Irony in The New York Times

Is it me, or does anyone else find it ironic that The New York Times ran an uncritical appraisal of ECT ("“Shock Therapy Loses Some of Its Shock Value") in the same edition of its Science Section (Sept. 19, 2006) as an article entitled "In Science-Based Medicine, Where Does Luck Fit In?"

Luck has everything to do with ECT, in my opinion. I think it is essentially a crapshoot. I'm not saying that no one benefits: Clearly, many people do. It's even possible that the majority of people do; at least, I have no way of knowing how many people have been helped. But others have their lives blighted due to permanent, sweeping memory loss and cognitive impairment. And there is no way to tell in advance if you will be lucky or unlucky.

According to the National Mental Health Association's position statement (which, in the interests of full disclosure, I should say that I helped to draft), ECT involves "serious risks,"” and the NMHA "“recommends that ECT be presented as an alternative with extreme caution, only after all other treatment approaches, such as medication and psychotherapy, have either failed or have been seriously and thoroughly evaluated and rejected."

Yet the Times piece plays down potential risks and devotes lots of ink to well-known satisfied customers, such as Dick Cavett and Kitty Dukakis; it gives much less space to people whom ECT did not help and, in fact, harmed. It's true that the article quotes Ernest Hemingway, who died by suicide after condemning ECT as "“ruining my head and erasing my memory." But that happened in 1961, and the Times asserts that "ECT today is a far more refined and limited therapy."

With the current state of psychiatric treatment, I would not seek a ban on ECT: Again, there are people who feel it saved their lives after other treatments failed to relieve their symptoms. However, I do believe that those who are contemplating this controversial procedure should have the opportunity for fully informed consent, and this is usually not the case. For example, the information about ECT offered by the American Psychiatric Association on its Web site is misleading in its downplaying of the procedure's risks.

If you want to learn more about ECT, I urge you to visit www.ect.org, a Web site developed by Juli Lawrence after her own experience with ECT. Another place to get information is the Committee for Truth in Psychiatry (CTIP), a national organization of more than 500 former ECT recipients.

During my own struggles with debilitating depression, I never considered ECT; I knew too much about it.

posted by Susan Rogers

Rate This Medication

PsychCentral has added an interesting new element to their website. In the medication library you'll find all the typical information about uses, missed doses and side effects. But, you'll also find user reviews listing pros and cons and general comments about the drugs. Using a 1-10 scale medications are rated overall, for the severity of side effects, as well as by price. It has a lot of potential as a consumer participation site, and I hope that it can be used to learn about real experiences with medications and to provide feedback and advice.

User ratings have been useful to me when making many different types of decisions, some important and others frivolous. What's important to remember though, is that they do have potential to be misleading. If you're using this site, make sure you look at the number of reviews that have been submitted and read through them all to see who's doing the reviewing. Then, if you can, add, add, add. Registration is free, but it is required in order to post and comment.

Voice your opinion in the PsychCentral Medication Library

posted by J. Melinn

The Art of Avoiding Depression

There is an interesting article about depression on PsychologyToday.com. It starts off by pointing out that our technology-saturated culture may play a role in the high rates of depression in our society.

The article goes on to describe that depression, despite being a biological condition, is very much reliant on modern culture. According to the author “the idea that a chemical imbalance causes depression, rather than reflects it, ignores the fact that the brain’s biochemistry responds to our ways of thinking—in short, to life experience.”

This article offers thought-provoking ideas about depression, its causes, and how it can be coped with. Read the full article on MSN.


posted by Christa Andrade

Emotional Support Goats?

An article published some time ago in the New York Times described a growing epidemic: unqualified service dogs.

Back in 2003 the Department of Public Transportation ruled that emotional support animals for people with illnesses like depression and anxiety have as much right on planes as service dogs for people with physical disabilities.

This sounds fair. For individuals who own dogs that are trained to, say, alert others when their owner is about to have a panic attack, this law enables them to travel with their support dog. However, people have begun to exploit the situation by bringing untrained, uncertified “emotional support” animals on planes. What’s more, this phenomenon is spreading to restaurants, retail stores, hotels, and apartments.

According to Beth Landman’s article “Wagging the Dog, and a Finger”, people are bringing all sorts of unqualified support animals, including “monkeys, miniature horses, cats, and even an emotional support duck.” In addition, there have been two instances at airlines of people bringing their emotional support goats along for the trip.

According to Joan Foling, chairwoman of the International Association of Assistance Dog Partners, there is a clear difference between service dogs, which perform physical tasks that their owners are unable to carry out, and emotional support dogs. While emotional support is a very broad term, these support animals should be trained and certified to carry out tasks for their owners which directly help them do things they could not do in their animal’s absence. When it comes to emotional support, the way in which the animals help is harder to define.

Service animals need special training to assist their owners with tasks they are unable to do themselves. Many people are trying to get certifications for their dogs to be service animals, when they have no special training that would merit certification.

The Americans with Disabilities Act strove to put as few regulations on service animals, since there are countless tasks they can complete for the disabled who are unable to do so. Also, animals other than dogs can be trained to help humans. Now, this openness, which was meant to help people with disabilities, is enabling people to certify unqualified service animals.

This practice is not only unfair to people who truly need service dogs to enable them to live independently, it also makes light of mental illness. Using it as an opportunity to bring your pet along on a flight, or to dinner makes mental illness more of an excuse, than a legitimate medical condition.

posted by Chrisa Andrade

“A Day in the Life of Bipolar Disorder” Writing Contest

From the National Council for Community Behavioral Healthcare:

http://www.nccbh.org/SERVICE/bipolar-contest.htm

WHAT: As part of the 2006 World Mental Health Day observation, AstraZeneca Pharmaceuticals is organizing a writing contest among people with bipolar disorder called “A Day in the Life of Bipolar Disorder.” The goal of this contest is to educate on this disease and provide a deeper understanding of what the disease is like from the point of view of those who live with it. How does it impact day-to-day activities? How does it affect relationships? Does it require medications?

Through the entries collected for this contest, and the subsequent educational and promotional opportunities, people will gain a stronger understanding of how this disease impacts individuals in different ways and the range of ways people are coping, surviving, and thriving with it.

WHO: This contest is open to consumers who are living with Bipolar Disorder or to relatives of those individuals.

WHEN: Entries are due into AstraZeneca by September 25. Only winning entries will receive notification by Oct. 2. Award winners may be invited to a special awards presentation and recitation of their winning entry on the AstraZeneca campus on October 10.

WHY: World Mental Health Day (WMHD) occurs during the second week of October each year and is a key activity of the World Federation for Mental Health (WFMH) to help raise awareness about mental health worldwide. AstraZeneca is supporting WMHD 06 as part of its commitment to promoting mental health awareness among consumers.

HOW: Participants must write an original 800-1,200 word essay on what an average day is like living with their disease and sign a written release authorizing AstraZeneca to use their essay in this and future educational and promotional projects.

Check the website for more details http://www.nccbh.org/SERVICE/bipolar-contest.htm

How Skinny Is Too Skinny? Fashion World Draws the Line

http://news.yahoo.com/s/nm/20060912/en_nm/life_spain_models_dc

A top-level fashion show in Madrid has banned too-thin models on the grounds that young women might be influenced by their “rail-thin” appearance to lose an unhealthy amount of weight and possibly to develop an eating disorder such as anorexia or bulimia. Such restrictions have been sought by Spain’s Association in Defense of Attention for Anorexia and Bulimia for several years, so those folks are undoubtedly happy; and a spokesperson for the Association of Fashion Designers of Spain said the group supported restrictions.

However, other fashionistas are not pleased, and at least one modeling agency has called the ban “outrageous” and discriminatory against naturally “gazelle-like” models.

I know that there are beautiful women who were born to sashay down fashion world runways wearing haute couture, and who eat like horses yet never gain an ounce; and, of course, I am sorry for these “gazelle-like” creatures. (Hah!) But I don’t think that banning them from modeling – that is, declining to hire them -- is discriminatory, any more than I think refusing to hire men who are six feet tall and weigh 180 pounds as jockeys is discriminatory. (Actually, I don’t want to get into horseracing since that raises a whole bunch of other ethical questions, but you get the point.) And I know that there are other influences on young women besides the fashion industry that may lead them to develop eating disorders. But I do think that if models were more “Real Women Have Curves” and less “heroin chic,” they would set a better standard for suggestible young women. I’m a big fan of Eileen Fisher clothing ads – not of the clothes, necessarily, but of the ads -- because these ads depict real women -- often identified as women who work outside the fashion industry, such as brain surgeons and rocket scientists -- of all sizes, ages, and colors. Eileen Fisher celebrates diversity and provides great role models!

posted by Susan Rogers

Wow! Only half.

Last week the Justice Department released results of a survey that showed more than half of American prisoners reported mental health problems within the last year. I’m not sure the news comes as news to people who work on the front lines, but it seems to be getting a lot of play and hopefully raising awareness about the need for appropriate mental health services. Below are links to different takes on the story and one to an older PBS article on ways to address the criminalization of people with mental disorders.

Human Rights Watch alert

More reserved article at the Seattle Post-Intelligencer

The study, by the Bureau of Justice Statistics

From PBS last year: “Breaking the Cycle”

Intro:

“Once released from prison, mentally ill ex-offenders are faced with the challenges of reintegrating into their communities. Those who do not make a successful transition relapse and return to prison. But across the country, community groups and prison and mental health officials are working together to break this cycle.”

Full article, including links to information about model programs.

posted by Daniele Sadres

Doughnut Hole Season Is Upon Us

About now, many who chose a Medicare Part D plan earlier in the year are hitting the dreaded doughnut hole in coverage—the point where they must begin paying the total cost for their prescriptions. This occurs when a recipient’s drug costs have reached the limit the plan he or she chose will cover for the year. Below, Jacob Burkett, a lawyer who works as a benefits specialist at the Mental Health Association of Southeastern Pennsylvania, the Clearinghouse’s mother organization, describes in further detail what the doughnut hole is about, why many recipients didn’t see it coming, and what they can do now to mitigate the crisis.

Jake’s Take:
Generally, doughnuts and doughnut holes are not viewed as the wisest approach to your health. Nonetheless, many Medicare Part D plans include them. That’s right; these plans can have huge gaps in coverage, which are referred to as “doughnut holes.” During these gaps in coverage, the consumer is responsible for paying for the entire drug cost in addition to the monthly premiums.

Essentially, it works like this:

• a consumer is enticed to enroll in a plan because it has reasonable co-pays and premiums
• The consumer pays the deductible and begins using the plan to obtain his or her prescription drugs, paying a co-pay each time.
• When the total amount of drug costs reaches around $2,251, the consumer is held responsible for the entire cost of each drug—a 100% co-pay (the “doughnut hole”).
• The consumer is then expected to continue paying 100% out of pocket until total drug spending reaches around $5,100, at which point Medicare will step in and pay 95% of the costs.

Why would consumers knowingly choose a plan that would leave them paying 100% for their scripts? In many instances, Medicare recipients were simply confused. In selecting a plan, they had to choose from dozens. Each plan offered different co-pays, premiums, deductibles, doughnut hole coverage, drug formularies, and network providers. Anyone would find it difficult to consider all six of these factors when selecting a plan and could easily overlook one of them. Many consumers didn’t realize they would reach the coverage gap so quickly, either because they did not know the total costs of their medications or did not realize the amount included funds paid by the plan. And more and more consumers are now becoming aware of their oversight when they are told by their pharmacist they have zero coverage from their plan.

Here is a typical example of the doughnut hole in action: A consumer pays a $25 co-pay for a monthly medication that is $625. The total amount of the drug would be $625 and the coverage gap would be reached after just 4 months. The consumer then must pay for another 4 months at the full price of $625 until the government steps in with catastrophic coverage after costs exceed $5,100. In all, the consumer would end up paying $100 in co-pays under the plan, $2,500 in the doughnut hole, and then $125 after the $5,100 threshold is reached. And, on top of these costs, consumers are expected to continue paying their monthly premium- even when the plan is not paying anything for their medications.

Of course, not all plans are bad. Many plans have provided consumers with significant savings, and some plans do not have any coverage gaps. The problem some consumers have is not knowing what plan best suits their needs. Medicare recipients, or their caregivers, can call Medicare at 1-800-MEDICARE for assistance in selecting a plan. Internet savvy recipients can use the very helpful “Plan Finder” at www.medicare.gov. By investigating all the options, recipients should be able to find a plan that meets their individual needs.

There is still hope for those currently stuck in the doughnut hole. Though they can generally only change plans beginning November 15th, there are places they can turn for help until that point. Consumers can apply for help from drug manufacturer programs that assist those who cannot afford medications. Each plan is different and frequently will only cover specific medications, but it is nonetheless worth a try. To find all these plans, visit:

www.pparx.org

Affected consumers also need to consult their healthcare providers. Many medications should not be abruptly discontinued, so consumers need to inform their providers of any changes. Moreover, their physicians may discuss medication alternatives or even provide samples to get consumers through.

Consumers should also contact their legislative representatives about their predicament. Some states have programs that may cover drug costs in the doughnut hole, like the PACE Program in Pennsylvania. Additionally, calling senators and representatives will let them know that they need to fix Medicare Part D. The links below will provide you with the contact information for your legislators.

http://www.senate.gov/
http://www.house.gov/

The National Coalition of Mental Health Consumer/Survivor Organizations has arrived

Just to prove I'm not too behind...I was going to post this announcement on Monday, but since it's made it's way into my email and alerts three times already today, I thought I better get to it ASAP. The Clearinghouse is very proud to be part of the new National Coalition of Mental Health Consumer/Survivor Organizations. Here's the press release:

WASHINGTON, D.C. (9/6/06) -- Mental health consumer/survivors have formed a national coalition to ensure that they play a major role in the development and implementation of health and mental health care and social policies at the state and national levels.

“The creation of the National Coalition of Mental Health Consumer/Survivor Organizations (NCMHCSO) is a milestone,” said the group’s director of public policy, Lauren Spiro. “The formation of this Coalition takes us to the next level – it enables us to raise our collective voice, based on our experience of mental health recovery, and be heard at the seat of power. The Coalition embraces the disability movement’s motto, ‘Nothing about us without us.’ ” The Coalition will collaborate with other advocacy groups to ensure that consumer rights policies continue to move towards promoting full participation and integration in the community.

The rapidly growing Coalition currently consists of organizations run by consumers representing 28 states and the District of Columbia, including representatives from the three federally funded consumer-run national technical assistance centers: the Consumer Organization and Networking Technical Assistance Center, the National Empowerment Center, and the National Mental Health Consumers’ Self-Help Clearinghouse.

The Coalition supports the efforts of the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to transform the mental health system to one that is recovery-based and consumer- and family-driven, and supports SAMHSA’s consensus statement on recovery (www.mentalhealth.samhsa.gov/publications/allpubs/sma05-4129/). The Coalition proposes a new consensus for the mental health field based on the following principles:

• Recovery is possible for everyone. To recover, we need services and supports that treat us with dignity, respect our rights, allow us to make choices, and provide assistance with our self-defined needs. This range of services must include consumer-run and -operated programs.
• Self Determination: We need to be in control of our own lives.
• Holistic Choices: We need choices, including a range of recovery-oriented services and supports that provide assistance with housing, education, and career development.
• Voice: We must be centrally involved in any dialogues and decisions affecting us.
• Personhood: We will campaign to eliminate the stigma and discrimination associated with mental illnesses.

The Coalition, whose office is in Washington, D.C., received start-up funding from the Washington-based Public Welfare Foundation. For additional information, visit http://www.NCMHCSO.org or call Lauren Spiro, 978-590-2014.

I'm Confused

The Ad Council and the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), which funds the Clearinghouse, have launched a campaign this week to encourage people who are having trouble coping with the psychological effects of last year’s hurricanes to seek mental health services. The campaign will include a series of print, billboard, television and public service ads, which perplexes me a little. I thought mental health services were falling short for people who are already seeking services. Perhaps this is true only in the areas where the hurricanes hit, though I could swear I read something about the demand exceeding the supply in places that took in many of the evacuees. I’m glad to hear that someone is reaching out to people who may need help, but I hope the help really is available. Here’s a link to the story, which includes a national toll-free number people can call for information about local services:

http://www.healthday.com/view.cfm?id=534676


posted by Daniele Sadres

Some Reasons to Discuss Mental Illness with Your College-Bound Kids

I just read this story about an increase in the prevalence of mental illness among college students, which, on the positive side, has coincided with increasing numbers of students —reportedly about 20 percent—seeking counseling. Parents who have mental illness might be especially interested in this article because so many mental disorders seem to run in families and you might want to look out for signs that your child needs support. Also, if I were a parent, I’d definitely discuss drug and alcohol use with my college-bound kids because research indicates these things can trigger illnesses such as bipolar disorder and schizophrenia in people who are predisposed. Here’s a link to the story:

http://www.foxnews.com/story/0,2933,211084,00.html

posted by Daniele Sadres