Tagged Mental Health

Questions Raised About Sen. Dean Heller’s Support Of Unproven ‘Brainwave’ Treatment For Veterans

The company marketing the treatment has connections to Sen. Dean Heller (R-Nev.) The Trump administration is encouraging the VA to use more alternative treatments, even though doctors and mental health experts caution against steering patients to procedures that haven’t been scientifically demonstrated to be safe and effective.

Questions Raised About Sen. Dean Heller’s Support Of Unproven ‘Brainwave’ Treatment For Veterans

The company marketing the treatment has connections to Sen. Dean Heller (R-Nev.) The Trump administration is encouraging the VA to use more alternative treatments, even though doctors and mental health experts caution against steering patients to procedures that haven’t been scientifically demonstrated to be safe and effective.

Scientists Acknowledge Genetic Research Needs To Be Presented With ‘Great Care’ In Racially Charged Landscape

Geneticists are alarmed that their research is being misinterpreted by white supremacy groups. “Studying human genetic diversity is easier in a society where diversity is clearly valued and celebrated — right now, that is very much on my mind,” said John Novembre, a University of Chicago evolutionary biologist. In other public health news: brain science, obesity, concussions, mental health, surgery centers and more.

Navy Lures Once-Mocked Researcher Out Of Retirement To Lead Venture Selling Viruses For Potential Cures

The success of a therapy technique that injects viruses into bacteria and lets them reproduce like crazy until the germs explode was great news for Dr. Carl Merril — and convinced him to return to work as a government scientist, starting a new company. Other public health news includes: babies’ sleep, depression, maternal death rates, caregivers, medical data profits, mental health and surgery center ratings.

Navy Lures Once-Mocked Researcher Out Of Retirement To Lead Venture Selling Viruses For Potential Cures

The success of a therapy technique that injects viruses into bacteria and lets them reproduce like crazy until the germs explode was great news for Dr. Carl Merril — and convinced him to return to work as a government scientist, starting a new company. Other public health news includes: babies’ sleep, depression, maternal death rates, caregivers, medical data profits, mental health and surgery center ratings.

‘Beautiful Boy’ Movie Explores The Difficulties Of Addiction And The Ways It Impacts Loved Ones

The movie tells the story of Nic Sheff and his father David, offering a look into a family touched by addiction. After seeing the movie, David recalled his difficult struggle to view his addicted son with sympathy, to make the mental shift from “how could he do this to me and the family and to himself, to understanding that he was troubled and ill.”

‘Beautiful Boy’ Movie Explores The Difficulties Of Addiction And The Ways It Impacts Loved Ones

The movie tells the story of Nic Sheff and his father David, offering a look into a family touched by addiction. After seeing the movie, David recalled his difficult struggle to view his addicted son with sympathy, to make the mental shift from “how could he do this to me and the family and to himself, to understanding that he was troubled and ill.”

The Unique Challenges Older LGBTQ Americans Face Add Extra Layer Of Complexity To Aging, Experts Say

For example, a 63-year-old transgender woman wonders if she would be accepted at a long-term care center. Would she have to hide who she is and go back into the closet “to get the care I deserve to get?” In other news on aging, predicting Alzheimer’s, knee replacement surgery and staying active in the later years.

The Unique Challenges Older LGBTQ Americans Face Add Extra Layer Of Complexity To Aging, Experts Say

For example, a 63-year-old transgender woman wonders if she would be accepted at a long-term care center. Would she have to hide who she is and go back into the closet “to get the care I deserve to get?” In other news on aging, predicting Alzheimer’s, knee replacement surgery and staying active in the later years.

As U.S. Suicides Rates Rise, Hispanics Show Relative Immunity

(Maria Fabrizio for KHN)

The young man held the medication in his hand — and considered using it to end his life.

But then he “put it down and said, ‘No. I need help,’” before heading to a Laredo, Texas, emergency room, said Kimberly Gallegos, who at the time earlier this year was a mobile crisis worker for a local mental health center.

Gallegos was helping evaluate whether the patient, a Latino in his early 30s, should be immediately hospitalized or could go home safely until seeing an outpatient doctor.

He returned to the home he shares with his mother and a sibling. The family agreed to lock up the medication — which belonged to a family member — and watch out for any problematic behaviors and other warning signs of suicide, Gallegos recalled.

The man’s experience illustrates a “suicide paradox,” experts say. Even though Latinos face economic disadvantages and other stress in their lives, their suicide rate is about one-third that of non-Hispanic whites, both in Texas and nationally.

Experts attribute the relatively low suicide rate among Latinos to the culture’s strong family and community support systems, which appear to provide some degree of protection.

“It definitely did make me feel a lot more comfortable knowing that now that the family was aware of what he was going through and experiencing, that they would be a lot more vigilant with him,” Gallegos said.

In Texas, the suicide rate among non-Hispanic whites has been steadily increasing during the past 16 years, from 13.4 deaths per 100,000 residents in 2000 to 19.2 deaths per 100,000 in 2016. Meanwhile, the rate has remained largely unchanged among Hispanics, with 6.7 suicides per 100,000 residents in 2016 — the same as the national rate.

Nationwide, suicides have increased nearly 30 percent since the turn of the century.

As a group, Latinos face obstacles that can affect their health and well-being: They earn less than non-Hispanic whites, and are more likely to lack health insurance coverage. In 2017, 16.1 percent of Hispanics were uninsured compared with 6.3 percent of non-Hispanic whites, hampering access to mental health care and other treatment. In addition, Latino immigrants contend with the challenges of moving to a new country, sometimes after leaving violence and other traumatic conditions at home.

But the practice of “colectivismo,” the building of a latticework of relationships through extended family, work colleagues and friends, is prevalent in the Latino community and can help provide an emotional safety net, said Luis Garcia, who has developed suicide prevention programs for Latino youth in California. Even activities such as regular church picnics or salsa dancing can help, said Garcia, vice president of cultural diversity at Arcadia, Calif.-based Pacific Clinics.

“Latinos or Hispanics have a preference to work in groups,” Garcia said. “It’s something that, believe me, we practice on a daily basis.”

Ties That Bind — And Fray 

To be sure, Latinos are a multifaceted population from numerous countries who shouldn’t be viewed through a single lens or set of assumptions, Garcia and other researchers stressed. And not all family or community relationships are necessarily healthy.

Still, when immigrant families assimilate and ties to the Latino culture fray, so do the protective effects, according to a study published in 2014 in the Journal of Clinical Psychiatry. Researchers, who analyzed suicidal thoughts and attempts, found that those inclinations increased as Latinos spent more years in the U.S. and started losing their fluency in Spanish and connections to Latino social networks and identity.

In addition, Latino youth appear more vulnerable to suicide attempts than white teens. In 2017, 8.2 percent of Hispanic high school students attempted suicide in the prior year compared with 6.1 percent of whites and 9.8 percent of blacks, according to federal data.

Still, the higher rate of teen suicide attempts has not resulted in a corresponding increase in suicide deaths among Latinos, for reasons that are unclear, said Luis Zayas, a professor at the University of Texas at Austin and author of the book “Latinas Attempting Suicide: When Cultures, Families and Daughters Collide.”

One possibility, Pacific Clinics’ Garcia said, is that the attempt is a teen’s cry for help and attention, and there may be an extended cultural support system to fall back on.

Sometimes, though, vulnerable individuals must be encouraged to lean on that support. Sarai, a 15-year-old Latina in Southern California who requested that her full name not be used, credits a mental health counselor at Pacific Clinics with helping her reach out to friends and family, rather than bottle up her feelings.

Sarai’s problems manifested when she began cutting herself. Her family did not notice because she wore long sleeves to cover the marks on her forearms.

“I thought every time I did it, that it would let out some of the frustration and anger and sadness that I had,” Sarai said.

One day, she found herself sitting on the kitchen floor, looking at the bleach in the sink cabinet and contemplating suicide. “I was just looking at the bottle of bleach and thinking, ‘This is it. I’m just going to do it.’ But then I heard my mom’s footsteps, and it totally snapped me out.”

Still, the experience scared Sarai enough that she told her family that she needed to talk to someone about her anxiety, and they sought professional help.

Sarai’s counselor persuaded her to share her feelings rather than to inflict pain on herself, the Latina teen said.

Over time, Sarai opened up to her older sister about her history of cutting, calling her up late one night when she was tempted to start again. “We talked ’til probably 3 in the morning,” Sarai recalled. The inclination to hurt herself “completely went away,” she said.

Cynthia Rodriguez, who has counseled Sarai for about a year and a half, said she encouraged the teen to not hide her emotional struggles and “to take advantage” of the support of close friends.

Sarai eventually told a few friends that she used to cut herself. “They became like my little second family,” she said.

Missing Data? 

While family and community support might partially explain the suicide paradox, it’s likely not the only factor. It may also be that some Latino suicides are misclassified, in part due to the stigma associated with it, said Ian Rockett, a professor emeritus of epidemiology at West Virginia University School of Public Health, and a longtime researcher on suicide.

Federal suicide data, which is based on death records, relies on information compiled by local medical examiners or coroners, family and others, Rockett said. It can be more difficult to sort out what happened with an opioid overdose or when a car careens into a tree, he said.

One clue is a note. One of Rockett’s studies, published earlier this year, found that nearly 33 percent of non-Hispanic whites committing suicide left a note compared with 26.5 percent of Hispanics and 19.6 percent of non-Hispanic blacks.

Back in Laredo, Gallegos learned that the young man who had contemplated suicide believed suicide was against his family’s religion and that he had brought shame upon his family even by harboring suicidal thoughts.

Once he realized his mother didn’t hold such beliefs, his tense posture began to ease, said Gallegos, who now works as a quality management adviser for the Laredo-based mental health center.

“He was a lot calmer,” Gallegos said. “He was grateful that his mom was there.”

Want To Talk?

The National Suicide Prevention Lifeline (1-800-273-8255) is open 24 hours a day, with an option for Spanish speakers (1-888-628-9454).

Prefer to chat online? Go to the Lifeline’s homepage — https://suicidepreventionlifeline.org/ — and click on the “chat” button in the top right corner.

Must Reads Of The Week From Brianna Labuskes

Just in case our ever-decreasing anonymity in this tech-driven world hasn’t scared you enough, new studies find that within a few years 90 percent — 90 percent! — of Americans of European descent will be identifiable from their DNA. If you fall into that group, it doesn’t even matter whether you’ve given a DNA sample to one of the popular gene-testing sites (like 23andMe). Enough of your distant relatives have, so there’s a good chance you’re in the system.

Take your mind off that by checking out what you may have missed in health care this week.

The biggie, of course, was President Donald Trump’s opinion piece in USA Today about “Medicare-for-all.” (And the rebuttal from Vermont Sen. Bernie Sanders.)

Fact checkers came out in droves to comb through Trump’s arguments and found that nearly every paragraph contained a misleading statement or falsehood.

The Washington Post: Fact-Checking President Trump’s USA Today Op-Ed on ‘Medicare-for-All’

More than shedding any kind of light on the complicated topic, the back-and-forth highlights how much of a role health care is playing in the upcoming midterm elections. Each side has doubled down on its respective talking points (read: preexisting conditions and Medicare-for-all — I warned you you’d get tired of me saying that). In fact, health care is featured so heavily in ads that it trumps the topics of jobs or taxes.

The Wall Street Journal: Health Care Crowds Out Jobs, Taxes in Midterm Ads

(Side note: If you do want some light shed on Medicare-for-all and single-payer systems, check out these great pieces from KHN’s own Shefali Luthra.)

Speaking of midterms, the Democrats’ attempt to block the administration’s expansion of short-term plans (very predictably) failed, with only Maine Republican Sen. Susan Collins joining the Democrats. It was never about winning, though. What it did was force Republicans to go on record with a vote that is potentially politically dangerous in the current landscape.

Politico: Senate Democrats Fail to Block Trump’s Short-Term Health Plans

In stark contrast to the sharply partisan discourse, Trump signed two bipartisan health care measures into law this week. The bills banned “gag clauses” on pharmacists, which had prohibited them from offering consumers cheaper options. The legislation won’t directly affect drug prices, but it might mean people will pay less at the register.

The New York Times: Trump Signs New Laws Aimed at Drug Costs and Battles Democrats on Medicare


For the first time, premiums for the most popular level of insurance sold in the health law marketplaces have gone down. The numbers are the latest sign that the marketplace is stabilizing. (Centene’s expansion into new states is another from this week.) CMS Administrator Seema Verma touted the success, saying the news counters any accusations of sabotage. Health experts, however, said those price tags would have been even lower if not for the administration’s actions over the past year.

The Washington Post: Premiums for Popular ACA Health Insurance Dip for the First Time


The Justice Department approved CVS’ $69 billion merger with Aetna, and although the deal still needs approval from state regulators, the green light is a major hurdle cleared. The merger would reshape the health landscape and mark the end of an era for free-standing pharmacy benefit managers. The potential consolidation is just one of many in recent years in a fast-evolving industry — a trend critics worry will lessen competition and drive up prices for consumers.

The New York Times: CVS Health and Aetna $69 Billion Merger Is Approved With Conditions


Hospitals scrambled to ensure patient safety as Hurricane Michael battered Florida and Georgia this week. “It was like hell,” said one doctor who rode out the storm at Bay Medical Center in Panama City, Fla. The hurricane brought with it memories of last year’s power outages that came with Hurricane Irma and were linked to the deaths of several nursing home residents.

The New York Times: Hospitals Pummeled by Hurricane Michael Scramble to Evacuate Patients


Now that the Brett Kavanaugh battle is over and he’s taken a seat on the Supreme Court, Planned Parenthood has gone into planning mode in case anything happens to Roe v. Wade. A key component of the organization’s plan is to shore up networks in states where abortion would likely remain legal (with longer hours for clinics, for example). On the other side, abortion-rights opponents are getting primed for a new high court that’s likely friendlier to them by strategizing what cases would be best to move forward with.

NPR: With Kavanaugh Confirmed, Both Sides of Abortion Debate Gear Up for Battle

How do you fight measures to expand abortion rights in progressive states? Make it about money. A battle in Oregon illustrates a strategy that — although unlikely to be successful — gives opponents of the bills at least a hope of winning.

Politico: Oregon’s Unlikely Abortion Fight Hinges on Taxes


Holes in the court system have allowed state judges to grant full custody of migrant children to American families — without notifying their parents. Federal officials say it should never happen, but oversight of the problem is scattershot and challenging because states handle adoption proceedings differently.

The Associated Press: Deported Parents May Lose Kids to Adoption

Democrats have been vocal about what they don’t like when it comes to immigration policy. But they have a problem: a lack of cohesion within the party about the correct way forward.

The New York Times: The Democrats Have an Immigration Problem


In the miscellaneous, must-read file:

• A gripping piece takes you into the bowels of a Philadelphia neighborhood dubbed the “Walmart of heroin.” “Drug tourists” come from all over to buy the cheap, pure heroin flowing through the veins of the streets, and some never make it out. (Warning: Make sure you have some time before you start, it will suck you in completely.)

The New York Times: Trapped by the ‘Walmart of Heroin’

• Why were nursing home residents getting extremely pricey therapy in the last weeks of their lives? Bloomberg takes a closer look at these cash-strapped facilities and the questionable decisions made about patients’ rehab.

Bloomberg: Nursing Homes Are Pushing the Dying Into Pricey Rehab

• In good news from the segment of people who were too old to take advantage of the HPV vaccine, the Food and Drug Administration just approved its use for those up to age 45.

The Associated Press: FDA Expands Use of Cervical Cancer Vaccine up to Age 45


As an office of ardent dog lovers, we were distressed to hear the news that therapy dogs in hospitals are little germ machines, leaving behind happiness but also superbugs.

Have a great (hopefully superbug-free) weekend!

Dementia And Guns: When Should Doctors Broach The Topic?

Some patients refuse to answer. Many doctors don’t ask. As the number of Americans with dementia rises, health professionals are grappling with when and how to pose the question: “Do you have guns at home?”

While gun violence data is scarce, a Kaiser Health News investigation with PBS NewsHour published in June uncovered over 100 cases across the U.S. since 2012  in which people with dementia used guns to kill themselves or others.  The shooters often acted during bouts of confusion, paranoia, delusion or aggression — common symptoms of dementia.  Tragically they shot spouses, children and caregivers.

Yet health care providers across the country say they have not received enough guidance on whether, when and how to counsel families on gun safety.

Dr. Altaf Saadi, a neurologist at UCLA who has been practicing medicine for five years, said the KHN article revealed a “blind spot” in her clinical practice. After reading it, she looked up the American Academy of Neurology’s advice on treating dementia patients. Its guidelines suggest doctors consider asking about “access to firearms or other weapons” during a safety screen — but they don’t say what to do if a patient does have guns.

Amid a dearth of national gun safety data, there are no scientific standards for when a health care provider should discuss gun access for people with cognitive impairment or at what point in dementia’s progression a person becomes unfit to handle a gun.

Most doctors don’t ask about firearms, research has found. In a 2014 study, 58 percent of internists surveyed reported never asking whether patients have guns at home.

“One of the biggest mistakes that doctors make is not thinking about gun access,” said Dr. Colleen Christmas, a geriatric primary care doctor at Johns Hopkins School of Medicine and member of the American Neurological Association. Firearms are the most common method of suicide among seniors, she noted. Christmas said she asks every incoming patient about access to firearms, in the same nonjudgmental tone that she asks about seat belts, and “I find the conversation goes quite smoothly.”

Recently, momentum has been building among health professionals to take a greater role in preventing gun violence. In the wake of the Las Vegas shooting that left 58 concertgoers dead last October, over 1,300 health care providers publicly pledged to ask patients about gun ownership and gun safety when risk factors are present.

The pledges came in response to an article by Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis. In response to feedback from that article, his center has now developed a toolkit called What You Can Do, offering health professionals guidance on how to reduce the risk of gun violence.

In a nation bitterly divided over gun ownership issues, in which many staunchly defend the right to bear arms under the Second Amendment, these efforts have met dissent. Dr. Arthur Przebinda, director of Doctors for Responsible Gun Ownership, framed Wintemute’s efforts as part of a broader anti-gun bias on the part of institutional medicine. Przebinda said asking physicians to sign such a pledge encourages them “to propagandize Americans against their constitutionally protected rights to gun ownership and privacy.”

Przebinda said he gets several requests a day from patients looking for gun-friendly physicians. Some, he said, are tired of their doctors sending them anti-gun YouTube videos and other materials. His group, which he said has over 1,400 members, has set up a referral service connecting patients to gun-friendly doctors.

For doctors and other health professionals, navigating this politically fraught issue can be difficult. Here are the leading issues:

Is it legal to talk to patients about guns?

Yes. No state or federal law bars health professionals from raising the issue.

Why don’t doctors do it?

The top three reasons are lack of time, being unsure what to tell patients and believing patients won’t heed their advice about gun ownership or gun safety, one survey of family physicians found.

“There’s no medical or health professional school in the country that does an adequate job at training about firearms,” Wintemute argued. He said he is now working with the American Medical Association to design a continuing medical education course on the topic.

Other doctors don’t believe they should ask. Przebinda argues that doctors should almost never ask their patients about guns, except in “very rare, very exceptional circumstances” — for example, if a patient is despondent or homicidal. He said placing patients’ gun ownership information into an electronic medical record puts their privacy at risk.

When should they broach the subject?

The Veterans Health Administration recommends asking about firearms as part of a safety screening when “investigating or establishing the suspected diagnosis of dementia.” The Alzheimer’s Association also recommends asking, “Are firearms present in the home?” as part of a safety screening. That screening is part of a care planning session that Medicare covers after initial dementia diagnosis and annually as the disease progresses.

The American College of Physicians recommends physicians “counsel patients on the risk of having firearms in the home, particularly when children, adolescents, people with dementia, people with mental illnesses, people with substance use disorders, or others who are at increased risk of harming themselves or others are present.”

Wintemute said he does not suggest all doctors routinely ask every patient about firearms. His group recommends doing so when risk factors are present, including risk of violence to self or others, history of violent behavior or substance misuse, “serious, poorly controlled mental illness” or being part of “a demographic group at increased risk of firearm injury.”

What should health care providers recommend patients do with their guns?

The National Rifle Association and What You Can Do both offer tips on how to store guns safely, including using trigger locks and gun safes.

The Alzheimer’s Association advises that locking up guns may not be enough, because people with dementia may “misperceive danger” and break into a gun cabinet to protect themselves. To fully protect a family, the organization recommends removing the guns from the home.

But health professionals may be reluctant to recommend that due to legal concerns, said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research. Most states allow the temporary transfer of firearms to a family member without a background check. But seven states don’t: Connecticut, Hawaii (for handguns), Massachusetts, Michigan, New Jersey, North Carolina and Rhode Island, according to Vernick. He recommends health professionals look up their state gun laws on sites such as the NRA Institute for Legislative Action or the Giffords Law Center to Prevent Gun Violence.

In addition, 13 states have passed “red flag” laws allowing law enforcement, and sometimes family members, to petition a judge to temporarily seize firearms from a gun owner who exhibits dangerous behavior.

What happens when clinicians ask about guns?

Natasha Bahr, an instructor and social worker who works with geriatric patients at a clinic focusing on memory disorders at the University of North Texas Health Science Center, said as part of a standard assessment, she asks every patient, “Do you have firearms in the home?”

“I get so much pushback,” she said. About 60 percent of her patients refuse to answer, she said.

Patients tell her, “It’s none of your business,” “I have the freedom to not answer that question” or “It’s my Second Amendment right,” she said. “They make it sound like I’m judging, and I’m really not.”

Dr. John Morris, director of the Knight Alzheimer’s Disease Research Center at Washington University in St. Louis, said he asks his patients about firearms in the context of other safety concerns. When safety is at risk, he typically advises families to lock up firearms and store ammunition separately.

“People with dementia typically lack insight into their problems. So they will protest,” he said. Dementia is characterized by “the gradual deterioration not just of memory but of judgment and problem-solving and good decision-making,” Morris noted.

In one case, Morris said, he had to persuade the daughter of a dementia patient to secure her father’s hunting rifles. Uncomfortable with the role reversal, she was reluctant to do so.

“It’s very difficult to tell your father he can no longer have his firearms,” Morris said. The father responded: “I have never misused my firearms. … It’s not going to be a problem,” Morris recalled. “But, he’s remembering his past history — he can’t predict the future.”

Eventually, the daughter decided to remove the rifles from the home. After a few weeks, her father forgot all about them, Morris said.

Morris said the story highlights how difficult it is for families to care for people with dementia. “They’re forced to make decisions, often against the persons’ will,” he said, “but they have to do it for the person’s safety and well-being.”


KHN’s coverage of these topics is supported by
Gordon and Betty Moore Foundation
,
John A. Hartford Foundation
and
The SCAN Foundation

When Doctors Are Stumped By Rare Cases, They Can Call In These ‘Disease Detectives’

The Undiagnosed Diseases Network, set up by the National Institutes of Health, brings in specialists trained to diagnose mystery symptoms and “the rarest of rare diseases.” In other public health news: ketamine clinics, health apps, ICU dementia, mental illness, food scarcity, immunology and more.

When Doctors Are Stumped By Rare Cases, They Can Call In These ‘Disease Detectives’

The Undiagnosed Diseases Network, set up by the National Institutes of Health, brings in specialists trained to diagnose mystery symptoms and “the rarest of rare diseases.” In other public health news: ketamine clinics, health apps, ICU dementia, mental illness, food scarcity, immunology and more.