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MGH Community News |
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MGH Community News |
| March 2013 | Volume 17• Issue 3 |
Highlights
Sections
Social Service staff may direct resource questions to the Community Resource Center, Lindsey Streahle, x6-8182. Questions, comments about the newsletter? Contact Ellen Forman, x6-5807. |
Fuel Assistance Funds May Dry Up as Winter Moratorium Ends In most years Massachusetts legislators request additional federal LIHEAP ( Low-Income Home Energy Assistance Program, often referred to simply as Fuel Assistance) funds. Typically these additional funds have been forthcoming. Due to sequestration, funds for the program have been cut, and it is not clear if Massachusetts will receive any additional. According to Charlie Harak of the National Consumer Law Center, LIHEAP runs the risk of running out of funds, for the first time ever, before the end of this year’s application period (April 30). Eligible clients should apply as soon as possible. The state’s annual Winter Moratorium on terminations of heat-related utilities ends on April 1 this year. Gas and electric companies could send out "second notices" to those with overdue bills as early as April 2, and a final notice around April 20; terminations could occur 3 days after the final notice is received. Social Service staff can consult Community Resource Center staff and/or see our website for other utility financial assistance options and for programs and strategies for managing overdue bills (“arrearages”). -Adapted from e-mail correspondence from Charlie Harak, posted to utilitynetwork@lists.nclc.org, March 20, 2013.
Amid Outcry Faulkner Modifies Inpatient Detox Unit Closing Plan Brigham and Women’s Faulkner Hospital is modifying its plan to close a 15-bed inpatient drug and alcohol detoxification unit after the proposal drew heavy criticism from patients, hospital staff, and mental health advocates who said the state has too few such specialized facilities and the change could harm patients. The unit treats patients who have other serious health conditions, such as diabetes or high blood pressure. It is one of two high-level detox programs in the city. The other is at St. Elizabeth’s Medical Center in Brighton which has 11 beds. There are 140 such high-level beds in Massachusetts, the rest of which are in Worcester, according to the Department of Public Health. Faulkner had planned to reserve six beds on a medical floor for people with addictions to help offset the beds lost in the closure. In negotiations with the state Department of Public Health, executives have agreed to increase that number to nine and continue many of the therapeutic services that have been part of the separate unit.
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Hospital administrators, who say their plan will allow them to improve care and serve more patients with addictions, will reevaluate the demand for those additional beds after six months and decide whether to maintain them, Edward Liston-Kraft, Faulkner’s vice president of clinical and professional services, said in an interview. Faulkner will also be introducing a new outpatient program focusing on Suboxone, a drug that helps curb withdrawal symptoms of opiate-addicted patients and can help many patients go through detox at home. See the full The Boston Globe articles:
In a recent editorial (Confidence in Mass. welfare system depends on preventing abuse, March 3, 2013), The Boston Globe charged that the state Department of Transitional Assistance has failed at its most basic administrative tasks — establishing eligibility and keeping track of its clients. They cited the following as evidence: in mid-January, the state auditor received evidence of $1.3 million in fraudulently obtained benefits during a three-month period. The state inspector general’s report came next, citing potential eligibility errors — including undisclosed assets and job income — in 33 percent of the department’s portfolio which could be costing taxpayers $25 million annually, according to the report. The editorial added that the federal government has informed the Patrick administration that it overpaid food stamp recipients by nearly $28 million during 2010 and 2011. The department, meanwhile, is still licking its wounds after reams of voter registration mailings to welfare recipients and applicants came back as undeliverable — an indication that the state may be continuing benefits to people who’ve left. Welfare officials admit to losing track of 3,000 holders of electronic benefit cards. The editorial asserted that the Patrick administration, which is pushing a $1.9 billion tax plan for education and transportation, shouldn’t underestimate how much irregularities in the welfare system undermine public support for government programs more generally. They also reported that newly appointed interim director of the Department of Transitional Assistance Stacey Monahan, immediately sent the right message by insisting on biweekly reports on the misuse of electronic benefit cards for the purchase of alcohol, tobacco, and other disallowed items. She is also preparing a plan that addresses training, technology, and other methods to ensure that recipients are in compliance with all eligibility requirements. To implement it, she’ll need more than the four fraud investigators now working for the department. In a subsequent letter to the Editor (March 10, 2013), Georgia Katsoulomitis, Executive director of the Massachusetts Law Reform Institute and Carol J. Trust, Executive director of the Massachusetts chapter of the National Association of Social Workers, assert, in part, that it’s unfortunate that the Globe gave the impression that programs are rampant with eligibility fraud. The inspector general’s report did not find fraud. It did not find that $25 million in welfare benefits are wasted. It did not say that the families were ineligible or were overpaid. The report found gaps in the agency’s record-keeping. As the inspector general pointed out, once the Department of Transitional Assistance fills these gaps, the state might find that all the families were eligible for benefits. The fraud found by the state auditor amounts to less than one-fifth of 1 percent of welfare and food stamp benefits. It’s time to stop repeating the myth of widespread abuse, as it will only pressure the agency to delay or deny benefits to desperately needy residents. -See the original editorial and the letter to the editor... Fallon Strikes Deal with Partners Fallon Community Health Plan, a Worcester-based insurer that has been expanding aggressively into Eastern Massachusetts, said it has struck an agreement with Partners HealthCare System to give members access to Partners’ teaching hospitals in Boston. Under the deal, Fallon members enrolled in the insurer’s Select Care network, its largest health insurance offering, will have unrestricted access to Partners-owned Massachusetts General and Brigham and Women’s hospitals. Previously, Select Care members could visit Mass. General and Brigham and Women’s only for second opinions or specialty procedures. -See the full Boston Globe article... -See the Fallon Community Health Plan press release... Guide for Persons with Mental Health Conditions Who Want to Work Although many individuals with mental health conditions do not work, competitive employment remains a vibrant goal for most, and most people with mental health conditions are able to work successfully if they receive the support they need. The Temple University Collaborative has written A Practical Guide for People with Mental Health Conditions Who Want to Work, designed for people with mental health diagnoses who want to return to successful careers. The Guide offers encouragement and vital information on the importance of work, the availability of rehabilitation programs, the in-and-outs of the Social Security Administration's work incentives, the challenges of starting a new job and grappling with disclosure, and strategies for long-term success at work. Designed for those with mental health conditions to use on their own, or as of organized support programs, the Guide aims to help people achieve economic self-sufficiency. Read the full guide. -From News from Margolis & Bloom, LLP - March 18, 2013, Margolis & Bloom, LLP MBTA May Need Additional Fare Increase MBTA officials recently painted a dark picture of the T’s future if no funding increase from the state materializes. Facing a projected deficit of $130 million for fiscal 2014, Charles Planck, director of strategic initiatives for the MBTA, presented the Massachusetts Department of Transportation’s finance committee with options for how the T could balance its budget as required by law. T officials are hoping to receive additional state funding through an expansive transportation finance plan proposed by Governor Deval Patrick earlier this year, which relies on a slew of tax increases to fund investments in roads, bridges, and public transportation, which would help shore up the T’s finances over the long term. But it will probably be months, long after the T’s April 15 budget deadline, before the Legislature votes on the funding plan. In one scenario, the T’s deficit would be closed solely with fare hikes. In that case, Planck said, fares would need to rise by a total of 33 percent, increasing subway fares from $2 to $2.60, bus fares from $1.50 to $2, and fares on The RIDE from $4 to $5.25. In another scenario, T officials would implement a 15 percent fare increase to cover half the deficit. The other half would come from cuts to operating costs: the elimination of the 30 least popular bus routes, curbed schedules on the T and commuter rail, and the closure and sale of some MBTA facilities and fleet, which would lower maintenance costs. Some of those cuts, Planck said, would not just limit the hours and frequency of service on the T, but would dramatically reshape the area that it covers. -See the full The Boston Globe article ...
Boston Gay and Lesbian Adolescent Social Services (GLASS) Boston Gay & Lesbian Adolescent Social Services (GLASS) opened in 1995, as New England’s first (and the country’s fourth) community center serving young people in the gay, lesbian, bisexual and transgender community. Boston GLASS provides counseling, advocacy and referrals for health care services and housing to Gay, Lesbian, Bisexual, Transgender and Questioning (GLBTQ) teens and young adults, many of whom are youth of color. Services include (a partial list):
More Information Or contact
Ismael Rivera “Heads Up” Mentor Program for Kids with Mentally Ill Family Members Cambridge Family & Children’s Service’s Mentor Program is piloting a new specialized mentor program. Heads Up intends to establish 5 initial mentor/mentee matches that will connect youth (ages 8-22) who live or have lived with a family member with a mental illness to caring adults who grew up under similar circumstances. Through supportive and lasting relationships, mentors will help youth process their emotions, learn about mental health, and build self-confidence. Mentors provide friendship, encouragement, and guidance to youth and help introduce them to new experiences and resources. Mentors and mentees will meet in the community weekly, doing creative and goal-based activities that appeal to both of them, such as visiting a museum or shooting hoops. With parental guidance, mentors will also be equipped to discuss mental health with their mentees, providing support around a topic that can often be stigmatized or misunderstood. Heads Up is coordinated by CFCS staff, who will recruit, screen, train, and supervise volunteer mentors. All mentors will undergo an intensive screening process, including an application, in-person interview, SORI, CORI and reference checks. Eligibility: Mentees should be between the ages of 8-22, reside in the Greater Boston Area, live or have lived with a family member (such as a sibling or caregiver) with a mental health condition, and be able to commit to meeting 2-3 hours weekly with their mentor for at least one year. Heads Up is free of charge for participating families. More Information
To Refer: Please contact Yelena Tsilker, Mentoring Fellow, at ytsilker@helpfamilies.org or 617-876-4210 x141. Families may submit an application by e-mail, mail, or fax, or a caseworker or clinician may do so on their behalf. -Thanks to Barbara Maxam for sharing this exciting resource. “Surviving Our Struggle” Helps Male Victims of Sexual Exploitation In the past few years, the scourge of human trafficking has started to receive the scrutiny it deserves. But the vast majority of the attention and support programs have been aimed at girls. Surviving Our Struggle is a new Boston program dedicated exclusively to boys who have been forced into commercial sex. Operated through the Justice Resource Institute in Downtown Crossing, the program helps boys who have been driven into prostitution find housing, health care, GED training, and hope. Procopio says there are many misconceptions about underage male prostitutes: that they don’t have pimps; that they are all gay; that they choose the life. In fact, he says most of the young boys on the streets are running away from domestic violence, drugs, or sexual abuse at home. They can be helped. But first they have to be seen. To Refer Contact Boston GLASS (see accompanying story) at 617-266-3349. -See the full The Boston Globe article ... YouthHarbors Finds Shelter For Homeless Adult High School Students YouthHarbors, a privately funded program, began three years ago to fill an urgent need in student homelessness and provide assistance to young adults struggling to make it on their own. Launched in Malden in 2009 and then in Everett the following year, the program was recently expanded to Roxbury and was scheduled to start in Somerville at the end of last month. “When kids are struggling whether they are homeless or almost homeless, our job is to make sure they are housed so they can stay in school,’’ said Danielle Ferrier, who oversees the program. YouthHarbors was established by an organization called Rediscovery at the Justice Resource Institute, which had been serving homeless young adults who had aged out of foster care. Advocates saw that the students who needed the most help had no support and had been struggling to make it on their own. YouthHarbors targets students ages 18 to 21, many mired in personal and family troubles that have kept them languishing in school. It places its case managers in school buildings to work directly with students. When students seek help or are referred to them, case managers surf the Internet for listings in search of families with rooms to rent. They ensure that each placement is safe and families are screened before students sign a lease. YouthHarbors pays the $500 monthly rent. Students should ask a guidance counselor if their school participates in the program. -See the full The Boston Globe article ...
LIFT trains college student volunteers to work with clients to find jobs, secure safe and stable housing, make ends meet through public benefits and tax credits, and obtain quality referrals for services like childcare and healthcare. LIFT-Boston provides client services in the areas of:
LIFT-Boston Region Offices
More information about LIFT at the LIFT Boston website: http://www.liftcommunities.org/boston. Social Service staff can learn more and access a referral form (preferred) on our website. -Thanks to Kitty Craig-Comin for bringing this to our attention.
Medicare Reminder – Dental Care (Limited) Medicare will not cover dental care that you need primarily for the health of your teeth. For example, Medicare will not cover routine checkups, cleanings or pay for you to get fillings. Medicare will never pay for dentures. Even if Medicare has paid for you to have a teeth pulled (extracted) as preparation for a medical procedure, you will be responsible for the cost of your dentures. However, Medicare will cover some dental services if they are required to protect your general health, or you need dental care in order for another health service that Medicare covers to be successful. Some Medicare private health plans cover routine dental services. If you have a Medicare private health plan, check with your plan to see what dental services may be covered. Learn more about Medicare coverage of dental care at www.medicareinteractive.org. -From Medicare Redesign Proposals Pose Significant Risks to Beneficiaries , Medicare Watch , Volume 4, Issue 9, The Medicare Rights Center, February 28, 2013.
Four Myths about Medicaid's Long-Term Care Coverage The fact is that Medicaid (MassHealth in Massachusetts) is the largest source for funding nursing home care, but there are many myths about exactly who qualifies for it and what coverage it provides. Many patients and families also wrongly believe Medicare offers long-term care coverage. As we are all aware, Medicare's coverage of nursing home care is quite limited. Medicare covers only up to 100 days of "skilled nursing care" per illness. Here are four myths followed by the real story.
Before applying for Medicaid, it is crucially important to consult with your elder law attorney. Social Service staff can learn more on our MassHealth Long-Term Care page. -See the full story on ElderLawAnswers.com...
Dual Eligibles Demonstration Project Timeline Revised As reported previously (Massachusetts Moves Ahead on Duals Demonstration, MGH Community News, September 2012), Massachusetts is participating in a demonstration program to test managed care models for Dual Eligibles (those enrolled in both Medicare and Medicaid). Massachusetts and CMS will contract with managed care plans to provide all Medicare and Medicaid services to Dual Eligibles aged 21-64. Individuals may select a plan or they will be automatically assigned to one. Members will have the ability to opt out of the demonstration prior to the passive enrollment taking effect. They will also retain the right to disenroll or switch plans on a month to month basis at anytime during the year. Of potential benefit to our clients, under the project the Integrated Care Organizations (ICOs)must cover supplemental benefits including: day services, home care services, respite care, peer support/navigation, care transitions assistance, home modifications, community health workers, medication management, non-medical transportation, preventive, restorative and emergency dental benefits, PCA, and DME. Unfortunately, the MOU provides no standards for determining when these services must be provided. MassHealth and CMS have agreed to certain changes in key dates for the Duals Demonstration implementation. This is partially to ensure that there is sufficient time for robust public awareness and targeted outreach efforts so that individuals have a meaningful opportunity to learn about the Demonstration and select an ICO prior to the auto-assignment process. The original plan was for coverage to begin on April 1, 2013. Under the new timeline, the first self-selected enrollments will begin July 1, 2013. Key dates in the revised timeline:
-Source and for more information see the state website...
TAFDC Benefits Earning Power Declines MassBudget's new brief, TAFDC: Declines in Support for Low-Income Children and Families finds that this cash assistance has shrunk significantly over time.
The availability of training and education assistance through the program has also declined. -Adapted from support for low-income children and families, Noah Berger, Massbudget.org, March 18, 2013. -See the full report: TAFDC: Declines in Support for Low-Income Children and Families, by Nancy Wagman and Jeff Bernstein, Massbudget.org, March 18, 2013 Potential Impact of Sequester on Social Security Staffing and Benefit Processing Sequestration was included as an enforcement mechanism with the Budget Control Act of 2011. Under the sequester, current Social Security beneficiaries (old-age, survivors and disability) will continue to receive benefits. However, if no action is taken, federal spending reductions are expected to significantly affect Social Security Administration (SSA) operations. According to the U.S. Office of Personnel Management, federal agencies such as the SSA generally must provide notice to employees at least 30 days in advance of any furloughs. However, if the furloughs will last longer than 22 workdays, SSA employees must be given 60 days advance notice. Depending on Congressional action, SSA furloughs may take effect beginning in April and last through the budget year, which ends Sept. 30, 2013. Congressional reports estimate the following potential effects on the SSA:
-Adapted from Allsup Outlines Potential Impact of Sequester On Social Security . Allsup is a private Social Security disability claims services company. Boston Homelessness Increases and Cuts Loom Boston saw a small increase last year in the number of people living on city streets, in emergency shelters, and in substance abuse and mental health facilities, according to data released in early March from the city’s annual homeless census. The census, conducted the night of Dec. 12, 2012, found a total of 6,992 homeless men, women, and children in Boston, up from 6,647 one year earlier, for a 5.2 percent increase. There were increases in most categories, with the largest change in runaway and homeless youth. At Pine Street Inn there is a decline in homeless single men but more women and families said Lyndia Downie, executive director. With 110 beds for women last winter there were usually 10 or 15 women who had to sleep on the floor each night. This winter the number is often 30 or 40 she said. A spokeswoman for Mayor Thomas M. Menino, Dot Joyce, said she is troubled by the increases and by looming cuts in aid for housing assistance that may be triggered by the federal sequester. If the cuts go through and Boston loses federal funding for emergency shelters and rental assistance, it is unlikely it could be found elsewhere in the city budget. The state has already cut about $360 million in funding to Boston over the past decade, she said. According to Downie, the overall homeless population has declined by as much as 28 percent since the mid-2000s, and programs placing chronically homeless people in housing with supportive services have a retention rate near 90 percent. With continued funding, she believes those trends could continue. “I’m hoping this is a blip . . . and we can redouble our efforts and make a difference next year,” she said. -See the full The Boston Globe article... Some Preschools’ Seats Empty After Freeze on State Aid The preschool years are critical years in a child’s life, a time when achievement gaps emerge, and the prime moment to intervene. But in Massachusetts, 30,000 children from low-income families linger on preschool waiting lists, unable to obtain the state voucher that will pay for their care. The backlog has nearly doubled since 2011, when state budget problems led to a freeze in issuing new vouchers. “We have empty seats,” said Deborah Kincade Rambo, president of Catholic Charities of Boston, which serves about 1,100 children. “We know there are people out there who would like to be able to get their children into child care, but they can’t because they can’t access the state subsidies.” And if parents don’t have access to child care, parents can’t work. Fewer students mean less revenue, so providers shrink capacity to cut costs, said William Eddy, executive director of the Massachusetts Association of Early Education and Care. “The whole Massachusetts early education system is completely destabilized right now,” he said. And, he added, it does not help that the state has failed to increase the value of vouchers for six years. To begin putting more students in classrooms, Governor Deval Patrick has proposed boosting spending on early childhood education next year by about $130 million. Those dollars would be used to increase the pool of money low-income families can access to help pay for day care. It would also bump up the rate paid to day care centers. The governor also wants to increase capacity during the next four years. -See the full The Boston Globe article ... Choosing Wisely Urges MDs and Patients to Limit Unnecessary Tests Choosing Wisely, launched in 2012 by the ABIM Foundation (American Board of Internal Medicine), has brought together the leaders of 26 physician societies representing more than 350,000 American doctors to do something many patients may find shocking: recommend that we get less medical care. Each participating physicians group has identified five common tests and procedures that may be overused, unnecessary or potentially harmful to patients. There are already 135 such guidelines posted on Choosing Wisely's website. By the end of the year, they expect to have more than 200 recommendations, from 40 doctors' groups. Another, patient-focused version of the list, using less technical language, can be found at consumerhealthchoices.org, a free site produced by the board's partner Consumer Reports, which also offers practical advice for raising questions with your physicians. The underlying message: When it comes to medical care, "less is sometimes better." The campaign is intended to launch informed conversations between doctors and patients that will improve the quality and safety of health care. Limiting unnecessary procedures across the system, of course, could have a major impact on health care costs. But Daniel Wolfson, chief operating officer of the foundation says that's not the campaign's primary goal. "In most situations the byproduct is lower costs," he says, "but there are some things on the list that would actually increase costs. We're only trying to enhance appropriate care." -See the full Huffingtonpost.com article ... Cited in/linked from HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, March 15, 2013. States Urged to Expand Medicaid With Private Insurance The White House is encouraging skeptical state officials to expand Medicaid by subsidizing the purchase of private insurance for low-income people, even though that approach might be somewhat more expensive, federal and state officials say. Ohio and Arkansas are negotiating with the Obama administration over plans to use federal Medicaid money to pay premiums for commercial insurance that will be sold to the public in regulated markets known as insurance exchanges. Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in the option since Gov. Mike Beebe of Arkansas, a Democrat, received a green light from Kathleen Sebelius, the federal secretary of health and human services. The idea of using “premium assistance” to buy private insurance for new Medicaid beneficiaries is a sharp departure from the 2010 health care law, in which Congress expanded Medicaid to cover the poorest Americans and assumed that people with higher incomes would obtain private coverage through the exchanges. In many states, Republicans are trying to create a hybrid of the two alternatives, taking federal money for the expansion of Medicaid but using it to help people buy commercial insurance instead. The idea appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid. Advocates for beneficiaries are torn. On one hand, they want to provide coverage to as many people as possible, and the use of private insurance may be the only way to entice Republicans to support the expansion of Medicaid. On the other hand, they say, private insurance will often be more costly than Medicaid, in part because it pays higher rates to health care providers. They said they feared that higher federal costs would fuel demands in Congress for cutbacks in Medicaid. In addition, many advocates prefer Medicaid because it has strict limits on co-payments and deductibles and provides benefits that may not be available in commercial insurance. These include long-term care, dental services, medical equipment and even personal attendant services for some people with severe disabilities. Federal officials said state Medicaid programs could provide these extra services as a supplement to private insurance. -See the full The New York Times article ... -Cited in/Linked from HEALTH CARE WEEKLY UPDATE, Barbara Roop & John Goodson, Health Care for Massachusetts, March 22, 2013. Opinion: Medicare Savings can be Found in Overpayments to Plans The General Accountability Office (GAO) estimates that the Centers for Medicare & Medicaid Services (CMS) overpaid Medicare Advantage (MA) plans between $3.2 and $5.1 billion from 2010 to 2012. GAO released the estimates this month in its report, Medicare Advantage: Substantial Excess Payments Underscore Need for CMS to Improve Accuracy of Risk Score Adjustments. The Affordable Care Act (ACA) reduces excessive payments to MA plans; however, according to the GAO report, CMS continues to adjust payments to MA plans based on plan reports of the relative health and risk associated with each beneficiary. MA plans continuously reported higher beneficiary risk than actually supported by medical records, resulting in overpayments. As policymakers continue to look for ways to achieve federal savings in the Medicare program, some have proposed policies to turn Medicare into a premium support model, or voucher program, raise Medicare’s age of eligibility or impose further means testing on middle class beneficiaries. All of these options increase health care costs for older adults and people with disabilities, many of whom are in no position to pay more. According to the GAO, if CMS adjusted MA risk scores by 6.4 percent, thus reducing overpayments to MA plans, the result would be billions of dollars in savings to the Medicare program. The Medicare Rights center urges policymakers to look instead at policies like this as well as other worthwhile options, like obtaining lower prices for pharmaceutical drugs and advancing the delivery system reforms in the ACA, to strengthen the Medicare program. - Adapted from Medicare Savings can be Found in Overpayments to Plans, Medicare Watch, Volume 4, Issue 11, The Medicare Rights Center, March 14, 2013.
Adults with mental illness are far more likely to smoke, putting them at greater risk for health problems and a shortened life, a report released last month by the Centers for Disease Control and Prevention found. While a national anti-smoking campaign and the ever-increasing cost of cigarettes have dramatically lowered overall smoking rates in the United States over the past 50 years, more than a third of people with mental illness smoke — 36 percent between 2009 and 2011, compared with 21 percent of people with no mental illness. The report does not include people who struggle with substance use but have no other mental illness. When that group is included, smoking rates are even higher. Some mental health specialists say people with certain disorders may be genetically predisposed to nicotine addiction or see cigarettes as a means of easing nerves and staying focused. Some fear that, without cigarettes, they would need to increase their medications. People with mental illness may be less able to navigate the health care system to get to the doctors, support groups, or cessation tools that can help them quit. And, despite the significant health risks, many doctors or therapists have seen smoking as a problem that is secondary to managing symptoms of schizophrenia or depression. And some older patients may remember a time when cigarettes were a pervasive part of mental health treatment, a mode of socializing at group homes and a reward given for good behavior at inpatient facilities. The evidence has been clear for years that people with mental illness have far higher rates of physical illness than the general population. Dr. Ken Duckworth, medical director for the National Alliance on Mental Illness began studying the issue in the 1990s, when he was medical director for the state Department of Mental Health. In 2001, the agency completed a report documenting those disparities. Among the most alarming figures was that heart disease killed the department’s clients between ages 25 and 44 nearly seven times as often as in the state’s overall population. The study helped to prompt a national examination of medical disparities for the mentally ill. The National Association of State Mental Health Program Directors published a report in 2006 with this alarming statistic: People with serious mental illness die about 25 years earlier than the general population. While suicide accounted for about 30 percent of the difference, most of the disparity was attributed to medical conditions, such as heart and lung disease. The group cited smoking as a major risk factor, along with poor nutrition and lack of exercise. -See the report Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness — United States, 2009–2011. On February 5, 2013, this report was posted as an MMWR Early Release on the CDC Morbidity and Mortality Weekly Report (MMWR) website: http://www.cdc.gov/mmwr. -See the full The Boston Globe article ...
DSM-5 Somatic Symptom Disorder Debate The inclusion of the new somatic symptom disorder category in the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) continues to spark heated debate. Somatic symptom disorder will now appear in the new section of the manual entitled "Somatic Symptoms and Related Disorders," which will replace the old "Somatoform Disorders" section. And the requirement that these symptoms be "medically unexplained" has been eliminated. In a "Personal View" published online March 19 in BMJ, Allen Frances, MD, writes that the new disorder could result in "inappropriate diagnoses of mental disorder and inappropriate medical decision making" and urged clinicians to ignore the category completely. Dr. Frances, who was chair of the DSM-IV Task Force, has voiced several strong objections to changes in the upcoming DSM-5 throughout the manual's creation. In the new editorial, he writes that somatic symptoms disorder "lacks specificity" and could cause the mislabelling of a sizeable proportion of the public as mentally ill. However, a statement sent to Medscape Medical News from 3 members of the DSM-5 workgroup on somatic symptoms in response to the editorial strongly disagrees. "The DSM-5 diagnosis does not question the reality of patients' suffering and emphasizes instead that psychiatric disorders are more properly diagnosed on the basis of features such as disproportionate and excessive thoughts, feelings, and behaviors, rather than by negative features like 'medically unexplained symptoms,' " write the workgroup members. BMJ. Published online March 19, 2013. Editorial -See the full Medscape article ... Belief in Miracles in Terminal Illness- How to Maintain an Alliance Patients and their families who hold fast to their belief in miracles are a real challenge for staff. Unfortunately, such situations can result in a standoff, in which the healthcare team dismisses the belief in miracles and even imposes negative beliefs about the patient and family. Belief in miracles is recognized as an important aspect of spiritual beliefs and practices. Belief in a higher power with the ability to perform miracles is a very sacred aspect of life and spirituality. And research has documented that spiritual beliefs are viewed as a key means of coping. A helpful mnemonic developed by Joann Bodurtha, MD, MPH, to assist clinicians with communicating with patients about their beliefs is "AMEN" (see below). The AMEN tool was based on the work of Rhonda Cooper, MDiv, BCC, Chaplain at Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore. This model can guide clinicians to hear the patient's story and beliefs and offer a nonjudgmental approach while providing the necessary honest information about the disease and its treatment. AMEN Protocol
-See the full Medscape.com article ... Ethical Issues in the Psychiatric Treatment of the Religious 'Fundamentalist' Patient Psychiatry's historical relationship with organized religion has been, at best, an ambivalent one -- and some might use the term "adversarial." The cultural, more than clinical, influence of Freud's dismissive views of religion continue to shape the attitude of many psychiatrists -- often without self-awareness. For Freud, religion was at best a kind of neurotic compromise, and at worst a dark stage of human development that the enlightenment of psychoanalysis should eclipse. The article focuses on:
-See the full article: Ronald W. Pies, Cynthia Geppert. Ethical Issues in the Psychiatric Treatment of the Religious 'Fundamentalist' Patient. Medscape. Mar 19, 2013. |
