MENTAL HEALTH STUDY

Back to table of contents Previous article Next article Members in the NewsFull AccessAfter a Long Journey Psychiatrist Helps at HomeJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:3 Aug 2001https://doi.org/10.1176/pn.36.15.0012Whenever tourists visit certain parts of New Orleans’ French Quarter, they often think that they have died and gone to heaven. Luscious ferns and purple bougainvillea spill over wrought-iron balustrades. Fountains splash water in shadowy, inner courtyards. The air is soft, pregnant with the scent of gardenias and jasmine.Yet only a few blocks up from the French Quarter—say, along Canal Street—the atmosphere is not so heavenly. In fact, it’s pretty down to earth. Here, it is clear that life can be tough at times, that people can have mental illness and not afford treatment.Irma Bland, M.D.: “I love seeing patients recover from very challenging circumstances, knowing that we are making a difference in their lives.”Thus, enter Irma Bland, M.D. For people in this neighborhood and many throughout greater New Orleans, Bland is a savior of sorts. Indeed, she is CEO of public mental health in the greater New Orleans area, with more than 500 employees and an annual budget of $36 million to get help to such individuals.How did Bland come to assume such an important position in the mental health world? It is a long story with many twists and turns, she explains in an articulate, thoughtful voice from her spacious office at 136 South Roman Street.It may well have started back in the 1950s, when she was a little girl in New Orleans. One Christmas, her mother gave her older brother a doctor’s kit and her a nurse’s kit. That didn’t sit well with little Irma—second born but first girl! She chuckles.In any event, by the time she entered Dillard University in New Orleans in 1966, she intended to become a medical technologist. But a West Indian professor there took a look at her high school credentials and exclaimed, as Bland recalled, “No, no, no, you will be doctor!” His brashness was not unusual for Dillard teachers, Bland says with a faint smile, “because Dillard was a historically black, Methodist university, and the culture was such that teachers saw your potential, encouraged you, and pushed you beyond your own expectations.”So Bland pursued a premedical education at Dillard. She then went to medical school at the University of Chicago and eventually had to decide on a specialty. She considered gastroenterology, but soon realized that she was more interested in GI patients’ emotional health than in their physical health. When all was said and done, she decided on psychiatry because, as she says, “I liked the idea of being involved with patients in a way that you get to know them, to understand them, and the work you do with them makes such a substantial impact on what they are able to do with their lives.”After finishing medical school at the University of Chicago in 1974, she did a psychiatry residency there, followed by a fellowship in adolescent psychiatry at Northwestern University in Chicago, and then went on to train as a psychoanalyst at the Chicago Institute for Psychoanalysis.Bland worked at Northwestern from 1978 to 1987, first as an adolescent psychiatrist, then later as an associate director of residency training and coordinator of diagnostic assessment and psychotherapy training in its outpatient clinics. Then around 1987 she says her trajectory changed dramatically. “I had left New Orleans as a young woman on my way to medical school in Chicago with no intentions of ever returning,” she admitted. “But as life would have it, events culminated in my coming home.”Louisiana State University School of Medicine in New Orleans had recently acquired a new chair of psychiatry, Howard Osofsky, M.D., Ph.D. Both the department chair and the medical school dean wanted to find a psychiatrist with a psychoanalytic background to teach their psychiatry residents and run the outpatient clinics. They recruited Bland, and she accepted.Bland taught psychoanalytic psychotherapy to residents and ran psychodynamically oriented clinics there from 1987 to 1995. During these years she also interfaced considerably with the community and her administrative skills evolved as well, not only in terms of directing the outpatient clinics, but also when she became the associate chair for clinical affairs in LSU’s psychiatry department.In 1995 the assistant secretary of Louisiana’s Office of Mental Health approached Bland about becoming the medical director of the office’s Metropolitan New Orleans area. She accepted and, while filling this position, continued to work part time teaching psychiatry residents at LSU. In June 2000 she was promoted to regional administrator/CEO for Region One of the Louisiana Office of Mental Health.Making Lemonade From Lemons It has been a year or so since Bland became head of Region One—one of the nine public mental health regions in Louisiana. What are her responsibilities? Running New Orleans’ acute care hospital units for adults, New Orleans’ adolescent hospital, and New Orleans’ community mental health centers.“Although there are associate administrators or chief operating officers for the day-to-day operations at the hospitals and clinics,” she explains, “it is my responsibility to provide direction for them and to be involved in strategic planning, development, and implementation. I also oversee a regional pharmacy that provides medications for all of our patients. So basically, I have to provide executive direction and oversight and work with my regional medical director, with my operating officers at the facilities, and with my regional pharmacist.”And what are the facilities that she heads up like? Since one picture is worth a thousand words, and since Bland is obviously a woman of physical action as well as of intellectual oversight and planning, she springs from her executive chair, escorts her visitor to the garage under her office building, and drives to, first, the acute care hospital and, second, one of the community mental health centers in her domain. At the two facilities she chats with various staff members who obviously know her well and think highly of her.As Bland drives her visitor away from the facilities, she talks about some of the challenges facing her in her position. For instance: “Last year we went through a major budget cut, which meant that we had to cut not just hospital beds, but staff positions,” she says. “The situation was very hard on our staff psychologically. Not only were staff members who lost their jobs affected in very real ways, but it left remaining staff members with fewer resources to work with, they had to shift their frame of reference, and so forth. So what we did was restabilize the organization psychologically during this major downsizing, but we also attempted to create something positive out of a bad situation. And this was to compensate for the downsizing of hospital beds by building a more comprehensive continuum of care than we had had before. For instance, at our adolescent hospital, we reduced the number of beds. But we built, at the same time, a respite program on the front end that would divert kids from having to be in the hospital in the first place, that is, to stabilize them in crises, and on the back end we built a transition program to move kids out of the hospital quicker, yet to have them continue in treatment in an outpatient day treatment program so that they would have a little more time to stabilize.”Although tourists tend to associate New Orleans with the French quarter (above), many residents of New Orleans live in more modest neighborhoods (left) and sometimes need the public mental health services of Bland and her 500 employees.Another challenge, she explained as she heads her car toward the French Quarter, “is that funding is never predictable. And sometimes it leaves me in a crisis mode because the public mental health system is still the safety net. We are dealing with people who have serious, persistent, and chronic mental illness, with children who have severe behavioral and emotional disorders. We are dealing with the sickest of the mental health population, and their needs are continuing to increase, yet the money to provide care for them is not increasing and is even being slashed.“But what I dislike most of all,” she confides as she drives past St. Louis Cathedral, “is that so much of it is out of my control. I mean, you have your little part of the world where you can exert some influence, but sometimes the decisions come from on high, from the legislature, and you have to carry them out, even though they may not be the most rational decisions or make sense in terms of resources. Yes, I think all public health care is in a vulnerable position, but especially public mental health care.”Offers Hope for RecoveryBut even with such frustrations and with her inability to bestow mental health on all of New Orleans’ citizens, Bland loves her job most days, she admits as she halts her car before the hotel on Royal Street where her visitor is staying.What does she love most? “I love the fact that everything we do provides an opportunity for someone to recover from an illness that robs him or her of a sense of self-identity,” she said. “I love seeing patients recover from very challenging circumstances, knowing that we are making a difference in their lives. I love serving the traditionally underserved—ethnic minorities—and bringing my knowledge and skill to bear on their mental health problems. I love getting people to work together as a team and to watch them grow professionally. I love bringing together all of the things that have been a part of my education and my training. In some ways it feels like social activism. I am, after all, a child of the 1960s generation.”So who is Bland in her deepest heart of hearts, who is that fairy godmother who waves a wand over public psychiatry in New Orleans, not just at Mardi Gras time, but throughout the year, and who makes it work?One can ask Jackie Foster, Bland’s “right hand” for eight years now. As she told Psychiatric News. “I call her phenomenal! She really is. She likes to get the job done, and she does what she has to do to get it done. She gets everybody involved and makes sure that things are running smoothly.”Or one can ask Patrice Ambrose, M.D., a young psychiatrist who first worked under Bland during her residency and who now works in one of Bland’s mental health clinics. “She is very caring, very committed to what she does,” she said. “And I am privileged to be working for her!” ▪ ISSUES NewArchived

Enlightening Sessions, Exciting City Make APA's Annual Meeting a Must

Investigating the Quality of Life of Patients with Acute Leukemia, with a Focus on Age and Patient-Reported Experience

Independent foundations' primary focus is grant making.In general, their assets come from the gift of an individual or family.Community foundations' assets usually come from many donors rather than a single source, and grant making is limited to a particular region.Community foundations are usually classified as private charities under the tax law and are subject to different rules and regulations than are other private foundations. Access To CareAccording to 1988 Census Bureau estimates, over thirty-one million Americans are without health insurance.The demographics of these people are diverse, and their ranks continue to grow as the service industry burgeons and as competition in health care increases.Regional disparities in access also exist.Foundation funding in this area ranges from economic analyses of the problem to direct provision of care.

Talbott and Financing Policy: Reducing Fragmentation

In 2004, the American Academy of Pediatrics (AAP) Board of Directors formed the Task Force on Mental Health and charged it with developing strategies to improve the quality of child and adolescent mental health* services in primary care. The task force acknowledged early in its deliberations that enhancing the mental health care that pediatricians and other primary care clinicians† provide to children and adolescents will require systemic interventions at the national, state, and community levels to improve the financing of mental health care and access to mental health specialty resources. Systemic strategies toward achieving these improvements are the subject of other publications of the task force: “ Strategies for System Change in Children's Mental Health: A Chapter Action Kit ” (chapter action kit),1 “Improving Mental Health Services in Primary Care: Reducing Administrative and Financial Barriers to Access and Collaboration,”2 and “Enhancing Pediatric Mental Health Care: Strategies for Preparing a Community.”3 The task force also recognized that enhanced mental health practice will require competencies not currently achieved by many primary care clinicians; in the policy statement “The Future of Pediatrics: Mental Health Competencies for Pediatric Primary Care,”4 the task force collaborated with the AAP Committee on Psychosocial Aspects of Child and Family Health to outline these competencies and propose strategies for achieving them. This report offers strategies for preparing the primary care practice itself for provision of enhanced mental health care services. The task force proposes incrementally applying chronic care principles to the care of children with mental health and substance abuse problems as primary care clinicians apply them to the care of children with chronic medical conditions such as asthma. Most primary care clinicians will find that significant gaps exist between their current practice and the proposed ideal. The task force offers guidance in … Address correspondence to Jane Meschan Foy, MD, Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail: jmfoy{at}wfubmc.edu

Back to table of contents Next article Government NewsFull AccessFDA Panel: Drug Labels Should Specify Benefits as Well as RisksJim RosackJim RosackPublished Online:19 Jan 2007https://doi.org/10.1176/pn.42.2.0001At the end of a sometimes contentious nine-and-a-half-hour public advisory meeting last month, the U.S. Food and Drug Administration's (FDA) Psychopharmacologic Drugs Advisory Committee (PDAC) issued recommendations to the agency that if accepted would be precedent setting.David Shern, Ph.D., president and CEO of Mental Health America, addresses attendees at a press briefing last month during the FDA hearing on suicidality and antidepressant medications. The briefing was sponsored by a coalition of 15 mental health advocacy organizations, including APA.Jim RosackThe PDAC recommended that the FDA add the following three items to the labels of all antidepressant medications marketed in the United States:New language expanding the age range (to about age 25) covered by the existing black-box warning on increased risk of suicidal thoughts and behaviors associated with the medications in clinical-trials data.New language addressing an apparent "protective effect" of the medications for older patients, detailing a significant reduction in suicidal thoughts and behaviors associated with the use of the medications in patients over age 65.New precedent-setting language on the dangers of untreated mental illness.At the center of the discussion was a 140-page report detailing the FDA's metaanalysis of suicidality in clinical trials that studied use of antidepressant medications in adults. The analysis (see Original article: page 10) sought to determine whether there existed, for adults taking the medications in clinical trials, an increased risk of experiencing an adverse event representative of suicidal thoughts and/or behaviors, compared with patients taking placebo.FDA staff experts in drug safety and medical statistics who conducted the metaanalysis reported an age-related risk of suicidal thoughts and behaviors associated with antidepressant therapy in which risk was higher in younger patients and lower in older ones. Those over age 65 appeared to benefit significantly from a protective effect associated with the medications.The meta-analysis was completed using methods similar to those used in the FDA's analysis of antidepressant use and suicidality in children and adolescents, released in 2004, which resulted in the agency's imposition of black-box warnings on all antidepressant labels (Psychiatric News, October 15, 2004; November 5, 2004).When the meeting had finally drawn to a close, the committee's stated desire to balance label warning language—directly within the black box at the beginning of the labels with language emphasizing the newly confirmed benefits of the medications for elderly patients and the dangers of leaving depression untreated—were seen by APA as somewhat of a victory."We welcome [the panel's] consensus findings," said APA President-elect Carolyn Robinowitz, M.D., in a prepared statement released December 14, 2006, the day after the hearing."The [PDAC] reported t wo very important findings," Robinowitz said. "First, untreated depression puts people at risk for suicide, and the label must reflect that fact; and second, antidepressant treatments show a protective effect for suicidality."Robinowitz also noted that the panel acknowledged preliminary data appearing to document "serious downsides to a previous label change—the black-box label on pediatric antidepressant use—adopted in 2004." Data from the Centers for Disease Control and Prevention (CDC) suggest that since the imposition of that warning, there has been an increase in the number of deaths by suicide in adolescents—a reversal of a decade-long decline in suicides among youth."This new CDC information and the advisory committee's own findings on the efficacy of antidepressants in adults send a clear message," Robinowitz said, "that antidepressant medications save lives.She added, "While we remain concerned about the impact of any addition to the black-box [warnings], we applaud the advisory committee's suggestion that, for the first time, the FDA place statements about both risks and benefits within the current black-box label. This will help physicians and patients make appropriate, informed decisions about any proposed course of treatment."At times the panel's deliberations seemed to mirror the complexity of the meta-analysis it had been asked to consider. By mid-day, PDAC members had not only absorbed a large amount of data and two separate and seemingly equal analyses with largely parallel conclusions, but also the words of the numerous mental health clinicians, researchers, patient and professional advocates, and patients and family members themselves who testified before the panel.Unlike the September 2004 meeting of the PDAC, at which the child and adolescent analysis was reviewed and where public comment was overwhelmingly in favor of restricting access to the medications, at last month's meeting 29 of 67 speakers spoke in favor of protecting access to antidepressant medications without increased warning language or restrictions on prescribing.During t he public-comment section of the PDAC meeting, Robinowitz, along with about 20 other speakers who had joined with APA and Mental Health America in a coalition of patient and professional advocacy organizations, urged the FDA to weigh carefully the potential negative impact of expanding the warning language and the potential barrier to care increased warnings could create (see Original article: page 10).Darrel Regier, M.D., M.P.H., director of the APA Division of Research and the American Psychiatric Institute for Research and Education, warned the committee that basing new FDA policy regarding warning language on the latest metaanalysis would be less than prudent."Relying on spontaneously reported adverse-event data from clinical trials without systematic suicide-risk assessment poses many problems," Regier said. "In fact, the current policy based on these data has led to black-box advisories, plummeting treatment rates, and undocumented `advice' on how to monitor any patient placed on antidepressant medications."Regier invoked the panel's own history to illustrate the profound importance of the panel's recommendations and the FDA's subsequent actions."If the FDA proves to have overreacted to the first round of pediatric data in 2004," he said, "the substantial reduction in prescription[s] of [antidepressant] medications for this at-risk population [that followed the imposition of the black box] may be seen as precipitating the recent CDC-documented increase in completed suicides in the adolescent population."Committee Seeks BalanceAfter the public-comment period, PDAC panel members had several hours of discussion and debate, only to get bogged down in a 45-minute discussion of whether they should in fact take a vote on their recommendations.In the end, all panel members agreed that the existing labels must be changed and that existing label language was far too negative, possibly resulting in access-to-care barriers.The panel recorded two official votes, the first unanimously endorsing the idea that the current label must be changed in light of the findings of the adult meta-analysis. However, when it came down to voting on the question of whether to recommend to the FDA that the changes be made within the black box, the panel voted 5-2 in favor of altering the existing black box.The import of the panel's final recommendations seemed lost on few, if any, in attendance."I cannot think of another example of a drug, or drug class, where we have ever approved language added to a label discussing the eventual outcomes of failing to treat a disease," Robert Temple, M.D., director of the FDA Office of Medical Policy, told panel members late in the day.The FDA is not bound to accept the recommendations of its advisory panels; however, the agency nearly always does.At a press briefing after the meeting, Thomas Laughren, M.D., director of the FDA's Division of Psychiatry Products noted, "I think we have a very good idea of what this advisory committee thinks. Its recommendations are clear, and I would say, it is likely the agency will follow them."▪ ISSUES NewArchived

Do Canada and the United States Differ in Prevalence of Depression and Utilization of Services?

10.1176/appi.ps.59.1.105

COVID-19 and Stress-Related Disorders.

Introduction/ObjectivesThe healthcare intake process plays a significant role in informing medical personnel about patients’ demographic information, subjective health status, and health complaints. Intake forms can help providers personalize care to assist patients in getting proper referrals and treatment. Previous studies examined factors that could be included in intake forms independently, but this study analyzed loneliness, religiousness, household income, and social integration together to see how the combined effect influences mental and physical health status. This study aims to determine which of those 4 variables better inform patients’ mental versus physical health status.MethodsOne hundred and seventy-nine participants completed surveys, including the SF-12® Health Survey, measuring perceived physical and mental health, UCLA 3-item Loneliness Scale, and a demographics questionnaire with questions about household income and time spent dedicated to religious practice, if applicable. Additionally, individuals answered social integration questions about how often they contact close family and friends or volunteer in the community. Using loneliness, household income, religiousness, social integration as independent variables, and controlling for demographic variables such as age, gender, and race, 2 regression models were built with Mental and Physical Health Composite Scores from the the SF-12® Health Survey as dependent variables.ResultsLoneliness was associated with mental health measures (b = −2.190, P < .001), while household income was associated with physical health measures (b = 0.604, P = .019) above and beyond other variables in the regression models.ConclusionsIntegrating the 3 loneliness questions into intake forms can help approximate an individual’s mental health status. This would allow the provider to be able to assess mental health problems more effectively and provide needed resources.

His voice is calm, but psychiatrist Richard Weisler, MD, sounds troubled after reading statistics from a rapid assessment survey of greater New Orleans, La, that was conducted 7 weeks after Hurricane Katrina splintered the homes and lives of hundreds of thousands of Gulf Coast residents. The assessment, prepared for the Louisiana Office of Mental Health by the Centers for Disease Control and Prevention (CDC), shows that 45% of 166 individuals interviewed scored high enough on a rating scale for posttraumatic stress disorder (PTSD) that they would be expected to accept a referral for mental health services. When extrapolated, that figure translates into between 142,000 and 214,000 adults returning to New Orleans who may feel they need mental health care.

The central place of psychiatry in health care worldwide.

County-Level Estimates of Need for Mental Health Professionals in the United States

Universal hepatitis B vaccination in adults aged 19–59 years: Updated recommendations of the advisory committee on immunization practices—United States, 2022