Reuters (8/5, Rapaport) reports researchers found “older women who are under a lot of social strain may be more likely to develop brittle, fracture-prone bones after menopause than their counterparts with worry-free lives.” The findings were published in Journal of Epidemiology & Community Health.
Related Links:
— “Social stress tied to lower bone density after menopause, “Lisa Rapaport, Reuters, August 05, 2019
Medscape reports that a large cohort study, published online July 22 in Depression and Anxiety, “of Israeli patients with cancer found that antidepressant adherence above 50% was associated with one quarter less mortality over four years compared with adherence below 20%.” Investigators “reported that any adherence above 20% was linked to increased survival over the four years of the study.”
Related Links:
— “Cancer Survival Linked to Antidepressant Adherence, “Helen Leask, Medscape, August 05, 2019
The Washington Post (8/5, Wan, Bever) reports that according to research, mental illness is not to blame for America’s mass shootings. In a 2018 report of active shooters, the FBI “found that 25 percent of active shooters had been diagnosed with a mental illness. And of those diagnosed, only three shooters had been diagnosed with a psychotic disorder.” Similarly, “in a 2015 study that examined 235 people who committed or tried to commit mass killings, only 22 percent could be considered” as having a mental illness. In addition, “a 2004 report conducted by the Secret Service and the Education Department found that only 12 percent of perpetrators in more than three dozen school shootings showed an interest in violent video games.”
The AP (8/5, Johnson) reports experts say that “Trump’s focus on ‘mentally ill monsters’ oversimplifies the role of mental illness in public mass shootings and downplays the ease with which Americans can get firearms, experts said.” Mental health experts “repeated what they have said after previous mass shootings: Most people with mental illness are not violent, they are far more likely to be victims of violent crime than perpetrators, and access to firearms is a big part of the problem.” The AP adds that “a country’s rate of gun ownership is a far better predictor of public mass shootings than indicators of mental illness, said Adam Lankford, a University of Alabama criminologist who published a 2016 analysis of data from 171 countries.” Meanwhile, “last month, the U.S. Secret Service released a report on mass public attacks in 2018, finding that ‘no single profile’ can be used ‘to predict who will engage in targeted violence’ and ‘mental illness, alone, is not a risk factor.’”
TIME (8/5) reports that physicians “across specialties are growing increasingly frustrated by” the linkage of mass shootings and mental illness by public figures and are “arguing for a stronger focus on gun control over mental health.” As a results of studies failing to find a link between mental illness and mass shootings, “an increasingly large and vocal cadre of doctors has been arguing for years that gun violence is more an issue of access and regulation than it is mental health.”
The Hill (8/5, Weixel) reports that “the country’s largest organization of psychiatrists on Monday pushed back against comments from politicians linking the most recent spate of mass shootings to mental illness.” In a statement, “the American Psychiatric Association (APA) said gun violence is a public health crisis, and noted that ‘the overwhelming majority of people with mental illness are not violent and far more likely to be victims of violent crime than perpetrators of violence.’” The APA said, “Rhetoric that argues otherwise will further stigmatize and interfere with people accessing needed treatment. Individuals can also be emboldened to act violently by the public discourse and divisive rhetoric.”
Related Links:
— “Experts: Mental illness not main driver of mass shootings, “Carla K. Johnson, AP, August 05, 2019
HealthDay (8/2, Preidt) reported researchers found that many American teens misusing prescription medications obtain them from multiple sources. The researchers “conducted two studies; the first one involved more than 18,000 high school seniors” and “found that about 11% of them said they misused prescription [medications] in the past year, and of those, 44% had multiple sources for the” medications. The second study involved “nearly 104,000 12- to 17-year-olds” and “found that the most common sources of prescription [medications] were: getting them free from friends and relatives, physician prescriptions for opioids, and buying stimulants and tranquilizers illegally.” Both studies were published in the Journal of the American Academy of Child and Adolescent Psychiatry, and can be found here and here.
Related Links:
— “Teens Are Getting Hooked on Leftover Prescription Meds, ” Robert Preidt, HealthDay, August 02, 2019
The AP (8/2, Ramer) reported that legislation “signed by Republican Gov. Chris Sununu” of New Hampshire “will require schools to develop policies on suicide prevention, response and risk assessment and to provide suicide prevention training for faculty, staff and volunteers.” The governor “described this year’s bill as part of a larger effort to rebuild the state’s mental health system.”
Related Links:
— “New Hampshire schools to develop suicide prevention policies, “Holly Ramer, AP, August 02, 2019
Healio (8/2, Michael) reported, “For adolescents with severe mental illness, consistent access to a single primary care physician during the transition from pediatric to adult care could ensure improved long-term outcomes,” researchers concluded. The findings of the 8,409-patient study were published online Aug. 2 in JAMA Network Open.
Related Links:
— “PCPs essential during transition to adult care in adolescents with severe mental illness, “Erin Michael, Healio, August 02, 2019
Healio (8/2, Demko) reported, “Anxiety disorders in pregnancy and the postpartum period were more prevalent than previously believed, with about” one in five “women meeting diagnostic criteria for an anxiety disorder,” investigators concluded in a 26-study, “multivariate Bayesian meta-analysis.” The findings were published online July 23 in the Journal of Clinical Psychiatry.
Related Links:
— “1 in 5 women have anxiety disorders in pregnancy, postpartum, “Savannah Demko, Healio, August 02, 2019
The following summary was prepared by Meiram Bendat, J.D., Ph.D., head attorney in this case:
On March 5, 2019, in a nationwide class action suit, the United States District Court for the Northern District of California held that United Behavioral Health (“UBH/Optum”), the country’s largest managed behavioral healthcare organization, illegally denied mental health and substance use coverage based on flawed medical necessity criteria.
The federal court found that, although required by the class members’ health plans to make coverage determinations consistent with generally accepted standards of care, UBH developed restrictive medical necessity criteria with which it systematically denied outpatient, intensive outpatient, and residential treatment. Specifically, the federal court found that UBH’s internal guidelines limited coverage to “acute” care, in disregard of highly prevalent, chronic, and cooccurring disorders requiring greater treatment intensity and/or duration. The court was particularly troubled by UBH’s lack of coverage criteria specific to children and adolescents. Additionally, the court held that UBH misled regulators about its guidelines being consistent with the American Society of Addiction Medicine (ASAM) criteria, which insurers must otherwise use in certain states such as Connecticut, Illinois, and Rhode Island. (The court also found that UBH failed to apply Texas-mandated substance use criteria for at least a portion of the class period.)
Although the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires parity for mental health and substance use benefits, insurers are permitted to evaluate claims for medical necessity. By applying internal guidelines or medical necessity criteria developed by for-profit, non-clinical specialty associations, however, insurers can easily circumvent parity in favor of financial considerations and prevent patients from receiving the type and amount of care they actually need. The consequences to patients can be devastating.
In his detailed ruling, Chief Magistrate Judge Joseph Spero found the following to be the generally accepted standards for behavioral healthcare from which UBH’s guidelines deviated:
1. It is a generally accepted standard of care that effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current symptoms;
2. It is a generally accepted standard of care that effective treatment requires treatment of co-occurring behavioral health disorders and/or medical conditions in a coordinated manner that considers the interactions of the disorders and conditions and their implications for determining the appropriate level of care;
3. It is a generally accepted standard of care that patients should receive treatment for mental health and substance use disorders at the least intensive and restrictive level of care that is safe and effective – the fact that a lower level of care is less restrictive or intensive does not justify selecting that level if it is also expected to be less effective. Placement in a less restrictive environment is appropriate only if it is likely to be safe and just as effective as treatment at a higher level of care in addressing a patient’s overall condition, including underlying and co-occurring conditions;
4. It is a generally accepted standard of care that when there is ambiguity as to the appropriate level of care, the practitioner should err on the side of caution by placing the patient in a higher level of care;
5. It is a generally accepted standard of care that effective treatment of mental health and substance use disorders includes services needed to maintain functioning or prevent deterioration;
6. It is a generally accepted standard of care that the appropriate duration of treatment for behavioral health disorders is based on the individual needs of the patient; there is no specific limit on the duration of such treatment;
7. It is a generally accepted standard of care that the unique needs of children and adolescents must be taken into account when making level of care decisions involving their treatment for mental health or substance use disorders; 8. It is a generally accepted standard of care that the determination of the appropriate level of care for patients with mental health and/or substance use disorders should be made on the basis of a multidimensional assessment that takes into account a wide variety of information about the patient.
The court acknowledged that accreditation by organizations such as URAC and NCQA does not entail substantive review of medical necessity criteria developed by insurers. Therefore, such accreditation does not guarantee use of medical necessity criteria that are consistent with generally accepted standards for behavioral healthcare or with the terms of insurance policies or any laws.
In light of the court’s findings, including that UBH’s experts (comprised of several of its own medical directors) “had serious credibility problems” and “that with respect to a significant portion of their testimony each of them was evasive – and even deceptive,” robust safeguards against abuses by managed behavioral healthcare organizations are clearly warranted, such as:
1. Legislation mandating exclusive adherence to medical necessity criteria developed by nonprofit, clinical specialty organizations such as the American Society of Addiction Medicine (ASAM), American Academy of Child and Adolescent Psychiatry (AACAP), and the American Association of Community Psychiatrists (AACP);
2. Formal recognition by the American Psychiatric Association that managed care psychiatric reviewers owe a primary ethical obligation to insureds, consistent with: a. AMA Principles of Medical Ethics: I,III,VII and AMA Code of Medical Ethics Opinion E-10.1.1 (https://www.ama-assn.org/delivering-care/ethicalobligations-medical-directors) and b. their fiduciary duties under ERISA (https://www.dol.gov/general/topic/retirement/fiduciaryresp).
Today’s ruling stems from two consolidated class actions, Wit et al. v. United Behavioral Health. and Alexander et al. v. United Behavioral Health, brought by Psych-Appeal, Inc. and Zuckerman Spaeder LLP under the Employee Retirement Income Security Act of 1974 (“ERISA”) in 2014, certified in 2016, and tried in October 2017. While the certified classes encompass tens of thousands of ERISA insureds, non-ERISA insureds (such as governmental employees) adversely impacted by UBH’s defective guidelines must rely on state and federal regulators to intervene on their behalf.
Related Links:
In a piece directed to parents, HealthDay (8/1, Canter) reports, “Young” female athletes “who eat too little risk menstrual irregularity, weak bones and eating disorders.” Some sports appear to be “riskier than others” when it comes to eating issues, “namely those that involve endurance or weight-classes and those that emphasize appearance, especially thinness.”
In another parent-focused piece, HealthDay (8/1, Canter) reports, “Exercise has many health benefits for boys,” but “some sports come with cautions, especially those with weight classes that could lead to excessive dieting or even anorexia.” A physician’s “evaluation is important if you see signs for concern.”
Related Links:
— “Is Your Daughter, the Athlete, Eating Enough?, ” Len Canter, HealthDay, August 01, 2019
Healio (8/1, Miller) reports, “High remission rates were observed in patients with three or more follow-up visits after routine depression screening and treatment,” researchers concluded after utilizing “VitalSign6 – a software program that utilizes the PHQ-9 screening tool and supports treatment decisions – on a convenience sample of 25,000 patients (mean age, 40.88 years) who were previously screened with the PHQ-2.” The findings were published in the July/August issue of the Annals of Family Medicine.
Related Links:
— “Remission rates high among patients with multiple follow-up visits for depression, “Janel Miller, Healio, August 01, 2019