October 23, 2024

By Courtney Wise

Plus, a psychiatrist’s advice on how to maintain a healthy sex drive while living with depression.

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Psychiatric street teams in LA try ‘practice-based evidence’ to reduce homelessness

Psychiatrist Shayan Rab wants to get LA’s unhoused off of the streets. But in a departure from the ‘build more housing and they will come’ position that’s dominated the discourse, he’s advocating for medically stabilizing unhoused people with severe mental illness on the streets first—before they move into a home. As associate medical director of Los Angeles County’s Homeless Outreach & Mobile Engagement program, he told the New York Times that his team created something akin to an outdoor psychiatric hospital, or “DoorDash for meds.” 

Their process sends teams of psychiatrists and psychiatric social workers into tent communities, alleyways, and underneath highway overpasses to persuade people with severe mental illness to begin a medication regimen. Though refusals are common and frustrating, he urges teams to keep going back. “Please do not be discouraged — even after the fourth or fifth refusal, someone will accept it,” Rab told fellow psychiatrists at a gathering of the American Psychiatric Association last spring. “Wait for them to trust you enough to say yes.”

He and other advocates of street psychiatry have accrued proof through the lives of people like Eric Covington that their work makes a difference. It took five months of visits from social worker Allen Ziegler for Covington to feel safe enough to share what led him to life on an LA underpass. It would take several more to get him mentally stabilized enough to move into a home. As their work continues, street psychiatrists record more stories like Covington’s each day.

Still, patients’ rights activists say it’s out of order to medicate people before it’s clear that they can consent to be medicated. Others reject the strategy, arguing it’s too unproven to veer so far from standard practice. Psychiatrists add that long-acting antipsychotics are extremely powerful, leaving some people sedated after injection — and vulnerable to harm, if they live on the streets. Others argue street psychiatry is too expensive; the same funds could build more housing.

But Curley Bonds, chief medical officer of Los Angeles County’s Department of Mental Health, said he’s seen enough Eric Covingtons to stand on “practice-based evidence”. Much of it is born of the risk taken by psychiatrist James Rodney Jones six years ago, when he first injected an unhoused woman with a long-acting injectable antipsychotic. His goal was to reduce homelessness; the county cautiously approved after considering how much spending could be reduced on a mentally ill homeless population cycling in and out of emergency rooms throughout the year. Last year, the street psychiatry team that Jones started served 1,919 people, 22 percent of whom ended the year with housing. Roughly 10 percent were treated involuntarily.

“There needs to be more dialogue about how it’s OK to break some of the rules,” said Bonds, referencing the field’s standards which discourage street psychiatry. “The rules don’t apply when someone has been on the street for 10 or 15 years and has difficulty engaging. You just can’t sit in your office waiting for those folks to show up for an appointment.” 

To that, housing-first advocates say research already shows homelessness can be reduced by simply providing housing for people on the streets. Treatment can be given once housed, making the time and money spent on street psychiatry an unwarranted expense, said Enrico Castillo, associate professor of clinical psychiatry at UCLA. “It’s a lot of money being spent before we have evidence,” he said.

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Ongoing war in Congo leaves behind mounds of untreated mental illness 

It’s not long ago that Nelly Shukuru’s neighbor in eastern Congo saved her life. Overwhelmed by the bleak conditions created by a war that has displaced millions, Shukuru told the Associated Press that she planned to hang herself. Forced from home and stuck in a fetid displacement camp, she felt the daily horror was inescapable. A neighbor stopped her just in time. “In my mind, the suffering was permanent,” said the mother of six, seated in a health clinic. “The people who have died are better off than I am.”

Her sentiments are shared by thousands more in the region. Between January and June last year, roughly 6,600 of the 600,000 people sheltered near Goma received mental health support. This year, that number catapulted to more than 20,000, according to Action Against Humber. Likewise, the number of people disclosing suicidal ideation leapt from five per month at the start of 2024 to more than 120 now. More than anything, people are experiencing anxiety, depression, post-traumatic stress disorder, and insomnia — with a sizable number battling substance abuse in an effort to forget the trauma. “All around us there is war, and the number of people facing difficulty is increasing daily,” said Innocent Ntamuheza, a psychologist with Action Against Hunger.

The need for psychological support is great, but largely unavailable. Calling the situation in Congo one of the world’s most neglected crises, the United Nations said that less than 30 percent of the $180 million requested for Congo’s humanitarian support and protection — which entails mental health services — has been funded. 

In the meantime, some aid groups are working to train locals in mental health first aid, teaching people to recognize the signs of a mental crisis and guiding people to help. Those who have received services say they’ve learned helpful strategies, including breathing techniques, to manage anxiety and harmful thoughts.

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New study finds we humans, being overconfident, tend to believe we are right when we are wrong

A new study finds that we humans are hardwired to believe that we are right when we are wrong. “Our brains are overconfident that they can arrive at a reasonable conclusion with very little information,” Angus Fletcher, an Ohio State University professor and coauthor of the study, told NBC News.

The study included nearly 1,300 people with an average age of 40. Everyone read a fiction narrative about a school that was running out of water because its local aquifer was drying up. The information provided about the issue varied across three groups:

Five hundred people read a narrative in favor of the school merging with another school, including three arguments supporting the merger and one neutral point. Another 500 people read a story with three arguments in favor of remaining separate, with the same neutral point. The control group of 300 people read a balanced story that included all seven arguments.

After reading, participants were asked their opinion about the right thing to do, and if they felt they had all necessary information to make a right conclusion. Most who read only one side of the issue agreed with the argument they read and believed they had enough information to be right. 

At that point, half of those given only one side were given the other side to read. Researchers then resurveyed their opinions on the issue. Participants who read all of the arguments were more willing to concede points or change their mind. They also felt less confident about their ability to form a right opinion on the subject. 

“People are more open-minded and willing to change their opinions than we assume,” Fletcher said. Unfortunately, he added that the willingness to change one’s mind does not apply to long held personal beliefs, like politics. 

The team concludes the study still offers a reason to be optimistic about our potential for change when presented with new information. The danger we face is “inattentional blindness,” or the tendency to not realize something obvious due to being already focused on something else, said Barry Schwartz, a psychologist and professor emeritus in social theory and social action at Swarthmore College. The hope we have is in being curious and humble, he said.

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In other news…

When I burn toast and the fire alarm goes off, my toddler niece runs around screaming, “Ow, ow! It hurts my ears!” The distress she feels at the sound of a sudden, piercing shriek is similar to what people with misophonia feel at the sound of people eating. The condition marked by an intense reaction to the sound of chews, slurps, and swallows was recently found to be more common than previously thought — and linked to mood disorders. Science alert reports that researchers at the University of Amsterdam analyzed genetic data from the Psychiatric Genomics Consortium, UK Biobank, and 23andMe database and found that people who self-report misophonia are more likely to have genes associated with anxiety, depression, and PTSD. Interestingly, they are also more likely to have tinnitus, a condition in which people hear a constant, sharp ringing in their ears. 

What to do if depression is affecting your sex life: Depression makes it hard to feel motivated to do anything, including fun stuff that you used to enjoy, like sex with your partner. Writing in to the Washington Post, one reader sought professional advice on how to get their mojo back, as the lack of physical intimacy began to undermine their marriage. Their biggest concern was how to navigate depression and sex without antidepressants, over a fear that the medication would reduce their libido even more. To that, psychiatrist Gregory Scott Brown said depression is still important to treat, especially as some antidepressants, like Prozac and Wellbutrin, are associated with improved sex in some people. 

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If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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