Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

newyorker.com

Post reply on HN
Print view View original

81–90 of 113 posts

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

#81

Post by NoZebra120vClip »

bill_joy_fanboy wrote: post #78
dredmorbius wrote: post #66

Earlier quoted context omitted.

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…

Like you said, I think looking at younger ages is sufficient. In 1999, teen (15-19) suicide was at around 8/100k, and it's now around 11/100k. It's lower in absolute numbers than in the general population, but there's still a disturbing uptick. https://www.charliehealth.com/research/the-us-teen-suicide-r...

It would be interesting to know how many people committing suicides were on SSRIs or antipsychotics, etc. at the time. These drugs are known to induce suicidal ideations (and ideations of violence, aggression, and homicide) and have carried black-box warnings. Sometimes, the cure is worse than the disease. Oh sorry, not a cure.

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

#82

Post by NoMoreNicksLeft »

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…

> Suicide is an example. You can't "overdiagnose" suicide unless you outright lie that it happened.

But you can do that. Throughout much of the 20th century (in the United States, at least), the cops might be willing to just call it an accident (he was cleaning his gun) or an unsolved homicide. Ostensibly to spare the family shame or to allow the family to bury them in the cemetery of their choice.

Furthermore, there seem to be factors that cause upswings and downswings in the suicide rate. There were alot more people jumping out of skyscraper windows in 1929 and 1930 than there were in 1925 and 1926, for instance (though we might expect the opportunity to have been roughly the same). Now, that doesn't directly rebut your argument here. But it would mean you'd need to show that if there is an upswing today that it has lasted longer or otherwise been worse than similar ones in the past, or that it doesn't seem to have the same sorts of causes.

If possible, it might actually be better to pick some other measurable event/behavior than suicide. Psychotic breaks, schizo episodes, or voluntary commitment.

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

#83

Post by NoMoreNicksLeft »

willcipriano wrote: post #2

Alternative title: "Bringing back the asylums without admitting we were wrong about closing them"

Not that anyone ever did the mentally ill any favors when they were tossed out on the street...

But it wasn't wrong to close them. They were torture dungeons where the government warehoused undesirables that it wasn't allowed to euthanize because we were supposed to be the good guys. Even now, they're literally a horror movie cliche... that doesn't happen by accident, it doesn't happen unjustifiably.

If you think that people want to bring them back without admitting that society was wrong to close them in the first place, how much of that is "I want the homeless to stop shitting on my front door stoop in San Francisco"?

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

#84

Post by rootw0rm »

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.

I propose πCU

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

#85

Post by NoMoreNicksLeft »

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…

> There’s gotta be some reason for the mental health crisis, along with all the other crises out there.

Evolution adapted you and everyone else out there to live in a small band of 50-200 people who only had occasional contact with other bands of about the same size. You do not have the psychological machinery to deal with more than that. Because humans are intelligent, and can learn to compartmentalize, we've scaled to a global civilization of 8 billion, most of whom live in constant daily contact with thousands of others, including direct contact with strangers.

This causes psychological malfunction, especially in those experiencing other sources of stress. Non-genetic hereditary factors contribute greatly. Cycles of abuse, dysfunction, and so on.

The world population has doubled even since I first learned what it was in grade school. And, soon enough, it will crash in the other direction, further confusing and causing strife.

Humans don't scale.

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

#86

Post by noelwelsh »

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.

The root cause is, I think, inequality. See, for example, https://equalitytrust.org.uk/health

"A much higher percentage of the population suffer from mental illness in more unequal countries; differences in inequality tally with more than triple the differences in the percentage of people with mental illness in different countries.

Rates of depression in US states are associated with income inequality (after adjusting for income, proportion of population with a college degree and proportion over 65). The more unequal the state, the higher the prevalence of depression."

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

#87

Post by teekert »

zer8k wrote: post #18
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.

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…

Yesterday I spoke to a couple, they were having second thoughts about their holiday because there was no mobile internet and no wifi and they booked a week. At first I though their kids (11 and 16) were complaining (couldn't imagine otherwise), but no, it was the 40 y/o parents.

That's what addiction looks like to me, my wife and me were pretty shocked.

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

#88

Post by alex_lav »

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.

I believe it is very clearly social media. Humans aren’t intended to have fake-insights into what people around them pretend to be doing

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

#89

Post by NoZebra120vClip »

noelwelsh wrote: post #86
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.

The root cause is, I think, inequality. See, for example, https://equalitytrust.org.uk/health "A much higher percentage of the population suffer from mental illness in more unequal countries; differences in inequality tally with more than triple the differences in the percentage of people with mental illness in different countries. Rates of depression in US states are associated with income inequality (after adjustin…

> income inequality

Then is this the corollary to "Money Can't Buy Happiness"?

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

#90

Post by LilBytes »

nmfisher wrote: post #37
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.

I can't talk about culture but in Australia, this definitely correlates with the spread of methamphetamine. Meth-induced psychosis is a very real thing.

Hard to say if positive outcomes for the average person in Australia started to decline before or after meth increased.

From my anecdotal (but significant observations), there's a coroally with people taking up hard drugs in townships where our youth have no observable pathways to a content adult life. It's my hypothesis people are giving up before they've started.

Regional Victoria and Regional Queensland, it's especially rife.

Edit: not to say other regional townships are worse or better, just haven't spent a significant enough time to observe it.

Post reply on HN