addiction among illnesses

Internet addiction might be considered a mental illness under proposed revisions to DSM-5, the mental-health industry’s guidebook.

The DSM-5, as the new edition will be called, is scheduled to be released in May 2013, and could list “Internet addiction” among its diagnoses.

The association says it is still considering how to address non-substance-abuse addictions.

“Gambling disorder has been moved into this category and there are other addiction-like behaviorial disorders such as ‘Internet addiction’ that will be considered as potential addictions to this category as research data accumulate,” the APA says on its website.

Experts say lots of the new diagnoses are problematic – like “oppositional defiant disorder.”

“That basically means children who say ‘no’ to their parents more than a certain number of times,” said Pete Kinderman of Liverpool University’s Institute of Psychology, according to Reuters.

“On that criteria, many of us would have to say our children are mentally ill.”

People who are excessively shy could also be diagnosed as mentally ill under the new guidelines, Kinderman said.

Kids’ temper tantrums might be explained by “disruptive mood disregulation disorder,” characterized by temper outbursts that occur at least three times per week.

David Elkins, president of the American Psychological Association’s society for humanistic psychology, helped launch a petition against the new manual, yielding more than 11,000 supporters, according to ABC News.

“Our main concern is that they’ve introduced some new disorders that have never been in a DSM before that we think are not scientifically based,” he said.

“We’re not opposed to the proper use of psychiatric drugs when there’s a real diagnosis and when a child or an adult needs pharmacological interventions,” he said. “But we are concerned about the normal kids and elderly people who are going to be diagnosed with these disorders and treated with psychiatric drugs.

“We think that’s very, very dangerous.”

Dr. Allen Frances, who worked on revisions for the current manual, DSM-4, agrees that the proposed changes are irresponsible.

“You don’t want to be inventing new diagnoses until you’re sure they can be accurately made, effectively treated that the treatments are safe,” said Frances, a psychiatry professor at Duke University, according to ABC News. “None of these conditions is fulfilled in DSM-5.”

“You can’t have one professional organization, like the American Psychiatric Association, responsible for vetting something so important,” he added.

The APA hasn’t commented directly on the backlash, but said in a statement that it considers “input from all sectors of the mental health community a vital part of the process,” according to ABC News.

“We are confident that the DSM-5 will be based on the most reliable scientific and clinical data.”

Source: http://www.nydailynews.com/news/dsm-5-mental-illness-bible-list-internet-addiction-illnesses-article-1.1020979#ixzz1mHYHMxjt

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Not Diseases, but Categories of Suffering

By GARY GREENBERG

Not Diseases, but Categories of SufferingYOU’VE got to feel sorry for the American Psychiatric Association, at least for a moment. Its members proposed a change to the definition of autism in the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders, one that would eliminate the separate category of Asperger syndrome in 2013. And the next thing they knew, a prominent psychiatrist was quoted in a front-page article in this paper saying the result would be fewer diagnoses, which would mean fewer troubled children eligible for services like special education and disability payments.

Then, just a few days later, another front-pager featured a pair of equally prominent experts explaining their smackdown of the A.P.A.’s proposal to eliminate the “bereavement exclusion” — the two months granted the grieving before their mourning can be classified as “major” depression. This time, the problem was that the move would raise the numbers of people with the diagnosis, increasing health care costs and the use of already pervasive mind-altering drugs, as well as pathologizing a normal life experience.

Fewer patients, more patients: the A.P.A. just can’t win. Someone is always mad at it for its diagnostic manual.

It’s not the current A.P.A.’s fault. The fault lies with its predecessors. The D.S.M. is the offspring of odd bedfellows: the medical industry, with its focus on germs and other biochemical causes of disease, and psychoanalysis, the now-largely-discredited discipline that attributes our psychological suffering to our individual and collective history.

This tension has been high since at least 1917. That’s when Thomas Salmon, a future head of the A.P.A. — which was founded in 1844 — noted that psychiatry’s “classification of mental diseases is chaotic.” He worried that “this condition of affairs discredits the science of psychiatry and reflects unfavorably upon our association” and urged his membership to forge a diagnostic system “that would meet the scientific demands of the present day.”

The American Psychiatric Association has been trying to do just that ever since, mostly by leaving behind ideas about the meaning of our suffering in favor of observation and treatment of its symptoms. In 1980, it hit on the strategy of adopting a medical rhetoric, organizing those symptoms into neat disease categories and checklists of precisely described criteria and publishing them in the hefty — and, according to its chief author, “very scientific-looking” — D.S.M.-III.

That book, with its more than 200 objectively described diagnoses, would have made Dr. Salmon proud. By meeting the scientific demands of the day, it was credited by many with having rescued psychiatry from the brink of extinction, and its subsequent revisions have been the cornerstone of the profession’s survival as a medical specialty.

But as all those Diagnostic and Statistical Manuals have stated clearly in their introductions, while the book seems to name the mental illnesses found in nature, it actually makes “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or no mental disorder.” And as any psychiatrist involved in the making of the D.S.M. will freely tell you, the disorders listed in the book are not “real diseases,” at least not like measles or hepatitis. Instead, they are useful constructs that capture the ways that people commonly suffer. The manual, they go on, was primarily written to give physicians, schooled in the language of disease, a way to recognize similarities and differences among their patients and to talk to one another about them. And it has been fairly successful at that.

Still, “people take it literally,” one psychiatrist who worked on the manual told me. “That is its strength in a political sense.” And even if the A.P.A. benefits mightily from that misperception, the troubles on the front page are not the organization’s fault. They are what happens when we expect the D.S.M. to be what it is not. “The D.S.M. has been taken too seriously,” another expert told me. “It’s the victim of its success.”

Psychiatrists would like the book to deserve a more serious take, and thus to be less subject to these embarrassing diagnostic squabbles. But this is going to require them to have what the rest of medicine already possesses: the biochemical markers that allow doctors to sort the staph from the strep, the malignant from the benign. And they don’t have these yet. They aren’t even close. The human brain, after all, may be the most complex object in the universe. And the few markers, the genes and the neural networks, that have been implicated in mental disorders do not map well onto the D.S.M.’s categories.

“We’re like Cinderella’s older stepsisters,” a psychiatrist told me the other day. “We’re trying to stick our fat feet into the delicate slipper so the prince can take us to the ball. But we ain’t going to the ball right now.” Which is why we might feel a little sorry for the beleaguered A.P.A.

On the other hand, given that the current edition of the D.S.M. has earned the association — which holds and tightly guards its naming rights to our pain — more than $100 million, we might want to temper our sympathy. It may not be dancing at the ball, but once every mental health worker, psychology student and forensic lawyer in the country buys the new book, it will be laughing all the way to the bank.

Gary Greenberg, a psychotherapist and the author of “Manufacturing Depression,” is writing a book about the making of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.

Source: http://www.nytimes.com/2012/01/30/opinion/the-dsms-troubled-revision.html?_r=1&emc=tnt&tntemail1=y

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Binge Eating Increasing Amongst Men

Via Scoop.itHealthcare Continuing Education

Writer Ron Saxen says binge eating destroyed his modeling career and relationships before he got help.
Show original

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No Health Without Mental Health

By Thomas R. Insel, MD (NIMH Director)

Mental Health in US

Click to View Mental Health Online CE Courses

Five years ago, Colton and Mandersheid surveyed mortality data from eight states and concluded that, on average, Americans with major mental illness die 14 to 32 years earlier than the general population. The average life expectancy for people with major mental illness ranged from 49 to 60 years of age in the states they examined — a life span on par with many sub-Saharan African countries, including Sudan (58.6 years) and Ethiopia (52.9 years). Average life expectancy in the United States is 77.9 years. It would appear that the increase in longevity enjoyed by the general U. S. population over the past half century has been lost on those with serious mental illness (SMI). In fact, this drop in life expectancy due to mental illness would surpass the health disparities reported for most racial or ethnic groups. Yet this population is rarely identified as an underserved or at-risk group in surveys of the social determinants of health.

Why is there such a profound disparity in life expectancy for those with SMI? Disorders such as schizophrenia, major depression, and bipolar disorder are risk factors for suicide, but most people with SMI do not die by suicide. Rather, the 5 percent of Americans who have SMI die of the same things that the rest of the population experiences — cancer, heart disease, stroke, pulmonary disease, and diabetes. They are more likely to suffer chronic diseases associated with addiction (especially nicotine), obesity (sometimes associated with antipsychotic medication), and poverty (with its attendant poor nutrition and health care) and they may suffer the adverse health consequences earlier.

The risks are striking. People with a mental illness are more than twice as likely to smoke cigarettes and more than 50 percent more likely to be obese compared to the rest of the population. But this only partly explains the premature mortality. Recently, when Druss and colleagues analyzed the early mortality data derived from a nationally representative survey, they found three drivers: clinical risk factors, socioeconomic factors, and health system factors.

The clinical risk factors include the frequent co-occurrence of mental illness with heart disease, diabetes or other medical conditions, generally referred to as “comorbidity.” For example, people with major depressive disorder are at higher risk for cardiovascular disease and stroke. Conversely, for those who have had a heart attack, experiencing depression increases their risk for cardiac-related death three-fold, more than any cardiovascular variable except congestive heart failure. And people with diabetes have double the risk for depression. We do not fully understand the relationship between diabetes or heart disease and depression, but current thinking attributes the increased risk to both depressive behaviors (e.g., poor diet, low activity, low adherence to treatment) as well as some common biology such as elevated inflammatory factors.

While we are still trying to understand the cause of comorbidity between mental disorders and other health problems, the health system factors may offer a better short-term target for change. Few people in the public mental health care system are receiving high quality health care.

The Patient Protection and Affordable Care Act outlines a specific model of integrated care, the patient-centered medical home (PCMH), which could improve access and quality of health care to those with multiple chronic disorders. The PCMH model includes comprehensiveness, holistic patient-centered care, and, emphasis on care in the community. The Centers for Medicare and Medicaid Services has been tasked with piloting a series of PCMHs and studying their impact over the coming years with the goal of wider dissemination in the future. Knowing that people with SMI are a high risk group for multiple chronic disorders and targeting the PCMH for their specific needs could be an effective approach to improving health outcomes for the entire population.

Short of a new health care system, there are models for improving health outcomes for people with mental illness. Collaborative care, in which primary care and mental health providers work closely together to deliver effective treatments within the primary care setting, represents a fundamental change toward addressing mental disorders in conjunction with other physical conditions. Over the past two decades more than 40 research trials have demonstrated the effectiveness of the collaborative care model. In the case of major depression, for example, studies have shown collaborative care programs to be an effective approach for treating depression alongside other conditions, and to be more cost-effective than standard treatment. A recent study indicates that implementing this approach for depression in the Medicare system would result in cost savings of approximately $15 billion annually.

Collaborative care for depression and diabetes or depression and heart disease is the proverbial low hanging fruit. What about schizophrenia and bipolar disorder, which are usually treated in specialty mental health clinics rather than primary care? Is it better to add primary care capacity to the behavioral health center or to integrate patients with SMI into primary care? Can our current system, which separates behavioral health from health care, ever be “equal” in quality or outcomes? These remain research questions of urgent importance.

The unavoidable fact is that we will not improve overall longevity or contain health care costs in this nation without addressing the needs of the nearly 5 percent of Americans with serious mental illness. This is a population that not only dies early; they have multiple chronic diseases requiring expensive care, often in emergency rooms and intensive care units. We need better strategies for dealing with this urgent public health issue and we need to ensure that whether these strategies are collaborative care for depression or an innovative medical home for those with serious mental illness, we implement these interventions where the need is greatest.

Source: http://www.nimh.nih.gov/about/director/2011/no-health-without-mental-health.shtml

 

 

 

 

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Mental Health Medications – Free Guide

Free resource from the National Institute of Mental Health.

This guide describes the types of medications used to treat mental disorders, side effects of medications, directions for taking medications, and includes any FDA warnings.

http://www.nimh.nih.gov/health/publications/mental-health-medications/nimh-mental-health-medications.pdf

Guide to Mental Health Medications

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