South Australia will trial a plan to employ forensic mental health staff to better manage people in the state’s court system, in a move designed to alleviate demand on public hospital emergency departments.

The 12-month pilot project, which has been based on the introduction of Court Liaison Services in many states across Australia, and in New Zealand and the United Kingdom, will begin in July.

The Australian Nursing and Midwifery Federation SA branch applauded the move but raised concerns about a severe lack of forensic mental health beds to meet demand.

ANMF SA branch secretary Adj Associate Professor Elizabeth Dabars said if no forensic mental health beds were available, forensic mental health patients will still have to be housed in EDs.

Adj Assoc Professor Dabars said it was unacceptable to leave forensic consumers in EDs when they do not require health care or for periods of more than four hours.

“We are aware of instances of these consumers being accommodated in the emergency department for up to eight days,” she said.

“It is not appropriate to accommodate them in a busy emergency department, and it is unreasonable for other patients attending the emergency department with a medical emergency or condition requiring assessment and treatment.”

Under the trial, two forensic mental health staff will provide advice to the courts on the appropriate assessment, treatment and management of forensic mental health consumers.

The role will include providing advice about the relationship between mental illness, crime and violence, and the staff will also act as a liaison between the consultant and the courts, the Corrections Department,

Article source: http://www.ncah.com.au/news-events/forensic-mental-health-staff-trial-aims-to-assist-eds/1776/

Thousands of new mothers have mental health problems according to a new study. Source:Supplied

THOUSANDS of Australian babies are being born to mothers with mental health problems, according to research which highlights the need for early intervention and support.

The biggest problems are drugs and alcohol, followed by stress-related disorders, says Dr Melissa O’Donnell, whose team studied the prevalence of mental disorders in parents before the birth of a child.

Parents’ mental health problems can have major negative implications for children, their research report says.

It is important for parents to seek treatment and support to alleviate their symptoms and reduce the impact on their children and families, Dr O’Donnell says.

“The majority of disorders are treatable,” she said.

The researchers found the prevalence of prior mental health disorders in mothers increased from 76 per 1000 births in 1990 to 131 per 1000 births in 2005.

Among fathers, it increased from 56 per 1000 births to 88, their report in the latest issue of the Medical Journal of Australia says.

The research was conducted in Western Australia, but Dr O’Donnell says the results would be similar throughout the country, where about 300,000 births are registered a year.

The proportion of Aboriginal children born to mothers with a prior mental health disorder is more than double the number for non-Aboriginal children, the research found.

Children of mentally ill mothers are at risk of developing their own mental health issues and problems with language development, behaviour and physical health.

Dr O’Donnell says mental disorders also put expectant mothers at greater risk of post-natal depression.

She says a growing awareness of mental health issues could have affected the data in the research.

“More parents are becoming aware and are seeking help.”

She says screening of mothers through the National Perinatal Depression Initiative has also been helpful.

“The rollout of that program has been very important.”

Article source: http://www.heraldsun.com.au/lifestyle/thousands-of-new-mums-face-mental-illness/story-fni0d7e4-1226646375893

The field of mental health will face its greatest upset in years on Saturday with the publication of the long-awaited and deeply-controversial US manual for diagnosing mental disorders.

Early drafts of the book, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, have divided medical opinion so firmly that authors of previous editions are among the most prominent critics.

Known informally as the psychiatrists’ bible, the $199 tome from the American Psychiatric Association is the guidebook that US doctors will use to diagnose mental disorders. The latest edition is the first major update in 20 years.

Though not used in the UK, where doctors turn to the World Health Organisation’s International Statistical Classification of Diseases (ICD), the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.

Criticisms have come from almost every corner. There are claims of expansionism, with common experiences and behaviours becoming newly medicalised. Temper tantrums become disruptive mood dysregulation disorder (DMDD); grief becomes major depressive disorder (MDD), according to Allen Frances, an American psychiatrist who chaired the task force behind the fourth edition of the manual. Other behaviours get their own labels: overeating becomes binge eating disorder; keeping too much junk, a hoarding disorder; a bit forgetful could be mild neurocognitive disorder.

David Clark, professor of experimental psychology at Oxford University, said mental health disorders are often hard to divide into clear categories, because too little is known about them, and there can be major overlaps. But the definitions are often valuable. For example, greater distinctions between various types of anxiety have led to more specific and effective treatments, he said.

Nick Craddock, professor of psychiatry at Cardiff University, and director of the National Centre for Mental Health in Wales, said some of the stranger aspects of the US manual will have no impact in Britain. But he said DSM-5 was flawed because definitions of disorders were sometimes changed on the basis of too little fresh scientific evidence.

“I don’t believe the science has advanced sufficiently in 20 years since DSM-4 to warrant making a new system,” he said. “That essentially is just a group of people agreeing on tweaking things and making them a little bit different. That to me is not a very helpful stage in the develop of psychiatric diagnosis. This is the wrong time in history to change the diagnostic system. ”

Changing the definitions of disorders alters who has them. That affects who gets drugs and other support, and who interventions are trialled on. If the criteria for attention deficit hyperactivity disorder (ADHD) are broadened, then more people are likely to be diagnosed with the condition.

The arrival of DSM-5 will mark the end of Asperger’s syndrome in the US.

Along with some other autism-related conditions, Asperger’s will now be consumed by the new category of “autism spectrum disorder”.

Some people diagnosed with Asperger’s are unhappy about the coming change. Carol Povey, director of the National Autistic Society‘s Centre for Autism, said: “The term Asperger Syndrome is a core part of their identity for many people and they understandably feel anxious about moves to remove the term. The changes won’t prevent people from continuing to use it to define themselves and nor should it,” she said.

Debbie Tucker, chair of the Asperger’s Syndrome Foundation, said the label can be useful in treating people, but that some did not want to be labelled. “Labels only become unhelpful and sometimes dangerous if used to discriminate. People with Aspergers are vulnerable to this,” she said.

Last month, Thomas Insel, director of the National Institute of Mental Health, declared that the organisation would not use DSM-5 definitions to set its research priorities. Writing about DSM-5 on his blog, he said: “The weakness is its lack of validity. Unlike our definitions of ischaemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” Instead, he said the NIHM would lay the foundations for a new classification system, based on brain imaging, genetics, cognitive science and other research.

“We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response,” he said.

guardian.co.uk © Guardian News and Media 2013

[Human brain image via Shutterstock]

Article source: http://www.rawstory.com/rs/2013/05/18/fifth-edition-of-diagnostic-and-statistical-manual-of-mental-disorders-published/

South Eastern Sydney Medicare Local (SESML) has signed an agreement with New Zealand-based clinical software developer HSAGlobal to use its HSAGlobal’s Collaborative Care Management Solution (CCMS) to manage two of its mental health programs.

CCMS is used in several of New Zealand eHealth projects, including as the software for the National Health IT Board’s shared care plan program, developed in association with the three Auckland regional District Health Boards (DHBs).

It is also the collaborative care platform for Project Chain in Canterbury, an integrated primary, secondary and community care program designed to create shared care plans for patients with multiple chronic conditions.

In Australia, CCMS has been used to develop a client and clinical management system for Victorian-based early childhood and parenting centres QEC and Tweddle, as well as the Latrobe Community Health Service’s (LCHS) mobile wound care project.

SESML has signed up to use CCMS to manage its Access to Allied Psychological Services (ATAPS) and Partners in Recovery programs to deliver better coordinated care across the primary, acute and community healthcare sectors.

SESML recently received its funding approval for the $549.8 million Partners in Recovery program, which is being coordinated through the 61 Medicare Locals. It aims to better support people with severe and persistent mental illness with complex needs and their carers and families.

“HSAGlobal has worked with a number of organisations to deliver integrated care and we feel confident that they have the experience to support us with both their consulting and project management expertise and their software as we improve health service integration in our area,” SESML CEO Lynelle Hales said in a statement.

“CCMS is designed to support this integration, with multiple healthcare providers being able to share information about a client’s care and contribute to a shared plan. We see a real advantage to our clients in having all members of their care team working from the same plan and being able to communicate and collaborate securely and in real time.”

Pulse+IT understands that a number of other Medicare Locals are also in discussion with HSAGlobal to use CCMS for a number of shared care programs.

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Article source: http://www.pulseitmagazine.com.au/index.php?option=com_content&view=article&id=1434:hsaglobal-signs-first-medicare-local-for-mental-health-management&catid=16:australian-ehealth&Itemid=327

In the new psychiatric manual, the DSM-5, irritable children who throw frequent temper tantrums can be diagnosed with disruptive mood dysregulation disorder.

CREDIT: Oleg Kozlov | Shutterstock

With the release of the latest edition of the mental health manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM), LiveScience takes a close look at some of the disorders it defines. This 10-part series asks the fundamental question: What is normal, and what is not?

As of May 22, many mental disorders will never be the same. The full nature of the changes — some quite controversial —will become apparent with the publication of the latest edition of the mental health manual that classifies these disorders.

This guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is an influential document. By setting forth the criteria used to diagnose disorders, it draws the line between what is normal and what is not. This diagnostic line can have many implications for people’s lives; for instance, a diagnosis based on its criteria can determine whether or not someone qualifies for special education services or disability benefits.

The high stakes, in combination with the complexity and mysteries of the human mind, makes revising this manual a challenging project, to say the least, and likely to generate heated controversy, which it has. [The 10 Most Controversial Psychiatric Disorders]

Keeping up with the times

Work on the latest edition, the fifth, began in 1999. Among the host of changes the new DSM-5 contains, some have sparked considerable discussion before its release at the annual American Psychiatric Association (APA) meeting Saturday (May 18) and subsequent official releaseon May 22.

First published in 1952, the DSM has periodically been reviewed and updated by the APA, with the last major revision completed about 20 years ago.

“Since that time, there has been a wealth of new research about mental disorders,” David Kupfer, chairman of the DSM-5 task force and a professor of psychiatry at the University of Pittsburgh School of Medicine, told LiveScience in an email. “Many of the changes in DSM-5 were made to better characterize symptoms and behaviors of groups of people who are currently seeking clinical help but are not well defined by DSM-IV,” Kupfer said, referring to the predecessor to DSM-5.

Psychiatric controversies

Before its publication, word of changes in the DSM-5 attracted no shortage of critics.

Among the flashpoints: Asperger’s disorder will be folded into autism spectrum disorder; grief will no longer exempt someone from a diagnosis of depression; irritable children who throw frequent temper tantrums can be diagnosed with disruptive mood dysregulation disorder. [Hypersex to Hoarding: 7 New Psychological Disorders]

One prominent critic has been Allen Frances, a professor emeritus of psychiatry at Duke University who chaired the DSM-IV task force.

Frances charges that through a combination of new disorders and lowered thresholds, the DSM-5 is expanding the boundaries of psychiatry to encompass many whom he describes as the “worried well.”

Diagnostic inflation?

The problem is that the manual has become too important; the diagnostic criteria carry too much responsibility, creating enormous pressure for expansion, Frances argues. For instance, a diagnosis of autism, or some other disorder, can entitle a student to special services. As a result, there is tremendous pressure to diagnose vague cases, Frances said.

News that the DSM-5 would fold Asperger’s disorder into autism spectrum disorders has raised concerns from families and advocates that some people might lose their diagnosis, and as a result, services.

“My contention is this system, without anyone really noticing it, has gotten out of control and it is diagnosing many of the worried well,” he told LiveScience, adding that as a result, these new patients are prescribed drugs that have the potential to cause harm.

The architects of the DSM-5 have disputed charges such as Frances’. In a Medscape Psychiatry article published in June, Kupfer called charges that changes in the DSM-5 will lead to more people being diagnosed with mental disorders as “patently wrong.”

“We sought to be conservative in our approach to revising DSM-5. Our work was aimed at more accurately defining mental disorders that have a real impact on people’s lives,” Kupfer told LiveScience in an email, adding that based on field trials and analyses of the changes, the task force does not expect to see more people receiving diagnoses.

He noted that DSM-5 includes approximately the same number of disorders as DSM-IV. (While some new disorders have been added, some have been combined or eliminated. Critics argue the additions will increase the diagnosis of disorders more than the other changes will decrease it.)

Setting the threshold

More than 46 percent of the U.S. population will meet the criteria for at least one DSM-IV diagnosis during their lifetimes, according to research by Ronald Kessler, a professor of health care policy at Harvard Medical School, and colleague Philip Wang published in 2008 in the Annual Review of Public Health.

When told this rate seemed high, Kessler said, “Here’s something even more shocking: 99.9 percent of the U.S. population has had a physical health problem in their lives. …There are all kinds of stuff that count as physical illness. That doesn’t mean you’re at death’s door.” (Kessler was not involved in the revisions to the DSM.)

The heaviest burden of mental illness falls on a small proportion of the U.S. population —about 6 percent of people in a given year —whose mental illnesses, such as schizophrenia or major depression, impairs them to the point that they can’t hold down a job, become suicidal or become socially isolated, for example, according to other research Kessler has published in the Archives of General Psychiatry in 2003.

Milder, less debilitating cases are more common; however, even these cases are associated with an increased risk of long-term problems compared with people with no diagnosis at all, Kessler and colleagues write in a 2003 paper that argues against the elimination of mild cases from the DSM.

Establishing psychiatric diagnoses is challenging because they rely on symptoms. “It’s not like you can look under a microscope,” Kessler said.

So, setting a threshold for a diagnosis can be somewhat arbitrary.

“At a certain point, you can say everybody’s sick,” he said. “The question is, where do you draw the line.”

Follow us @livescience, Facebook  Google+. Original article on LiveScience.com.

Article source: http://www.livescience.com/34496-psychiatric-manual-stirs-controversy.html

A national survey conducted by youth mental health organisation Inspire Foundation, questioned more than 3000 people under 25 years of age.

It found 75 per cent of participants were experiencing high to very high levels of psychological distress when they visited Inspire’s website, ReachOut.com, yet 60 per cent of them had never accessed professional help.

Inspire Foundation CEO Jonathan Nicholas said it was important for young people to have an anonymous, non-confronting place they could trust at any time and the internet provided this.

“Young people sometimes may not recognise that they need help,” he said.

“Asking for help may feel uncomfortable, or they may not know where to find help or what to expect from the range of services that are out there.”

Despite the site being the first port call for the majority of youth, the survey revealed 41 per cent were more likely to seek professional help after visiting the site.

The Foundation says the website is particularly popular with young people identifying as lesbian, gay, bi-sexual or transgender which made up almost one quarter of ReachOut.com’s users.

To get a copy of the full report visit:

http://inspire.org.au/young-people-go-online-for-help-during-tough-times/

Article source: http://www.probonoaustralia.com.au/news/2013/05/youth-reach-out-mental-health-help-online

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the “pop-a-pill” culture worse.

Says a former leader of the group: “Normal needs to be saved from powerful forces trying to convince us that we are all sick.”

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It’s the manual’s first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

• Two new books by mental health experts, “Saving Normal” and “The Book of Woe,” say the world’s most widely used psychiatric guide has lost credibility.
• A British psychologists’ group is criticizing the DSM-5, calling for a “paradigm shift” away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.
• Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity.

This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

The manual’s release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

“Way too much treatment is given to the normal `worried well’ who are harmed by it; far too little help is available for those who are really ill and desperately need it,” Dr. Allen Frances writes in “Saving Normal.” He is a retired Duke University professor who headed the psychiatry group’s task force that worked on the previous handbook.

He says the new version adds new diagnoses “that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders.”

Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual – including autism, attention deficit disorder and bipolar disorder – and billions of dollars spent each year on psychiatric drugs.

The group’s 34,000 members are psychiatrists – medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

The most contentious changes include:

• Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one’s death. Major depression is typically treated with antidepressants.
• Calling frequent, extreme temper tantrums “disruptive mood dysregulation disorder,” a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.
• Diagnosing mental decline that goes a bit beyond normal aging as “mild neurocognitive disorder.” Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize “senior moments.”
• Calling excessive thoughts or feelings about pain or other discomfort “somatic symptom disorder,” something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness.
• Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they’re alone and then feel guilty about it.
• _ Removing Asperger’s syndrome as a separate diagnosis and putting it under the umbrella term “autism spectrum disorder.”

Dr. David Kupfer, chairman of the task force that oversaw the DSM-5, said the changes are based on solid research and will help make sure people get accurate diagnoses and treatment.

Dr. Jeffrey Lieberman, the psychiatry association’s incoming president, said challenging the handbook’s credibility “is completely unwarranted.” The book establishes diagnoses “so patients can receive the best care,” he said, adding that it takes into account the most up-to-date scientific knowledge.

But Insel, the government mental health agency chief, wrote in a recent blog posting that the guidebook is no better than a dictionary-like list of labels and definitions.

He told The Associated Press he favors a very different approach to diagnosis that is based more on biological information, similar to how doctors diagnose heart disease or problems with other organs.

Yet there’s scant hard evidence pinpointing what goes wrong in the brain when someone develops mental illness. Insel’s agency two years ago began a research project to create a new way to diagnose mental illness, using brain imaging, genetics and other evolving scientific evidence. That project will take years.

The revisions in the new guide were suggested by work groups the psychiatric association assigned to evaluate different mental illnesses and recent research advances. The association’s board of trustees decided in December which recommendations to include.

Advocacy groups have threatened Occupy-style protests and boycotts at this week’s meeting.

“The psychiatric industry, allied with Big Pharma, have massively misled the public,” the Occupy Psychiatry group contends. Organizers include Alaska lawyer Jim Gottstein, who has long fought against overuse of psychiatric drugs.

The new manual “will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication,” says the website for the Committee to Boycott the DSM-5, organized by New York social worker Jack Carney.

Committee member Courtney Fitzpatrick, whose 9-year-old son died seven years ago while hospitalized for a blood vessel disease, said she has joined support groups for grieving parents “and by no means are we mentally ill because we are sad about our kids that have died.”

Gary Greenberg, a Connecticut psychotherapist and author of “The Book of Woe,” says pharmaceutical industry influence in psychiatry has contributed to turning normal conditions into diseases so that drugs can be prescribed to treat them.

Many of the 31 task force members involved in developing the revised guidebook have had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock.

Group leaders dismiss that criticism and emphasize they agreed not to collect more than $10,000 in industry money in the calendar year preceding publication of the manual.

___

Online:

American Psychiatric Association: http://www.psych.org

Occupy Psychiatry: http://occupypsychiatry.net

Committee to Boycott the DSM-5 : http://boycott5committee.com

___

AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner

Article source: http://www.huffingtonpost.com/2013/05/15/dsm-5-mental-health-psychiatric-manual-_n_3281434.html

What most concerns you about the way we work with autistic children today?

I’m really concerned about getting people on the higher end of the spectrum good jobs. Autism is a very diverse disorder ranging from someone who remains nonverbal with a very severe handicap to mild autism. And really, half the people in Silicon Valley have got some mild autism.

But I’m seeing too many kids today that are really talented and on the high end of the spectrum kind of going nowhere because their skills haven’t been developed. They haven’t learned how to work. When I was 13, I had a sewing job and when I was 15, I cleaned horse stalls.

Do you think the label of autism is hurting these kids, making them feel they are limited in a way that someone without the diagnosis might not be?

I think sometimes parents and teachers fail to stretch kids. My mother had a very good sense of how to stretch me just slightly outside my comfort zone. No surprises. You can’t chuck them in the deep end of the pool, that doesn’t work but she kind of just knew, you know, to get me to do things, like serve hors d’oeuvres at my mother’s parties and just bow and shake hands with the guests.

You write a bit about the controversy over how to define autism and how it has changed over the years in psychiatry’s diagnostic book, the DSM.

It’s not like having a diagnosis for tuberculosis. In fact, when I worked on the [part of the book about the] history of the DSM and I saw how it was laid out, how it changed over the years, it’s really pretty shocking. It’s probably half-based in science and half-based in doctors sitting around a conference room table in a hotel squabbling.

Do you think there is more autism now than there used to be or are we just better at recognizing it?

I think on the mild end of the spectrum most of it’s increased detection because I’ve worked with so many folks my age that I know are on the spectrum that are undiagnosed. And I think there’s some mental retardation—what used to be labeled mental retardation— that has gotten labeled autism. But I think there’s some actual severe autism that actually has increased.

Sensory issues, like being disturbed by sudden, loud noises or itchy clothing are a big part of your experience as an autistic person. Why do you think sensory issues have not received as much study as other aspects of autism?

I think that’s extremely important. They’re all extremely variable from nuisances to being completely debilitating and they can affect all levels of the spectrum. One kid will have a sensitivity problem with the flicker of fluorescent lights and you can get that problem in some dyslexics, [and in] some [with] ADHD, or a kid might have a problem with loud noise like in the cafeteria, or he might have problems with scratchy clothes. It’s extremely variable.

Do you think sensory issues are at the root of what makes autistic people different?

I think the core criterion is the social awkwardness, but the sensory issues are a serious problem in many, many cases of autism and they make it impossible to operate in the environment where you’re supposed to be social. How can you be social if you can’t tolerate those five TVs that are in that bar?

Are the social problems a consequence of kids tuning out very early on because they are overwhelmed?

That might contribute to it [and] I think my top priority for research is sensory. We need to find some good treatments.

What helps you to cope?

My problems are sort of more on a nuisance level. I can’t stand scratchy clothes, I’ve got to have soft kinds of cotton against my skin and I don’t know why some 100% cotton t-shirts itch and others don’t, it has something to do with the weave. I make sure I wash all the underwear that goes against my skin before I wear it, however I wear it inside out.

And then on noise sensitivity, one of the best ways to try and desensitize that is to have a child initiate the sound. Like one of the bad ones is the buzzer on the scoreboard in the gym so have a child go in the gym and turn it on, maybe with headphones on first, then gradually take the headphones off and he initiates the sound — that helps. Start the sound really faint[ly] and then gradually make it louder. That’s another thing you can do.

Tell me about what it’s like to be a visual thinker.

My mind sort of works like a search engine. You ask me something and I start seeing pictures. Why don’t you ask me a key word, something that’s not in the hotel room and not something common like house or car and I’ll tell you how my mind accesses the information?

How about a thermometer?

I’m seeing a big thermometer that we had outside our window of my childhood house. I’m seeing a thermometer that a poster has been painted to show how much money has been given to United Way. Now that’s got me off the subject of thermometers and now I’m thinking about charities and each one of those things is coming up as a picture.

You had your brain scanned, which must be a pretty scary and difficult experience.

I’ve been in scanners a whole bunch of times and they do give you earplugs since it’s quite noisy, but getting the pictures is just really fascinating.

The scan done out in Utah showed that in the parietal area of my brain, [much of it has been taken over by a large fluid filled cavity], my math department’s full of cerebral spinal fluid. That would account for [my] being bad in math. Then I also have some huge gigantic visual circuits. That would explain my visual thinking.

Of course, that I really found fascinating. The fusiform gyrus, the circuits involved with face recognition — those [were] abnormal and then another finding was that my amygdala, the fear center, was much larger than normal and that probably explains why I was so anxious and had so many panic attacks, although now I control them with anti-depressants.

You have often pointed out the strengths of the autistic mind, while many people focus only on deficits.

There definitely are some strengths. You see, there’s a point where mild autism is just a personality variation. There’s no black and white dividing line between autism and non-autism from the mild end of the spectrum. And some people on the mild end of the spectrum have extreme talent areas in things like computer programming, mathematics, art, design, graphics, writing skills, and I’m a big believer on building on the child’s strengths.

Do you think if people try to get rid of “autistic genes” those talents would be lost?

You’ve got to think about it. Who do you think made the first stone spear? It certainly wasn’t the social yakkity yaks around the campfire and you wouldn’t even have a recording device to record this conversation on if there wasn’t somebody mildly on the autism spectrum that invented it.

Article source: http://healthland.time.com/2013/05/16/qa-temple-grandin-on-the-autistic-brain/

Selenia Velez remembers the near daily phone calls from the pre-school, alerting her that her 2-year-old son had acted out aggressively and needed to be picked up immediately.

The calls went on for months, as Velez, 27, of Hartford, and her husband bounced between the pre-school and their son’s pediatrician, who recommended that they take him to a psychiatrist for an evaluation. But the psychiatrist was booked and held them at bay, as Velez watched her son’s behavior deteriorate.

“We just felt hopeless,” the mother of four recalls of her oldest son, now 7. “It was one of the most heartbreaking things you can go through as a mother. I was scared of him – I just didn’t know what was going on – and no one had answers.”

The situation is not unusual in Connecticut, where pediatricians too busy to do their own mental health evaluations refer children to child psychologists, who are in short supply. Gaps in the mental health screening and treatment of youths have become a focus of policy makers since 20-year-old Adam Lanza opened fire in December at Newtown’s Sandy Hook Elementary School, killing 20 children and six adults.

The American Academy of Pediatrics, citing the need for early intervention, has recommended routine mental health screening, using formal screening tools, for all children and adolescents. In addition, Medicaid rules require that states conduct comprehensive health screenings of Medicaid-insured children that include an assessment of mental health.

But data obtained by C-HIT indicates that only a fraction of children enrolled in the state’s Medicaid program receive a formal behavioral health screening.

In the first six months of last year, fewer than 5 percent of more than 180,000 children ages 4-19 continuously enrolled in the Medicaid program received specialized mental health screenings, according to billing data coded for behavioral screens. The number was highest for 4 and 5 year olds – 1,198 screenings, or 8 percent of the estimated visits over six months – dropping to fewer than 4 percent for children ages 9-14, and less than 3 percent for youths ages 15-19. The data do not include instances where providers might conduct screenings but not code or bill for them.

A 2003 study found that Connecticut was among 35 state Medicaid programs that lacked specialized screening tools for children’s mental health, instead relying on broad screens of physical and developmental issues that briefly addressed mental health. Studies indicate that use of formal tools is better than subjective surveillance in detecting problems. But Medicaid overseers do not specify what qualifies as a mental health assessment, leaving that up to states.

In 2012, the U.S. Government Accountability Office (GAO) found that nationally, 80 percent of children with a potential mental health need did not receive any psychosocial therapy, and over 70 percent did not have any mental health office visits.

In Connecticut, the Center for Children’s Advocacy and other organizations have been lobbying the state Department of Social Services, which oversees Medicaid, to mandate formal mental health screenings at all annual check-ups. Such a requirement already is in place in Massachusetts, where a 2006 court decision mandated that the state Medicaid program conduct regular mental health screenings of children under 21, using standardized screening tools, during well-child visits.

“I think the time is right for this in Connecticut,” said Jay Sicklick, deputy director of the Center for Children’s Advocacy. “We have an infrastructure that can support it,” referring to the Connecticut Behavioral Health Partnership, a state effort to forge a network of community providers serving Medicaid populations.

Some pediatric practices already do routine screenings for mental health.  A handful are piloting a more extensive evaluation – a “mid-level developmental assessment” — in collaboration with the Child Health and Development Institute (CHDI) of Connecticut. At Pediatric Associates of Bristol, on-site mental health professionals from Wheeler Clinic work with pediatricians to assess children and provide services.

At the Village for Families & Children in Hartford, staff members conduct behavioral health assessments of children who have been red-flagged in initial screenings, then provide on-site services or case management for families.  Yale-New Haven Hospital’s pediatric primary care center has a similar program.

“It’s very different from what usually happens, where you might have families waiting a year to 18 months for an evaluation,” said Kim Martini-Carvell, senior director of early childhood and family development programs at the Village. “We’re able to connect most of our kids with services within weeks.” Only about one-fifth of children need to be referred on for further mental health assessments, she said.

Velez considers herself one of the “lucky” parents who didn’t have to face a long wait to figure out what was wrong with her son and get him help. After getting “the run-around” from a psychiatrist recommended by her pediatrician, Velez took her son to the Village, where he was evaluated, treated and placed in a special pre-school program. He is now in first grade at a magnet school, “doing amazing,” Velez said.

Child development experts say that while screening is essential to early identification, it has to be part of a larger effort to expand access to care.

“We need primary-care providers to take on more of children’s mental health needs,” said Lisa Honigfeld, vice president for health initiatives at CHDI. “(But) the real issue for them is, ‘what am I going to do with the kids I screen if I find something?’

“The story here is not just the low rate of screening being done. It’s the lack of opportunities to connect kids to services.”

CHDI has been working to match-up pediatric practices with mental health providers – such as the Bristol practice and Wheeler clinic – in an effort to “get pediatricians comfortable with doing screenings and medication management, where needed,” with support from mental health professionals.

Honigfeld said the child behavioral health system in Connecticut remains fragmented – so much so that CHDI has identified pediatric practices that are “literally across the street from mental health facilities” and not collaborating. To fill the gaps, “We need more providers who are trained in early-childhood mental health issues,” she said.

Barbara Ward-Zimmerman, a child and adolescent psychologist who helped to establish the Bristol pediatrics-Wheeler Clinic collaboration, now assists other pediatric practices in developing mental health screening programs, in collaboration with community providers. More than 60 percent of children who screen positive for a mental health issue at Bristol Pediatric Associates are able to receive follow-up care in-house from a Wheeler psychologist and practice physicians, rather than face referrals.

“The pediatric office is the ideal setting to catch a lot of these kids” with anxiety, depression, ADHD and other disorders, Ward-Zimmerman said. “With half of pediatric office visits addressing behavioral health issues anyway, we are saying, ‘formalize the screening, identify the issue, integrate the care.’” She said formal screenings can be less time-consuming than subjective questioning of families and children.

In Massachusetts, Medicaid screening rates have risen from 15 percent to 65 percent, according to the most recent data. Every child who is found to have a potential mental health condition must be either treated by the primary-care provider or referred to a mental health professional for an evaluation.

Massachusetts has expanded its home-based and community mental health services to try to accommodate children identified through screening, although a 2012 report found that many families still cited long waits for treatment. The state also has a Child Psychiatry Access Project consisting of regional teams of child psychiatrists and care coordinators available for telephone consultations with pediatricians about mental health problems, including the prescribing of psychotropic drugs. Connecticut is considering a similar program.

While federal Medicaid officials haven’t required states to adopt formal screening, they issued an “informational bulletin” to states in March that stressed: “Numerous validated screens are available for use by medical professionals, and extensive research has proven them effective.”

Honigfeld and other child advocates say that while formal screening is important, it is pointless without expanding treatment options. Connecticut has a shortage of child psychiatric specialists, and services are “very splintered,” Honigfeld said.

A 2010 statewide survey found that 84 percent of Connecticut pediatric providers cited a lack of psychiatric specialists as a barrier to referrals. Earlier this year, Dr. Yann Poncin, medical director of the Children’s Psychiatric Inpatient Service at Yale-New Haven Children’s Hospital, testified to a legislative committee that the hospital’s emergency room was “flooded with children sent to us by schools, families and the police for psychiatric evaluations.” At times, he said, “we admit children who require acute psychiatric care to medical pediatric floors as they await a bed in a psychiatric unit” – a practice he called “unacceptable.”

In January, the state Office of the Healthcare Advocate issued a report deeming the mental health system “fragmented” and the workforce “insufficient.”

At Pediatric Associates of Bristol, Dr. Julie Schiff said she understands the reluctance of some pediatricians to take on mental health screening and triaging – especially given the shortage of psychiatrists available for referrals. But she said the practice’s physicians, who work closely with Wheeler specialists, are comfortable handing some behavioral health problems.

“Co-locating (behavioral health) in primary care has worked well for us,” she said. “The anxiety about, ‘what do I do with a positive screen?’ isn’t an issue, once you know there are resources there.”

Honigfeld said she is hopeful that more pediatric providers will take on basic mental health screenings and follow-up.

“We need primary-care providers to work at the top of their license and save those scarce (psychiatric) resources for kids who need them,” she said.

Article source: http://nhregister.com/articles/2013/05/06/news/doc5187c7d8a1847946340188.txt

Jimmy Anderson / Getty Images

Questions about alcohol use should be a part of regular physical checkups, according to a panel of experts.

About 21% of American adults admit that they engage in risky drinking behaviors, from overindulging, which can lead to physical and mental harm, to alcohol dependence. And it remains the third leading cause of preventable death in the U.S.

So in an effort to address the risk, a government-backed advisory panel–the U.S. Preventive Services Task Force (USPSTF)–reviewed the existing data to determine whether more rigorous screening could identify and intervene in more cases of potential alcohol abuse.

The task force members analyzed results from trials that randomly assigned adults, adolescents, and pregnant women to different screening and behavior counseling strategies for alcohol misuse between 1985 and 2011. They also studied systematic reviews of the impact of alcohol screenings that were published between 2006 and 2011.

Currently, the majority of pediatricians and family caregivers say they provide alcohol prevention services to adolescents, but not to most adults on a consistent basis. Doctors may feel they don’t have time to ask about and provide information concerning alcohol misuse, and many may not be familiar with screening tools meant to pick up problem drinking. And even if they are able to identify patients who need counseling, many doctors may lack the necessary training to properly advise patients.

However, based on the findings from their review, the researchers concluded that doctors should screen all adults ages 18 an older, including women who are pregnant, in order to identify more people who have problems with alcohol. The existing data, the panel determined, supported the benefits of finding these high risk people and providing them with proper treatment or counseling to prevent more serious alcohol abuse.

“Nearly 30% of adults drink more alcohol than is considered healthy and there are serious consequences for themselves, their families, and their communities. For example, alcohol misuse contributes to more than 85,000 preventable deaths each year,” says task force member Sue Curry, Dean of the College of Public Health at the University of Iowa.

She and her colleagues determined there was enough evidence to suggest behavior counseling interventions to reduce weekly drinking, as well as to limit drinking in the long-term and discourage binge drinking. Some of these counseling methods included stress management as well as drinking diaries, and face-to-face sessions or written self-help literature.

According to the researchers, the most effective behavioral interventions took no more than 10 to 15 minutes, and were delivered by the clinician and another nurse or provider.

The recommendation for widespread alcohol screening updates the USPSTF’s 2004 advice, and included a more detailed definition of alcohol misuse. The task force members expanded the scope of alcohol misuse to include any pattern of drinking — from risky binge drinking to dependence –  that interfered with an individual’s ability to meet their responsibilities.

“As an update to our 2004 recommendation, [the recommendation] will reinforce to providers that they can affect patients’ lives for the better by asking them a few simple questions and offering counseling to those who drink more alcohol than they should,” says Curry.

Ironically, while pediatricians and family physicians currently focus on providing alcohol screening for adolescents since teen drinking is a serious issue, there was not enough evidence to support screening for this group.

But expanding testing could help to lower  prevalence of dangerous drinking behaviors and associated harms, say the task force members. So far, the data aren’t clear on how effective brief counseling interventions are for those with more moderate drinking habits, but adopting more consistent testing for abnormal drinking behaviors not only protects those who abuse alcohol but those who surround them as well.

Read the full USPSTF recommendation here.

Article source: http://healthland.time.com/2013/05/14/task-force-recommends-screening-all-adults-for-alcohol-misuse/