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14 Jul 2012

Report says baby boomers face a mental health crisis




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Getting older does not just mean a risk for physical ailments like heart disease and creaky knees: A new report finds as many as 1 in 5 American seniors has a mental health or substance abuse problem.

And as the population rapidly ages over the next two decades, millions of baby boomers may have a hard time finding care and services for mental health problems such as depression – because the nation is woefully lacking in doctors, nurses and other health workers trained for their special needs, the Institute of Medicine said Tuesday.

Instead, the country is focused mostly on preparing for the physical health needs of what has been called the silver tsunami.

“The burden of mental illness and substance abuse disorders in older adults in the United States borders on a crisis,” wrote Dr. Dan Blazer of Duke University, who chaired the Institute of Medicine panel that investigated the issue. “Yet this crisis is largely hidden from the public and many of those who develop policy and programs to care for older people.”

Already, at least 5.6 million to 8 million Americans age 65 and older have a mental health condition or substance abuse disorder, the report found – calling that a conservative estimate that does not include a number of disorders. Depressive disorders and psychiatric symptoms related to dementia are the most common.

Baby boomers becoming more obese, could result in high Medicare costs

While the panel could not make precise projections, those numbers are sure to grow as the number of seniors nearly doubles by 2030, said report co-author Dr. Peter Rabins, a psychiatrist at Johns Hopkins University. How much substance abuse treatment for seniors will be needed is a particular question, as rates of illegal drug use are higher in people currently in their 50s than in previous generations.

Mental health experts welcomed the report.

“This is a wake-up call for many reasons,” said Dr. Ken Duckworth of the National Alliance on Mental Illness. The coming need for geriatric mental health care “is quite profound for us as a nation, and something we need to attend to urgently,” he said.

Merely getting older does not make mental health problems more likely to occur, Rabins said, noting that middle age is the most common time for onset of depression.

But when they do occur in older adults, the report found that they are too often overlooked and tend to be more complex. Among the reasons:

-People over 65 almost always have physical health problems at the same time that can mask or distract from the mental health needs. The physical illnesses, and medications used for them, also can complicate treatment. For example, up to a third of people who require long-term steroid treatment develop mood problems that may require someone knowledgeable about both the medical and mental health issues to determine whether it is best to cut back the steroids or add an antidepressant, Rabins said.

On the other side, older adults with untreated depression are less likely to have their diabetes, high blood pressure and other physical conditions under control – and consequently wind up costing a lot more to treat.

-Age alters how people’s bodies metabolize alcohol and drugs, including prescription drugs. That can increase the risk of dangerous overdoses, and worsen or even trigger substance abuse problems.

-Grief is common in old age as spouses, other relatives and friends die. It may be difficult to distinguish between grief and major depression.

That also means a loss of the support systems that earlier in life could have helped people better recover from a mental health problem, said Dr. Paul D.S. Kirwin, president of the American Association for Geriatric Psychiatry. Adding stress may be loss of a professional identity with retirement, and the role reversal that happens when children start taking care of older parents.

“There’ll never be enough geriatric psychiatrists or geriatric medicine specialists to take care of this huge wave of people that are aging,” Kirwin said.

The Institute of Medicine report recognizes that. It says all health workers who see older patients – including primary care physicians, nurses, physicians’ assistants and social workers – need some training to recognize the signs of geriatric mental health problems and provide at least basic care. To get there, it called for changes in how Medicare and Medicaid pay for mental health services, stricter licensing requirements for health workers, and for the government to fund appropriate training programs.


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14 Jul 2012

In the age of anxiety, are we all mentally ill?

When Cynthia Craig was diagnosed with postpartum depression eight years ago, she told her family doctor she felt anxious about motherhood. She wondered whether she had made a catastrophic mistake by quitting her job, whether she could cope with the long, lonely hours stay-at-home mothers face – and even whether she should have had children.


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“Anxiety is something I have always had, especially during times of change,” said Craig, 40, who lives in Scotland, Ontario. “But I was never worried about the level of anxiety, and it never prevented me from leaving the house, driving, socializing or even speaking in front of people.”

Her doctor referred her to an anxiety clinic, where a nurse asked Craig dozens of yes-or-no questions – are you afraid of snakes? do you hear voices? do you vomit from anxiety? – and made a diagnosis. “She said, ‘Let’s call it Generalized Anxiety Disorder with a touch of social phobia,’” Craig said.

That didn’t feel right to her, but the clinic’s psychiatrist agreed with the nurse and said Craig’s concerns about motherhood constituted an anxiety disorder, a form of mental illness, and prescribed Pfizer’s Effexor and then GlaxoSmithKline’s Paxil. Craig says the drugs exacerbated the very anxiety that she doubted required medication.

Craig’s case is one of millions that constitute an extraordinary trend in mental illness: an increase in the prevalence of reported anxiety disorders of more than 1,200 percent since 1980.

In that year, 2 percent to 4 percent of Americans suffered from an anxiety disorder, according to the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) of Mental Disorders, used by psychiatrists and others worldwide to diagnose mental illness.

In 1994, a study asking a random sample of thousands of Americans about their mental health reported that 15 percent had ever suffered from anxiety disorders. A 2009 study of people interviewed about their anxiety repeatedly for years raised that estimate to 49.5 percent – which would be 117 million U.S. adults.

Some psychiatrists say the increase in the prevalence of anxiety from about 4 percent to 50 percent is the result of psychiatrists and others “getting better at diagnosing anxiety,” as Dr. Carolyn Robinowitz, a past president of the APA who is in private practice in Washington, D.C., put it. “People who criticize that are showing their bias,” she said. “When we get better at diagnosing hypertension, we don’t say that’s terrible.”

Critics, including other leading psychiatrists, disagree. They say the apparent explosion in anxiety shows there is something seriously and dangerously wrong with the DSM. Its next edition, due in May, would lower the threshold for identifying anxiety.

The criticism rests on three arguments. First, the DSM fails to recognize that anxiety is normal and even beneficial in many situations, so it conflates a properly functioning brain system with a pathology. Second, the DSM’s description of anxiety is more about enforcing social norms than medicine.

Finally, they say, anxiety is adaptive. Its brain circuitry was honed by evolution for a purpose. Only when that mechanism misfires should a person be diagnosed as mentally ill.

“No human emotion is more basic than anxiety,” said sociologist Allan Horwitz of Rutgers University. “Many forms of it simply should not be categorized as disorders, because they’re the result of the way people evolved thousands of years ago, rather than something going wrong.”

Horwitz and other critics recognize that when the brain’s anxiety system misfires it can prevent people from functioning, as when someone is unable to leave home, interact with friends and family or walk past even a leashed dog. But the anxiety system is working properly when it makes someone afraid of heights or wild dogs or threatening strangers.

“Anxiety or panic symptoms that have been severe, persistent and cause clinically significant distress or impairment need to be diagnosed promptly,” said Dr. Allen Frances, a psychiatrist who led the previous DSM revision and questions some of the new criteria. “Very effective treatments are available.”

“We don’t oppose people getting treatment,” said Horwitz, co-author of the new book “All We Have to Fear: Psychiatry’s Transformation of Natural Anxieties into Mental Disorders.” “But people are much too willing to think they have a disorder that requires treatment.”

Many psychiatrists don’t see it that way. Under changes for the DSM-5 proposed by experts convened by the APA, symptoms such as excessive worry, restlessness, feeling on edge, avoiding activities that cause anxiety, and being overly concerned about health or finances or family would have to be present for only three months rather than six to justify a diagnosis of Generalized Anxiety Disorder (GAD). And people would have to display one physical symptom, not the current three.

“Because its threshold for GAD is set so ridiculously low, DSM-5 will mislabel as mentally ill many people who are experiencing no more than the normal and expected worries of everyday life,” said Frances.

Dr. Donna Rockwell, a clinical psychologist who has organized opposition to aspects of the DSM-5 process, warned that “unless come to their senses, GAD will be identical to the existential worries all of us face as part of being human.” That will bring “a bonanza to the drug companies,” she added, opening the floodgates to “more inappropriate, expensive and potentially harmful drug use.”

Drugmakers reported $661 million in U.S. sales of anti-anxiety drugs last year, according to IMS Health. Most psychiatrists see that as evidence people suffering from mental illness are getting help. On Thursday the Pharmaceutical Research and Manufacturers of America issued a report touting the many drugs being developed for mental illnesses, including 26 for anxiety.

“When anxiety symptoms impair a person’s functioning, what’s so bad about helping them get back to a normal state and using medication if appropriate?” asked Robinowitz.

The message that what used to be considered part of the human condition is pathological is getting through, at least to some people.

James Heaney, 44, told his family physician in 2000 that he often felt shy or mildly depressed in social situations – “like I saw on the TV commercial” telling viewers to “ask your doctor” about social anxiety. “There was no in-depth evaluation of my symptoms,” said Heaney, then a network administrator for a school district near Rochester, New York. After a 10-minute interview, he had a diagnosis of “mild social anxiety” and a prescription for Paxil. “For such a powerful drug,” he said, “it was remarkably easy to get.”

Research over the past decade shows that feeling anxious is how the brain’s emotion centers send signals to its thinking centers that something is amiss.

For instance, it is normal to be anxious over a sick child, a loved one’s illness, unemployment or other setbacks in life, said New York University sociologist Jerome Wakefield, co-author of “All We Have to Fear.”

“The feeling of anxiety tells you something poses a threat, which can motivate you to stay vigilant” – about, say, a change in a sick child’s symptoms, he said.


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14 Jul 2012

Court stays order to make president’s donations public

New Delhi, July 13 — A division bench of Delhi High Court Friday stayed its single judge’s order ruling that donations made by the President of India out of public funds do not pertain to his or her personal information, and come under the Right to Information (RTI) Act.

The bench of Acting Chief Justice A.K. Sikri and Justice Rajiv Sahai Endlaw issued notice to RTI applicant Nitish Kumar Tripathi, seeking his response by Aug 24.

Justice Vipin Sanghi June 14 dismissed a petition by the president’s secretariat challenging the Central Information Commission’s (CIC) May 4 order directing it to disclose donations made by the president.

The CIC’s order came on Tripathy’s plea, filed in June 2011, seeking information relating to the donations given by the president from “time to time”.

The division bench stayed the single judge’s order upholding the CIC’s direction to the president’s secretariat to make public the names of recipients of the donation, besides their address and the sum of donation given by the president.

In its appeal, the president’s secretariat sought quashing of the single judge’s June 14 order saying “disclosure of informations has no relationship to any public activity or interest. The impugned order is erroneous and liable to be set aside”.

“The CIC had directed disclosure of informations without first coming to the conclusion that larger public interest justifies the disclosure of such information,” the appeal said.

Justice Sanghi, dismissing the plea of president’s secretariat, ordered details on disbursement of presidential funds between 2004-11 to be made public.

“The donations made by the President of India cannot be said to relate to personal information of the president. It cannot be said that the disclosure of the information would cause unwarranted invasion of the privacy of either the President of India or the recipient of the donation,” he observed.

The court had made it clear that the president also came under the RTI Act. “The President of India is not immune from the application of the act.”

The court had also ruled that the donations made by the president were out of public money.

“Every citizen is entitled to know as to how the money, which is collected by the state from him by exaction has been utilised. Merely because the person making the donations happens to be the President of India, is no ground to withhold the said information,” the court had said.

IANS



This article was distributed through the NewsCred Smartwire.

Original article © IANS / Daily News 2012


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14 Jul 2012

New moves promote charity transparency

<!–enpproperty 2012-07-14 08:14:54.0He Dan in Shenzhen, GuangdongNew moves promote charity transparencycharity, catastrophes, donation1158963Society2@webnews/enpproperty–>

The government will no longer appoint individual charitable organizations as the exclusive recipients of donations for disaster relief operations after natural catastrophes, a senior official said on Friday.

The government will instead publish the ratings of charitable organizations as guidance for the public, Li Liguo, minister of civil affairs, said at a meeting in Shenzhen.

Painter Xing Dong helps an autistic child with a painting in Shenzhen, Guangdong province, on Friday. China’s first charity and welfare projects fair opened in the city, attracting 260 charity organizations, 104 foundations and 142 entrepreneurs. Qi Jieshuang / for China Daily

The new moves will also include publishing the donation requirements of disaster-hit areas and updating the information at different stages of the disaster-relief process, he said.

The government will also facilitate public supervision of the fundraising and spending processes of the organizations to improve transparency levels, he said.

Wang Zhenyao, director of the One Foundation Philanthropy Research Institute at Beijing Normal University, praised the moves and called them “great progress”. He said the measures will encourage more social organizations to participate in disaster relief efforts.

Given that social organizations were small and lacked skills in the 1990s, the central government usually only asked the Red Cross Society of China and the China Charity Federation to collect donations for emergency aid, said Wang, who used to head the social welfare and charities division of the Ministry of Civil Affairs.

In 2008, when a devastating earthquake hit Sichuan province in Southwest China, 13 public foundations were asked to raise money for the quake survivors, he recalled.

“The government has realized that disaster relief is not simply about giving food and rebuilding homes for the disaster-hit population. It’s complicated work, and social organizations with different expertise levels should be encouraged to join the process,” he said.

Also, to boost innovation in the social-work sector, the ministry will keep promoting its bottom-up reform of the social organizations’ registration process by encouraging local civil affairs authorities to have more NGOs directly applying for registration, Li said.

Currently, 19 provinces and autonomous regions – including Guangdong, Anhui and Jiangsu – have tested direct registration policies. The policies allow certain types of social organizations to directly apply for registration without having to find a supervising department.

Under national laws and regulations, a social organization must be affiliated with a supervising department as a pre-condition for registration.

That requirement stopped many grassroots organizations from getting registered as it was often difficult to persuade an administrative department or influential institute to be their supervising body and take legal responsibility for their operations, said Deng Guosheng, a professor specializing in philanthropic studies at the School of Public Policy and Management with the Beijing-based Tsinghua University.

Statistics from the ministry show that there are 460,000 registered social organizations on the Chinese mainland.

Deng estimated that the number of unregistered NGOs exceeds 1 million.

Since March, the civil affairs bureau of Shenzhen piloted a direct registration policy that applies to eight types of social organizations in sectors such as philanthropy, education and culture.

Hou Yisha, deputy head of the Shenzhen civil affairs bureau, said that there are about 5,000 social organizations in Shenzhen, and that more than 700 organizations were directly registered.

Li said that his ministry will speed up the reform process to facilitate direct registration at the national level.

He also said that the government will promote the registration of international NGOs, without giving details.

hedan@chinadaily.com.cn


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14 Jul 2012

Mental Experts Testify in Fla. Teen Beating Trial

A Florida teenager was in the midst of a severe mental illness episode triggered by a text message about his brother’s suicide when he attacked and nearly killed a 15-year-old girl outside a middle school, a psychiatrist for the boy’s insanity defense testified Thursday.

Dr. Alexander Neumeister of New York University testified that the text from victim Josie Lou Ratley to Wayne Treacy instantly changed his already-fragile mental state into one that was overly aggressive and also shattered his ability to control his actions. Neumeister and another defense expert say the episode resulted from post-traumatic stress disorder Treacy began suffering after his brother’s suicide a few months before the March 2010 attack.

“This text message was a game changer,” Neumeister testified. “It was like somebody kicked him into his chest. It was a massive implosion.”

A prosecution expert, Dr. Hans Steiner of Stanford University, said the PTSD diagnosis is correct but disagreed that Ratley’s text shoved Treacy into a mentally disconnected state.

“There’s no reason to think that he didn’t know what he was doing and that he didn’t know it was wrong,” said Steiner, also a psychiatrist.

Ratley and Treacy exchanged vulgar and insulting texts before the one about the brother was sent, and Treacy threatened earlier in the messages to kill the girl. But when she told him to “go visit your dead brother” Treacy reacted in the strongest possible terms: “I swear to god I’m gonna kill you! I’ll (expletive) find you! Your (expletive) is cold, dead meat (expletive)!”

Treacy, now 17, faces up to 50 years in prison if convicted of attempted first-degree murder in the vicious kicking and stomping attack that left Ratley, also 17, with permanent brain injuries. Treacy is pleading innocent by reason of insanity caused by PTSD. Closing arguments could take place Friday or Monday.

Testimony shows that after receiving Ratley’s text, Treacy either called or sent texts to several friends saying he was going to kill someone and would go to prison. He put on steel-toed boots and black martial arts gloves, rode his bicycle to Deerfield Beach Middle School and had a friend point out Ratley, whom he did not know. Ratley had let the friend, Kayla Manson, use her cell phone to communicate with Treacy before the texts between the two of them began.

Steiner, the prosecution expert, said those text messages clearly show that Treacy was able to appreciate the gravity of what he was going to do and the consequences.

“He’s spelling out what he’s going to do. He’s spelling out that he is going to jail because of it. He knows he’s going to go away. He knows this is not going to end well,” Steiner testified.

Neumeister, however, said that despite appearing outwardly normal, Treacy was in a “dissociative state” in which he had little mental control over his actions, especially once Manson pointed out Ratley in her red shirt at the school’s bus loop.

“He saw something red and then he was on autopilot,” Neumeister testified. “There is no way that he knew what he was doing.”

It wasn’t until a teacher physically knocked Treacy away from Ratley that this “dissociative” condition was likely terminated, the psychiatrist added.

“You can disrupt people in a dissociative episode, but you have to literally shake them. You have to be kind of drastic,” he said.

The defense must show that not only was Treacy suffering from mental illness but that he could not tell right from wrong. Steiner said if Treacy was in a dissociative state, it was a mild one.

During cross-examination, Assistant State Attorney Maria Schneider asked Neumeister if it was correct that “the vast majority of people with PTSD do not go out and attack people?”

“That’s right,” he replied.

Manson, the friend who pointed Ratley out to Treacy, is charged as a juvenile with being an accessory to attempted murder and faces trial in August.

—————

Follow Curt Anderson on Twitter: http://twitter.com/miamicurt


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