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Reinventing the E.R. for America’s mental-health crisis

newyorker.com

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Re: Reinventing the E.R. for America’s mental-health crisis

#61

Post by NoZebra120vClip »

lostNFound wrote: post #43
jdietrich wrote: post #31

The facilities described in this article seem to be broadly similar to a "psychiatric intensive care unit", a care concept that has been developed in the UK and Australia in recent decades. If you've ever been in an emergency department, you'll know that it's far from ideal if you're experiencing an acute mental health crisis. EDs are often noisy, chaotic, and aren't equipped to provide the continuity of care and sup…

Just a tiny nitpick to avoid confusion, but a PICU is already a thing and it means Pediatric ICU, not psychiatric.

Would ΨICU be mistaken for a fraternity?

Re: Reinventing the E.R. for America’s mental-health crisis

#62

Post by NoZebra120vClip »

bill_joy_fanboy wrote: post #36
zer8k wrote: post #18

Earlier quoted context omitted.

Is there a rise in mental illness or more people simply being diagnosed now? We're more aware of mental illnesses, leading to more diagnoses, leading to what appears to be a spike in mental illness. I haven't dug deeply into this but I wonder if studies on this have attempted to separate the two. Psychology is notorious for it's crisis of reproducibility. I take everything related to mental illness with two heaping s…

One way to cut the nonsense is to look at things that can't be fudged. Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. The rate for suicide was something like 10/100K in 2001 and is hovering at 14/100K now. This is a significant increase. If more people are killing themselves, it's almost certain that there are far more people are also miserable or struggling than the…

If suicide is directly correlated to mental illness, then what of euthanasia and assisted suicide? Anyone who applies to end their own life would be incompetent to make that choice, due to mental illness.

Re: Reinventing the E.R. for America’s mental-health crisis

#63

Post by edrxty »

1234554321a wrote: post #44
outlace wrote: post #16

Something is seriously wrong with our culture the past 10-15 years to have contributed to such a dramatic rise in mental illness.

20 years ago a mental illness, now they changed the name and it’s not an illness anymore so everything is ok.

Do you mind elaborating on what you're referring to so I don't have to assume the worst?

Re: Reinventing the E.R. for America’s mental-health crisis

#64

Post by mvncleaninst »

zer8k wrote: post #21
ksenzee wrote: post #11

Earlier quoted context omitted.

Contrary to the stereotype, most Americans have health insurance that covers inpatient and outpatient mental health care. That's why we can't get a universal socialized system implemented: too many Americans already have good enough insurance that they don't want to change it.

The problem is the people who need help most won't seek it because it will get them labeled. There are plenty of mental illnesses that create situations where doctor-patient confidentiality has to be breached (legally). This restricts their care. A more mundane example, in some states with red flag laws a lawful gun owner could potentially introduce liability by seeking a diagnosis for depression or anxiety. Even if…

The people who need help most can be legally compelled by a court to receive it

Saying that someone with anxiety "needs help most" is unconvincing given the presence of psychotic homeless who aren't receiving treatment because of limited capacity or lack of financial incentive

I really don't understand your comment: why does a violent, untreated psychotic "need help less" than a neurotic who rejects the help for legal reasons?

Re: Reinventing the E.R. for America’s mental-health crisis

#65

Post by dredmorbius »

bill_joy_fanboy wrote: post #36
zer8k wrote: post #18

Earlier quoted context omitted.

Is there a rise in mental illness or more people simply being diagnosed now? We're more aware of mental illnesses, leading to more diagnoses, leading to what appears to be a spike in mental illness. I haven't dug deeply into this but I wonder if studies on this have attempted to separate the two. Psychology is notorious for it's crisis of reproducibility. I take everything related to mental illness with two heaping s…

One way to cut the nonsense is to look at things that can't be fudged. Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. The rate for suicide was something like 10/100K in 2001 and is hovering at 14/100K now. This is a significant increase. If more people are killing themselves, it's almost certain that there are far more people are also miserable or struggling than the…

NB, this the fundamental reasoning behind Emile Durkheim's seminal and foundational work on sociology, Suicide: A Study in Sociology (Fr.: Le Suicide: Étude de sociologie, 1897).

The reasoning being that it's very difficult to hide bodies, and that statistics on suicide tend to point to some very deep-rooted pathology within a society.

Yes, it's possible to fudge those statistics somewhat (the distinction between "accidental" and "intentional" deaths being salient), but far less so than other indicia of psychological trauma, particularly at population levels (the focus of sociology).

https://en.wikipedia.org/wiki/Suicide_(Durkheim_book)>

Re: Reinventing the E.R. for America’s mental-health crisis

#66

Post by dredmorbius »

NoZebra120vClip wrote: post #62
bill_joy_fanboy wrote: post #36

Earlier quoted context omitted.

One way to cut the nonsense is to look at things that can't be fudged. Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened. The rate for suicide was something like 10/100K in 2001 and is hovering at 14/100K now. This is a significant increase. If more people are killing themselves, it's almost certain that there are far more people are also miserable or struggling than the…

If suicide is directly correlated to mental illness, then what of euthanasia and assisted suicide? Anyone who applies to end their own life would be incompetent to make that choice, due to mental illness.

Those modalities should be discernable when looking at data by age (assisted death tends to occur at older ages) and, with a slightly greater data burden, comorbidities.

When looking at data, an otherwise healthy 20 year old, and an 80-something with multiple chronic and/or terminal Dx's, would stand out.

The challenge in looking at population-level data is that the Dx may well not be available, though other indicia might suggest this (e.g., residence is an assisted-living or long-term care facility). In practice, studies are frequently limited to available data, and proxies are frequently used. These may not be appropriate for specific individuals, but at scale, the law of large numbers and general correlation are your friends.

Re: Reinventing the E.R. for America’s mental-health crisis

#67

Post by zer8k »

mvncleaninst wrote: post #64
zer8k wrote: post #21

Earlier quoted context omitted.

The problem is the people who need help most won't seek it because it will get them labeled. There are plenty of mental illnesses that create situations where doctor-patient confidentiality has to be breached (legally). This restricts their care. A more mundane example, in some states with red flag laws a lawful gun owner could potentially introduce liability by seeking a diagnosis for depression or anxiety. Even if…

The people who need help most can be legally compelled by a court to receive it Saying that someone with anxiety "needs help most" is unconvincing given the presence of psychotic homeless who aren't receiving treatment because of limited capacity or lack of financial incentive I really don't understand your comment: why does a violent, untreated psychotic "need help less" than a neurotic who rejects the help for lega…

My point was the breach of doctor-patient confidentiality. Which destroys the foundation of trust therapy requires. Being "legally compelled" to get help does not mean that help will be received. Forced compliance has never worked. There's plenty of history to back up that statement. I don't understand if you're trying to show how much you know about mental health or something but it appears you missed the greater point.

Re: Reinventing the E.R. for America’s mental-health crisis

#68

Post by stevenicr »

obblekk wrote: post #47

There’s gotta be some reason for the mental health crisis, along with all the other crises out there. It doesn’t make sense for every level of American to be meaningfully wealthier and higher income than 20 years ago and yet also be suffering (in multiple ways!) more as well. We even (mostly) fixed health insurance by massively redistributing income! The rest of the world seems to be tracking the same trends but 10 y…

"every level of American to be meaningfully wealthier" - I don't get this statement. I know a few people who own homes / property and they could perhaps qualify for this statement - but that gets into the weeds of they don't have that money in hand - sure they could sell, but they can't rebuy in the same city. Yeah second mortgages and of course when they die the property could convert to cash.. but they don't get to live much wealthier in general..

Most people I know that do not own property are doing much worse today than they were 10 years ago, and 15 years ago - everything is more expensive, and they do not earn much more.. they would be better off going back 15 years with what they earned then and pricing for housing / food / cars being what it was.

I'm wondering in what parts of the country that this is inverse.

Re: Reinventing the E.R. for America’s mental-health crisis

#70

Post by ISL »

seltzered_ wrote: post #27

The article has an insert section stating "Get Support If you are having thoughts of suicide, call or text 988" It's worth noting that this number has been associated with police interventions and a rise in psychiatric detentions: https://www.madinamerica.com/2023/05/psychiatric-detentions-...

Might it also be associated with fewer deaths?
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