Mental Illness in America

We’ve come a long way as far as cultural perception and stigma surrounding mental illness are concerned. As far back as ancient Egypt, Greece, and Rome, mental illness was viewed as divine punishment or unholy possession, and this perception continued on through the Middle Ages. In America, by the time the 18th century rolled around the perceptions had changed but the stigma had not. Although supernatural factors were no longer believed to be the common cause of mental illnesses, the lack of understanding and preconceived ideas about mental illnesses perpetuated the desire for the confinement of these individuals.

The first major move in the treatment of mental illness in America came from Dorothea Dix, an American teacher and author turned activist who sought to expose and change the horrific conditions of the mental institutions that existed throughout the nation. In the 1800s, the stipulations for institutionalization were vast and arbitrary. On top of the horrific terms on which people could be committed, the conditions in these places were shockingly terrible. One example of this occurred at Auburn Prison in 1821where the majority of 80 male patients in solitary confinement either broke down mentally or committed suicide. Dorothea saw the injustices these people faced — in her words, being kept “in cages, closets, cellars, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience!” —and pledged to help them the best she could.

Over a 40-year period, Dorothea was directly responsible for the United States government’s funding of 32 state psychiatric hospitals across the country. While her work did wonders for the advancement of people who are mentally ill, it also lead to mass institutionalization where any people seen as public nuisances or were viewed as dangerous were committed to these institutions.

The early 1900s offered some strides as well as some fallbacks. The use of electroshock therapy became widespread in the treatment of mental illness, often without the use of anesthesia. Patients were also subjected to frontal lobotomies and hydrotherapy where patients were submerged in or blasted with water as means of treatment. However, in the 1950s, new medications that could help stabilize unstable patients mixed with funding cuts to large, scandal-ridden state hospitals lead to deinstitutionalization which dramatically reduced the number of patients being held at these centers.

Stay tuned for Part 2 in the series of Mental Illness in America.

Finding Care in Medical Deserts: How Dallas, TX Struggles to Offer Adequate Help

The quality of healthcare in Dallas, Texas, has been portrayed as a gulf for certain sections of the population, like racial and ethnic minority groups with respect to the quality of practical care services rendered, and hands-on care that can be expected. In a groundbreaking report by the Institute of Medicine Crossing the quality chasm: A New Health System for the 21st Century the institute threw a gauntlet at all healthcare organizations to induce encompassing six prominent goals: safety, timeliness, effectiveness, efficiency, equity, and patient-centeredness. The essence of the proposal was to ensure equal administration of high quality care to all races and ethnicities, irrespective of any discretely private motive a patient might have for seeking medical attention.

Over time, studies of inequalities in admittance, usage, and consequences of health care in Dallas has looked for and continue to critically scrutinize situations that raise questions about moral, ethical, and economic concerns. These often translate to gross injustice that must be addressed if the recommendations of the Institute of Medicine can come to fruition. Based on significant variations in care according to age, gender, race/ethnicity, and socioeconomic status, aberrations have been noted in the Dallas system that decries expectations of “best care” for all and sundry. An important aspect to eliminating health care injustices, appropriately directed at tackling equity issues, by highlighting specific objectives targeted at eliminating identified injustices that seek to arrive at a culturally astute health care system, must establish a communally advantageous relationship between healthcare providers and the community. Essential mechanisms for arriving at such a relationship must comprise a strengthening of the patient, primary care provider relationships that mitigate kinks within the healthcare system and enhance patient accessibility to care. This will also assist the development of relationships with pertinent local community leaders/lay health advisors, advocates, and organizations.

In a study conducted by Dallas News at the University of Texas Southwestern Medical Center and Parkland Memorial Hospital, two iconic medical care providers of Dallas metropolis. The paper discovered at Parkland, decades of elusive entanglements that resulted in serious, and endless harm to an average of two patients per day; according to the hospital’s own admission statement. Records and testimonials from both hospitals, following referral to Federal inquiries, revealed instances of malpractices among loosely supervised residents, as well as, Medicare billing fraud supportive of the Dallas News findings. The paper has posted its archived findings, along with other investigative writings at its blog “DMN Investigates”. Which is accessible at www.dallasnews.com/medinvestigation. The findings are truly informative, exposing a whole lot of shortcomings, particularly, as applies to the Dallas Medical Care system. Procurement of the true information that went into the compilation of the reports proved very challenging as the hospitals refused to share the data on patient outcomes. However, the News channel resolved to ingenious reporting strategies backed by the implementation of the “open record law” and the like, to procure the data for the compilation of the studies.

The reporting uncovered several malpractices with the Medical Care industry and drew the attention of the Department of Healthcare and Human Services’ Office of the Inspector General. The investigative story exposed that generally, the Medical Care industry do not like to have open discussions, despite the notable grandness of their practice on human toll, grounded on their intense commitment to preserving what is described as “the privilege of self-regulation”, a concentrated defense against the exposition of shortcomings within the industry. Continuous studies by the newspaper, show that although no one takes delight in needless harm to patients, everything depends on the provision of an indiscriminate patient-centered care. Which will require in part, abandoning a reliance on cheap labor provided by residents, believed to offer new doctors the opportunity to learn from their mistakes. Measures to add resident supervision is being emphasized. A replacement of several key officials within the medical system is being implemented. Despite great achievements made because of studies of elusive behavior and malpractices, there is so much at stake with several valuable lives to protect. There is, therefore, still plenty of room for improvement within the Dallas Medical Care system. There exists some evidence that community health workers who play multiple roles in the healthcare system, and act as links between patients and providers, as well as, contributing to the management of patient aftercare can impact the quality of care and help reduce the cost of healthcare. Promotion of sustainable healthcare, disease prevention together with a quality healthcare is only attainable through a delicate balance of “compeers” that eradicates injustices in the healthcare system.

Opioid Use in the United States

The use of opioids is widespread and common in many first-world countries and is only globally second to cancer medicines in the rate of usage. Hundreds of millions of pain prescriptions are written each year, for various reasons, and the market for opioids is around $24 billion, an astronomical amount. While you would think that this number would be distributed throughout the world, it’s unfortunately mostly concentrated in the United States. This number works out to around 80 percent of opioids being used in the United States.

Lack of limitations

One of the reasons that the United States leads with the amount of opioids prescribed and used is likely the past lack of limitations on the drug. Previously, people who used opioids for pain relief were easily able to get multiple prescriptions from different doctors or have prescriptions renewed before they should be in an effort to take more medications. Another difference between the United States and other countries in opioid prescription is medical culture.  American doctors were much more willing to prescribe the pills for people suffering from acute and chronic pain. In other countries, opioids are only prescribed in extreme trauma cases, like childbirth, severe burns, and end-of-life care. Studying in Europe it was rather rare to see patients ask or receive the various potent opioids inappropriately.  Conversely, when I started my training nearly ten years ago the culture was to liberally give out opioids at the slightest whimper.  Since U.S. doctors were more willing to prescribe opioids, less serious medical conditions were and sometimes are treated with opioids.  Only now is the pendulum swinging the other way and there have been new regulations limiting opioid prescribing.  

Amount of prescriptions

According to the American Society of Addiction Medicine (ASAM), a number of opioids prescribed has quadrupled, with close to 300 million prescriptions written in 2012, “which is enough to provide every American adult with a bottle of opioid pills”. Not every American adult has a bottle of opioids, which is even more concerning because it means that others have lots of different opioids they’re constantly taking. While it may be still fairly easy to acquire a prescription from a doctor, many people also receive their opioids from family members or friends who have their own prescription.

High risk of addiction

Opioids whether legal or illegal can be extremely addicting, which is why it’s so concerning at the rate they’re being used in the United States.  In this document, ASAM breaks down a lot of the numbers associated with opioid use and addiction. People are willing to share pain medication, especially when they receive it for less serious medical conditions and then end up having pills or prescriptions left over that they can give to loved ones suffering from chronic pain, or to sell. Unfortunately, opioids are also a gateway to heroin usage. Many people initially start taking opioids and then work their way up to heroin, because they’ve become addicted to their prescription pills and need to get that high. It’s important to limit, or at least carefully monitor, the amount of opioids being consumed in the United States.

Factors That Matter for Behavioral Addictions

Behavioral addiction is categorized by an individual engaging in a non-drug related behavior repeatedly.  Common behavioral addictions include gambling and shopping addiction, hoarding and impulsive stealing.  Such addictions can damage an individuals employment, personal relationships and mental health issues.  Although not all behavioral addictions are in conjunction with a mental health issue, many individuals do suffer from a mental disorder that can lead to a behavior addiction.  When an person needs to be treated for a psychological disorder and an addiction it is known as a dual diagnosis.  Common psychological disorders that “co-occur” with a behavioral addiction can include impulse control problems, anxiety disorders, depression, bipolar disorder, schizophrenia, post-traumatic stress disorder and personality disorders such as borderline personality disorder.

Dual Diagnosis

While mental disorders can contribute to behavioral addictions, individuals with certain personality traits have been found to exhibit behavioral addictions.  Studies have shown that individuals who score high on impulsivity and risk seeking behaviors on personality assessments are more likely to have a behavioral addiction.  On a behavioral assessment, people who scored low on harm-avoidance are also more likely to exhibit a behavioral addiction.  Such studies have shown as well that people with specific sets of personality traits are likely to have a behavioral addiction.  Personality traits of high harm-avoidance, personal conflict, psychoticism, and lack of self-direction showed to be correlated within individuals who suffer from an internet addiction.  Individuals who scored high on impulsivity were more likely to have trichotillomania, an addiction of skin-picking or hair-pulling.

Substance Abuse

When an individual has a behavioral addiction he or she is addicted not to a substance but is addicted to the feeling he or she gets from the behavior.  For instance, someone who has a behavioral addiction to gambling has the reward feeling of excitement from winning.  That excitement generated by the behavioral action of gambling seeks the same thrill of winning over and over which eventually leads to an impulsivity to gamble to the point that it can have a negative impact on his or her daily life.  Although many behavioral addictions are not influenced by drug abuse, studies have found that such factors as drug and alcohol abuse have a significant impact on the behavioral addiction.  Studies found that individuals who were addicted to gambling were about 3.8 times more likely to display alcohol abuse.  While substance abuse has not been found to influence a behavioral addiction like gambling, hoarding, or trichotillomania, it does increase the risk of developing a behavioral addiction.

Genetics

Genetics can be a factor that matters to mental health patients as well.  Some individuals can be predisposed to a behavioral addiction by having a relative such as a parent or sibling that has a behavioral addiction.  Studies have shown that those that have a relative with a behavioral addiction and/or substance addiction are more at risk for developing a behavioral addiction.  Genetics has been shown to be responsible for an individual developing a behavioral addiction by up to 20%.  Similar research studies about addictions have found that genetics can put a person at risk of developing a behavioral addiction by 64%.

Sources
Projectknow. “Behavioral Addictions.”  Projectknow.

Recovery. “Choosing a Top Inpatient Behavioral Disorder Recovery Center.”

Alavi, Seyyed S., Ferdosi, Masound, and Setare, Mehrdad.  “Behavioral Addiction versus Substance Addiction: Correspondence of Psychiatric and Psychological Views.” International Journal of Preventive Medicine.