Tagged Mental Health

Must-Reads Of The Week From Brianna Labuskes

A turbulent news week is capped off by a bit of hope arising from Alzheimer’s research. Disappointment and dashed hopes are the norm in the field, but there’s been a tiny breakthrough: Scientists uncovered a link between the disease and common viruses that lay dormant in the brain after childhood. There’s lots of cautionary language being bandied about (like, don’t get association and causation confused!), but it does open new possibilities for research that has been at a standstill for decades.

And now for what you might have missed this week.


Dr. Atul Gawande, who has just been named to head the health initiative formed by Amazon, Berkshire Hathaway and JPMorgan Chase, has said the U.S. health system is like a car built with Porsche brakes, a Ferrari engine and a BMW chassis. “You put it all together and what do you get? A very expensive pile of junk that does not go anywhere.” Now that Gawande is in the driver’s seat, will he actually be able to do anything about high costs? Those in the medical field were quick to praise him as a “luminary,” but many had concerns about his lack of experience managing a large organization — and the fact that he seems to have lots of other big jobs from Harvard to The New Yorker already demanding his time.

Bloomberg: Can This Surgeon Help Buffett, Bezos and Dimon Solve America’s Health-Care Crisis?

Bloomberg: Doctor and Journalist Atul Gawande Picked for Dimon-Bezos-Buffett Health Firm

And, pharma might be breathing a small sigh of relief. Gawande insists that, despite all the headlines, drug costs aren’t what’s driving spending. The No. 1 culprit according to him? Surgery.

Reuters: Head of New U.S. Corporate Health Plan Cites Surgery As Biggest Cost


President Donald Trump ended his policy to separate migrant children from their parents this week, but chaos at the border continues. Mental health experts and physicians are focusing on the lasting psychological and physical toll on the kids — many who remain in detention centers. Other questions are percolating as well, like: Who benefits from the business of separation? Providing care for those who have been detained is expensive and private contractors are lining up for the work.

Modern Healthcare: Immigrant Detention Crisis Could Yield Profit for Some Providers and Payers

Los Angeles Times: ‘Children Must Not Be Abused for Political Purposes’: What Health Groups Say About Family Separation


Back before the health law, “unauthorized or bogus” insurance schemes were thick on the ground. Now that Trump has released his rule on association health plans (which give small businesses access to insurance options like those available to large companies and let them skirt some of the health law’s requirements), fraud experts are worried the era is going to make a return.

Modern Healthcare: Fraud Fears Rise As Feds Expand Access to Association Health Plans

And if you thought repeal-and-replace was a thing of the past, a group of conservatives helmed in part by the Heritage Foundation have released a new “repeal” plan. While it is extremely unlikely any Republicans in Congress will touch it with a 10-foot pole this close to midterms, the blueprint does show that there’s still an appetite to completely upend the health law.

The Hill: Conservative Groups Outline New ObamaCare Repeal Plan


What’s in a name? Well, critics of the administration’s plans to rename HHS — replated as the Department of Health and Public Welfare — says it means quite a lot. As part of a larger shake-up of agencies, Trump wants to tuck all public assistance programs (like SNAP) into HHS and change its name. But while officials say that adding “welfare” to the department’s title would make it clear what services it provides, others say the word brings with it a negative connotation that would make the programs vulnerable to budget cuts. (Spoiler alert: These moves require congressional approval and would strip some lawmakers of authority, so they’re unlikely to actually come to pass.)

Modern Healthcare: White House Proposes HHS Restructuring and Renaming to Consolidate Welfare Programs

The Wall Street Journal: Trump Proposes Combining Workforce Training, Welfare Programs in Agency Revamp


In the miscellaneous file this week: Some disabled veterans are being told they owe the government thousands of dollars because of an insurance program they didn’t even know existed; it’s not often you can all but feel the giddiness radiating off of articles, but these jaw-dropping results from a new therapy for Duchenne muscular dystrophy is getting everyone emotional; a drugmaker rode a nice wave of good PR and marketing for donating anti-overdose injectors to police departments. One little problem — the drugs were almost expired. And remember that NIH alcohol study where scientists courted the industry for funding? It was yanked after an internal investigation revealed that “so many lines” were crossed that “people were frankly shocked.”

The New York Times: Veterans Owe the D.O.D. Thousands for Survivor Benefits. Why Can’t They Opt Out?

Stat: Sarepta’s Gene Therapy for Duchenne Raises Hopes for ‘Real Change’

Stat: Drug Maker’s Donations of Overdose Antidote Were Close to Expiring

The New York Times: It Was Supposed to Be an Unbiased Study of Drinking. They Wanted to Call It ‘Cheers.’


And, as we head into the weekend, a question you can consider: What would you sacrifice for cheaper premiums?

Researcher Zeroes In On The Pre-Clinical Phase Of Alzheimer’s As Way To Stop Disease From Progressing

Reisa Sperling looks at the ten to fifteen year span before the onset of the disease when patients already have build-up of a protein that is believed to trigger the deterioration of the brain. In other public health news: pancreatic cancer, gout, depression, genetic testing, grandchildren for hire, and more.

Ultrasonic Signals Are Everywhere, But U.S. Diplomats’ Mysterious Illness Has Experts Reevaluating Their Side Effects

“We have turned very rapidly into a kind of Wild West of ultrasonic devices, vastly outstripping any kind of evidence-based guidelines for their use,” said Timothy Leighton, an authority on ultrasonic devices. In other public health news: abortion, suicide, salmonella, educational toys and more.

In New Hampshire, Even Mothers In Treatment For Opioids Struggle To Keep Children

Jillian Broomstein starts to cry when she talks about the day her newborn son Jeremy was taken from her by New Hampshire’s child welfare agency. He was 2 weeks old.

“They came into the house and said they would have to place him in foster care and I would get a call and we would set up visits,” she said. “It was scary.”

Broomstein, who was 26 at the time, had not used heroin for months and was on methadone treatment, trying to do what was safest for her child. The clinic social worker told her that since Jeremy would test positive for methadone when he was born, she would need to find safe housing or risk losing custody.

Broomstein moved in with a friend and her kids — but it turned out that friend had her own legal battles with the state’s Division of Children, Youth and Families, known as DCYF. The friend’s home would not pass muster as “safe housing” because of that.

Since Broomstein grew up in foster care and had no family to take her in, Jeremy was taken from her. She had 12 months to try to get her son back or lose her parental rights permanently.

To get their children back from the foster care system in New Hampshire, parents struggling with addiction are required to be compliant in drug treatment and have a safe place to live. If they can’t find housing or if they relapse, the clock does not stop ticking.

“I cannot stress enough that 12 months is a really short window for somebody who’s in early recovery,” said Courtney Tanner, who runs Hope On Haven Hill, one of the few places in New Hampshire where pregnant women and new mothers can live with their children and get treated for addiction. But with just eight beds here, the waitlists can be long.

There are more than 430,000 children in foster care in the U.S., according to the latest government figures. The opioid crisis is definitely a factor in an increasing trend of more children being removed from the home, but the scope of the problem is hard to measure due to poor tracking.

New Hampshire has some of the highest rates of opioid abuse in the country. One of the fastest-growing groups of heroin users is women of childbearing age. In the past few years the number of children taken into state custody has more than doubled, according to DCYF. Last year, New Hampshire spent $36 million for foster care.

“Here in New Hampshire, what I have seen is a mom can be enrolled in this program and compliant in treatment and they are giving birth to a child and that child is still being removed and put into foster care,” said Tanner.

In 2012 state legislators made major budget cuts to DCYF — and those dollars have not been restored. Child welfare workers in New Hampshire have more than triple the caseloads than in many other states, according to the agency’s director Joseph Rispam. Also as a result of the budget cuts, DCYF can only engage a family once case workers have opened a legal case of abuse and neglect. There’s little money to support parents before that happens.

“The result of that is … that more children coming into the foster care system that otherwise might not if we had the capacity to serve families more holistically up front,” said Ripsam.

After her son Jeremy was placed into foster care, Jillian Broomstein continued her methadone treatment and her parenting classes.

She was determined to get her son back. She finally got off a waiting list and got a bed at one of the residential treatment centers for young mothers. After a few months she was reunited with Jeremy. But she was told that her case was unusual.

“They said in court that it was an odd case that they gave me my child back so quickly,” Broomstein said. “It made me want to cry.”

“I knew it was going to be hard,” she said. “Not everybody tries to get their children back. A lot of people I’ve known just give up; they just resort back to drugs again.”

This story is part of a reporting partnership that includes NPR and Kaiser Health News.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
The David and Lucile Packard Foundation

When Erratic Teenage Behavior Means Something More

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students.

Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior.

“Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61.

Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs.

I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study.

And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department.

For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns.

O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school.

That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis.

“You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains.

As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department.

“Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two.

Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene.

Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering.

“It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.”

Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds.

Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room.

If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says.

“Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.”

When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say.

(And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.)

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room.

If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist.

This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best.

“One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.”

Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says.

She also suggests connecting with your local chapter of NAMI California (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness.

“If you’re struggling, you can meet other parents and ask their advice,” she says.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
California Health Care Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

When Erratic Teenage Behavior Means Something More

Mary Rose O’Leary has shepherded three children into adulthood, and teaches art and music to middle-school students.

Despite her extensive personal and professional experience with teens, the Eagle Rock, Calif., resident admits she’s often perplexed by their behavior.

“Even if you have normal kids, you’re constantly questioning, ‘Is this normal?’” says O’Leary, 61.

Teenagers can be volatile and moody. They can test your patience, push your buttons and leave you questioning your sanity — and theirs.

I’m not being flip. Mental health challenges are a serious — and growing — problem for teenagers: Teen and young-adult suicide has nearly tripled since the 1940s. The rate of 12- to 17-year-olds who struggled with clinical depression increased by 37 percent in a decade, according to a recent study.

And schizophrenia and other psychotic disorders often manifest themselves in adolescence.

In fact, half of all mental health conditions emerge by age 14, and three-quarters by 24, says Dr. Steven Adelsheim, director of the Stanford Center for Youth Mental Health and Wellbeing, part of the university’s psychiatry department.

For parents, it’s often hard to separate the warning signs of mental illness from typically erratic teenage behavior.

When O’Leary’s son, Isaac, now 23, was a teen, he had two run-ins with police — once for hosting a wild party while his mom was away, and again when he and a friend climbed up on the roof and challenged each other to shoot BB guns.

O’Leary dismissed those incidents as teenage pranks. But she did start to worry when she was in the midst of divorce proceedings with her then-husband and noticed that Isaac started exhibiting some unusual behavior. He complained of stomachaches and racked up absences from school.

That’s when she decided it was time for the family to see a therapist. “It’s a question of what’s normal for my kids,” she explains.

O’Leary is right. Mental health experts say the first step in recognizing possible mental illness in your children is to know their habits and patterns — to spot when they deviate from them — and to create an environment in which they feel comfortable talking with you.

Instead of asking your teen to talk, share an activity that will give your child the chance to open up: Cook dinner together, walk the dog, take a drive, says Tara Niendam, an associate professor in psychiatry at the University of California-Davis.

“You just want to know how they’re doing as a person. How are things going at school? How are their friends? How are they sleeping?” she explains.

As part of getting to know your teen, monitor and limit your child’s social media activity, says Dr. Amy Barnhorst, vice chair for community mental health in the UC-Davis psychiatry department.

“Social media gives us this important window into what’s going on in teenagers’ lives,” she says.

Once you know your child’s baseline, you’ll be more attuned to signs of mental illness: persistent changes in your child’s everyday life that last more than a week or two.

Be aware of disruptions in sleep, appetite, grades, weight, friendships — even hygiene.

Maybe your son is spending even more time alone in his room. Perhaps your daughter, who is particular about her appearance, stops wearing makeup and isn’t showering.

“It’s really when you see kids falling off the curve in every sphere of their lives,” Barnhorst says. “They’re having problems with their academics, problems with their family, problems with their friends, problems with their activities.”

Essentially, take note when “there’s a lot of shifting and chaos” in their lives, she adds.

Remember, you’re looking for changes in many aspects of your child’s life that last for a few weeks, not the typical — but temporary — sadness that comes with a breakup or the unfortunate mouthing off you get when you ask your kid to clean his room.

If your child still has the same friends and is participating in the same activities, unpleasant behavior “is not necessarily something to worry about,” Barnhorst says. “That could just be teenagers going through growing pains.”

But some behavioral changes could indicate a deeper problem. For instance, teenagers with depression may be more irritable than usual, Adelsheim says. They might snap at friends or even the family dog, he says.

“Young people will talk about their fuse being shorter than normal,” Adelsheim says. “Things that normally wouldn’t bother them do bother them.”

When you become worried that your child’s behavior may indicate something more serious, offer your child love and support — and seek help, experts say.

(And avoid phrases like “What’s wrong with you?” and “Snap out of it” when talking with your kids, Niendam advises.)

If your child threatens suicide, or you think he’s in imminent danger, take him to the emergency room.

If there’s no immediate danger, start with your child’s pediatrician or primary care physician. In some cases, the pediatrician will be able to address the problem directly — or may refer you to a mental health specialist.

This is where it could get tricky.

You may face a long wait for a specialist — especially if you live in a rural area — and may find that many aren’t accepting new patients. Barnhorst suggests calling your health insurance plan and asking for a list of in-network therapists, psychologists and psychiatrists. Then hit the phone and hope for the best.

“One of the most serious problems we have in this country on the mental health front is the lack of access to care,” says Dr. Victor Schwartz, chief medical officer of the Jed Foundation, a New York-based organization that works to prevent suicides in teens and young adults. “We haven’t trained enough professionals. They’re not distributed well enough across the country.”

Another option, he says, is to check with nearby universities to see if they have mental health clinics that train students and see patients.

While you’re seeking medical help, don’t forget to contact your child’s school, which may be able to make accommodations such as offering your child extra time for testing, Niendam says.

She also suggests connecting with your local chapter of NAMI California (namica.org), a grass-roots organization of people whose lives have been affected by serious mental illness.

“If you’re struggling, you can meet other parents and ask their advice,” she says.


KHN’s coverage of these topics is supported by
Heising-Simons Foundation
and
California Health Care Foundation

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

Must Reads Of The Week From Brianna Labuskes

A distinctly sad and sobering week: days of suicide stories follow the deaths of Anthony Bourdain and Kate Spade. The events, and a devastating report about spiking suicide rates across the country, threw self-harm and mental health awareness into the spotlight. Advocates took to social media to spread the message: Depression “doesn’t discriminate.”

Here’s what else you may have missed this week.

The Justice Department is refusing to defend the health law in court, leaving a coalition of blue-state attorneys general to do the heavy lifting. It’s a political gamble for the administration as it could rattle an already unstable marketplace as the midterm elections creep up on us.

“Of all the things the Trump administration has done to destabilize the market, this may be the most major,” said Timothy Jost, a professor emeritus at Washington and Lee University and a health law supporter. Also, meet the Texas plaintiffs at the heart of the case who feel compelled to follow the letter of the law, despite the lack of penalty.

In a compelling profile, they’re likened to people who don’t “take a tag off of their mattress” because of the legal warning.

The New York Times: Justice Dept. Says Crucial Provisions of Obamacare Are Unconstitutional

Politico: Texas Plaintiffs Personalize Uphill Legal Challenge to Overturn Obamacare

And, these insurers say they don’t expect to lose customers next year, but they’re still planning on raising premiums by the double digits. At first that might warrant a “huh?” moment, but it all comes down to a business calculation. The insurers know when one company loses customers that can have a ripple effect though the marketplace. So, they’re all in a defensive crouch.

Modern Healthcare: Insurers Downplay Mandate Repeal’s Effect, But Still Raise Premiums


Other big news is the grim outlook for Medicare’s trust fund — it’s now expected to be depleted in 2026 instead of 2029, as was projected last year. To be clear, though, the money that’s running out is used to pay for hospital visits. Other services are supported primarily through general funds.

The New York Times: Medicare’s Trust Fund Is Set to Run Out in 8 Years. Social Security, 16.


Single-payer, single-payer, single-payer. You’ve probably heard that phrase a lot in the past year or so, especially this week when the California gubernatorial race was at center stage. But Democrats are being warned not to actually utter those words on the trail, leadership being worried that it could divide the party and make progressive candidates vulnerable to attacks from the GOP. That doesn’t mean talk about universal coverage is verboten, it’s just that the hot buzzword won’t be on too many candidates’ lips this summer and fall.

Politico: The 2 Words You Can’t Say in a Democratic Ad

The New York Times: In Fight for California Governor, Candidates Head to Ideological Corners


Thanks, but no thanks: Pharma companies aren’t all that interested in taking advantage of the relaxed provisions included in the “Right-to-Try” legislation that lawmakers passed recently after a series of fits and starts. It turns out, Big Pharma likes to go through the FDA anyway … which opponents have been saying all along.

The Wall Street Journal: The ‘Right to Try’ Law Says Yes, The Drug Company Says No

And, you think it’s hard to control drug prices for popular, lifesaving medications? What about when the treatment is for a problem no one wants to talk about?

The New York Times: Prices Keep Rising for Drugs Treating Painful Sex in Women


In our miscellaneous file for the week: In somewhat-rare good news, a study found that many women with a common form of breast cancer can skip chemotherapy; a court is weighing whether punishing an offender for having a drug relapse counts as “cruel and unusual punishment”; marijuana addiction is surging, but experts are having a hard time convincing people it even exists; and remember Brazil’s Zika babies? They’re growing up.

The Associated Press: Many Breast Cancer Patients Can Skip Chemo, Big Study Finds

The New York Times: She Went to Jail for a Drug Relapse. Tough Love or Too Harsh?

Stateline: Yes, You Can Become Addicted to Marijuana. and the Problem Is Growing.

The Associated Press: From Shrieks in Bucket to Laughs, Brazil Zika Baby Improves


I also feel duty-bound to point out that the U.S. has now issued a health alert over the unexplained brain injuries that have cropped up in diplomats serving in China. The mystery — make of it what you will — continues! Lots to read this weekend!