Public health advocates and doctors from the University of New Mexico Health Sciences Center have begun work on an ambitious new project in which mental health experts will electronically train primary care doctors how to identify and treat mental and substance abuse disorders. The groups say the initiative will help more Americans — particularly those living in rural and medically under-served regions — get critical mental health treatment.

The Robert Wood Johnson Foundation (RWJF) and General Electric’s philanthropic arm is sponsoring a new mental health clinic in New Mexico that will use the electronically coordinated arrangements, which are based on an existing University of New Mexico innovation called Project ECHO (Extension for Community Healthcare Outcomes). Project ECHO is a form of “telemedicine” where specialists hold weekly, virtual training sessions where “primary care doctors, nurses, physicians’ assistants, and other clinicians from multiple sites present their cases to the specialist teams and to each other, discuss new developments relating to their patients, and determine treatment,” according to a fact sheet on the project.

A combination of high costs, spotty access, and societal stigma prevents most Americans from pursuing mental health treatment, even if they desperately need it. In rural, poor, and isolated regions, the problem is even worse. Over 85 percent of areas that the federal government classifies as “mental health professional shortage areas” are in rural communities, and “only in rural America did the National Advisory Committee on Rural Health find entire counties with no practicing psychiatrists, psychologists, or social workers,” according to a 2009 report by the Center for Rural Affairs. That means Americans living in rural regions who suffer from mental illness must travel extensive distances or forgo mental care altogether.

By spreading ECHO training technique to mental health care, experts hope that primary care doctors — who aren’t always well-versed in mental health issues — will soon be able to provide rural New Mexican families with mental checkups and treatment in the convenience of their own towns. “This approach with Project ECHO will bring mental health care to patients in their home communities with local clinicians,” said Bob Corcoran, president and chairman of the GE Foundation, in a press release. “We think this will not only improve access to mental health care, but ultimately improve overall well-being and quality of life for these patients and their families.”

If the experiment proves as successful as previous efforts to manage Hepatitis C and chronic conditions through the ECHO model, RWJF and the GE Foundation hope to spread it across the country.

Private, nonprofit efforts such as this may be necessary in the absence of federal legislation with America’s broken mental health system. Although many lawmakers promised to make mental health care issues a focus after the tragic shooting massacre in Newtown, Connecticut, bipartisan mental health and community resource bills have stalled in Congress. President Obama led a day-long conference earlier this month in which he urged Americans to “bring mental illness out of the shadows” and establish resources for all Americans to get help with mental issues.

In the wake of last December’s shooting massacre in Newtown, CT, many conservative lawmakers and state leaders called for strengthening America’s broken mental health care system. But now, the GOP’s stubborn opposition to Obamacare’s Medicaid expansion is preventing 1.2 million poor and mentally ill Americans from getting basic mental services, according to an analysis by the National Alliance on Mental Illness (NAMI).

Republican politicians have argued extensively for shoring up the U.S. mental health regimen to prevent future shootings. Rep. Louie Gohmert (R-TX) said that mental health issues have “languished” for decades, and that the two parties can easily come together to fix them. Sen. Ted Cruz (R-TX) voted against the compromise Manchin-Toomey background check bill, offering alternative legislation focused on school security and mental health resources. Florida Rep. Ander Crenshaw (R) also cited mental health services as an important part of addressing gun violence, as did Sen. Marco Rubio (R-FL), who signed onto Cruz’s gun safety bill.

Despite their professed zeal for making the U.S. mental health regimen stronger, however, these members of Congress don’t support the programs like Obamacare’s Medicaid expansion that could actually help ensure Americans’ access to those benefits. Crenshaw co-signed a letter with fellow anti-Obamacare Florida legislators in which he suggested that expanding Medicaid would be fiscally irresponsible. Cruz, Rubio, and Gohmert are all adamantly opposed to Medicaid expansion and the health law at large.

That amounts to denying essential health care to millions of poor and sick Americans, according to the NAMI study. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that 2.7 million uninsured Americans with mental disorders such as depression, anxiety, schizophrenia, or bipolar disorder would qualify for Medicaid and its mental health benefits if all states took part in the expansion. NAMI estimates that a third of all low-income Americans who would be added to expanded Medicaid rolls suffer from a mental illness.

By opposing federal Medicaid funding from Obamacare, these lawmakers and GOP-led states who refused expansion are putting the burden of reform onto state governments that have proven inept at fixing their dysfunctional mental health care systems. These states feature the lowest per-capita mental health spending in the country — as low as $75 per person in some cases. That simply isn’t enough to cover the cost of mental health treatment.

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President Obama advocated on Monday to elevate the conversation about mental illness to “a national level,” with the goal of eliminating the stigma that surrounds mental health issues and expanding access to treatment.

The president made his comments during opening remarks to a day-long White House conference on mental health. The conference was inspired by last December’s tragic shooting massacre at Sandy Hook Elementary School, whose perpetrator — Adam Lanza — had a history of mental health problems.

“All of you have shown an extraordinary commitment to what is a critical goal — and that is to make sure that people aren’t suffering in silence, and that we have the capacity to pool together all the resources and support and love that’s out there to go after an extraordinary challenge in our society,” Obama said to an audience comprised of mental health patients, their families, advocates, and medical professionals.

Obama’s rhetoric underscores the reality that the current U.S. mental health care system leaves millions of Americans by the wayside. Since the beginning of the recession, states have made massive cuts to safety net programs for the mentally ill. In Nevada, the cuts have been so dire that one state hospital began illegally dumping its homeless mentally ill patients onto buses for California, claiming that services would be more expansive there despite the Golden State’s similar cuts to mental health services. Affordable mental care is hard to come by for Americans who are financially better off, too. Inpatient services for mental health problems often have prohibitively expensive out-of-pocket costs, and many providers don’t accept private insurance due to low reimbursement rates.

Obama also empathized with the struggles that mentally ill Americans and their families face because of the stigma surrounding mental health issues, calling for a movement aimed at “bringing mental illness out of the shadows.”

“We want to let people living with mental health challenges know that they are not alone, and we’ve got to be making sure that we’re committed to support those fellow Americans. Because struggling with a mental illness, or caring for someone who does, can be isolating… It begins to feel as if, not only are you alone, but that you shouldn’t burden others with the challenge. And the darkness, day in, day out — what some call a cloud you just can’t seem to escape — begins to close in,” said the president.

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Over 2 million U.S. children are at risk for mental health problems related to a loved one being deployed for active duty warfare in the past decade. But these kids’ access to mental health services remains scarce, underscoring a major hole in the American medical system.

According to a new report by the American Academy of Pediatrics (AAP), of the 60 percent of active duty military personnel who are married, 44 percent have children — most of whom are born at a younger age than civilian American families. Pediatricians are concerned that these children are exposed to stressful environments at a greater rate than others. That’s partly due to their separation from family members during wartime — but much of it also concerns the mental health problems experienced by their military family members.

In the five years after the commencement of the Iraq war in 2003, the number of U.S. military suicides ballooned by 80 percent, reaching a record high in January 2013. AAP’s report finds that over 30 percent of returning soldiers from the Afghanistan and Iraq wars have encountered serious mental health problems such as post-traumatic stress disorder and depression.

While that may not be surprising for soldiers exposed to harmful environments, what’s less obvious is the effect that such disorders can have on children — especially the relatively young children of current active duty military and veterans. A recent study published in the Canadian Medical Association Journal found that suicide can be “contagious” among teenagers — and the younger the child, the more prominent the effect. According to the AAP’s findings, “one in four children of active-duty service members experience symptoms of depression, one in two report trouble sleeping, and about one in three children of active-duty military personnel experience excessive worrying.”

Unfortunately, accessing adequate care is difficult for military families. The AAP study finds that over 50 percent of military children receive their mental health care outside of the military health system — and the American private mental health system is decidedly broken.

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Mental health issues affect approximately 20 percent of the kids in the United States, according to a first-of-its-kind report from the Centers for Disease Control (CDC). The CDC, which partnered with several other federal agencies to study data on childhood mental illness between 2005 and 2011, say they expect that rate to increase even further in the coming years.

The mental health issues that affect children include attention-deficit/hyperactivity disorder (ADHD), autism, mood and anxiety disorders, behavioral disorders, substance abuse, and Tourette Syndrome. The CDC found that ADHD was the most commonly reported mental disorder, affecting about 4.2 million children between the ages of 3 and 17. About 1.2 million children in that age group are battling depression, and about 678,000 fall somewhere on the autism spectrum. And an estimated 40 percent of children who have been diagnosed with a disorder actually suffer from multiple different mental health issues.

The CDC estimates that treating those mental health issues costs the U.S. about $247 billion each year. But that actually represents just a fraction of what the nation should be spending, since less than a quarter of the children living with mental disorders are receiving the treatment they need:

Although the prevalence, early onset and effect on society make childhood mental problems a major public health issue, only 21 percent of affected children get treatment because of a shortage of pediatric sub-specialists and child and adolescent psychiatrists, according to the American Academy of Child & Adolescent Psychiatry.

“Our current health care system does not meet the needs of these children,” Martin J. Drell, the group’s president, said last week in a statement about the problem.

Making matters worse, fewer medical students are opting for careers in children’s mental health, while the current crop of professionals is aging out of the workforce. The dearth of providers means troubled youngsters in underserved rural and urban areas are less likely to get timely care.

“Children with serious medical conditions should not have where they live determine what kind of health care services they receive,” said Thomas K. McInerny, president of the American Academy of Pediatrics.

Researchers say their new report represents the first comprehensive look at mental health issues among children. “This report is a reflection of what’s happening in the nation as a whole,” one of the report’s authors, Dr. Ruth Perou, told the Daily Beast. “We’re finally opening a dialogue on mental health.”

After a series of recent mass shootings, there has been renewed interest in these kind of national discussions regarding mental health issues. Indeed, the U.S. has a long way to go in this area. Half of mentally ill Americans are currently skipping out on treatment because they can’t afford it, partly because mental health care providers don’t always accept private insurance. This problem was exacerbated by the recent economic downturn, which led many states to slash billions of dollars in funding from their mental health programs. Predictably, as those mental health services have disappeared, the prison population has skyrocketed. A recent survey of Texas’ juvenile detention facilities found that the rate of mental illness exceeds the rate of gang membership among teen prisoners there.

Fortunately, there has been some legislative movement in this area. At the beginning of this year, Sen. Al Franken (D-MN) held a series of hearings on the dire state of youth’s mental health services, and introduced a measure to strengthen school’s resources for identifying and treating kids’ mental disorders.

Unintended pregnancy doesn’t just take a physical and financial toll on a woman; according to a new study published on Wednesday, it also has emotional consequences.

Researchers at the University of North Carolina spoke with 680 women — 433 who had an intended pregnancy, 207 who said their pregnancy was mistimed, and 40 with an unwanted pregnancy — to gauge the impact of an unintended pregnancy on a woman’s mental health. They found that a women who didn’t mean to get pregnant were much more likely to suffer from postpartum depression, and more likely to risk long-term mental health issues:

Results show that postpartum depression was more likely in women with unintended pregnancies at both three months (11% vs. 5%) and twelve months (12% vs. 3%). The increased risk was highest at 12 months and indicates that this group of women have a long term risk of depression. When age, education level and poverty status were factored into the results, women with unintended pregnancy were still twice as likely to have postpartum depression at twelve months.

The research offers yet another reason why it’s important for women to have readily available access to contraception. Access to birth control would lower rates of unintended pregnancy — and therefore both abortion and, as this study indicates, maternal depression.

Rates of unintended or mistimed pregnancy are particularly high among low-income women, who struggle to find access to affordable contraception. Unfortunately, there is little being done to increase access to family planning that would ultimately be beneficial to preventing such pregnancies. Instead, states are continually pushing to make it more difficult for all women, and particularly low-income women, to access this type of reproductive care.

(HT: Kay Steiger)

The Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (APA), has been around in one form or another since the 1950s. It contains standardized definitions and a common language for the treatment of mental disorders, and it’s set to release its fifth edition — the first updated issue of the tome since 1994 — later this month. Count the National Institute of Mental Health (NIMH) as one group that’s canceling its subscription.

The DSM is sometimes described as the “bible” of the mental health field. It can take at least a decade to produce updates to the manual that incorporate shifts in medical research. But in a blog post on the NIMH website, the federal organization argues that, when it comes to the well-being of mental health patients, the DSM simply isn’t cutting it:

The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. [...]

Patients with mental disorders deserve better. NIMH has launched the Research Domain Criteria (RDoC) project to transform diagnosis by incorporating genetics, imaging, cognitive science, and other levels of information to lay the foundation for a new classification system.

The case against using the DSM boils down to the APA’s lack of clinical and longitudinal studies in crafting it — a major shortcoming that mental health advocates argue relegates the DSM to a semantics-based publication, with little connection to the needs and realities of actual mental health patients. Consequently, many updates to the DSM are more reflective of changes in sociopolitical thinking, rather than underlying scientific realities. For instance, one of the “updates” included in the DSM-V strikes kinky sex habits and queer behaviors such as S&M, fetishism, and transvestism from being considered “mental disorders of abnormal or unusual attraction.”

NIMH instead calls for a holistic — and scientific — approach to constructing an alternate diagnostic “Bible” that is “based on the biology as well as the symptoms” and maps the “cognitive, circuit, and genetic aspects of mental disorders [to] yield new and better targets for treatment.”