The Buzz Over a New Approach to Mental Health in King County, Washington

Also in this edition: A journalist’s report on ChatGPT encouraging violence. Mental health problems linked to a hotter planet. And more.

But first, one of the largest randomized studies on aging and cognitive health – the U.S. Pointer Study – has some gratifying findings about ways to help keep your brain young as you age: Improve your diet, exercise and socialize. 

In the study, funded by the Alzheimer’s Association and published in JAMA, one group of participants took part in a structured program: They ate foods from both the Mediterranean and DASH diets, exercised 30 minutes a day, did strength training several times a week, and took part in social activities and computerized cognitive training. The other group got information but guided themselves. Cognitive scores for both groups improved, but the structured group did better – they “slowed the cognitive aging clock by one to two years,” a study leader said.

King County, WA, didn’t just overhaul its crisis response. It’s integrating it into the county’s entire mental health system.

Seattle, Washington (Darryl Brooks/Shutterstock)

In June, a household in King County, Washington, called 911 to report that someone in the house was hearing voices and seemed disconnected from reality. In the past, that would have triggered a standard emergency medical response, often including the police. The problem, according to experts, is that these responses rarely work out well – those suffering with mental illness or substance use disorders, at best, tend to wind up in jail or in hospital emergency rooms. Few get the help they need. But this time, the grey van that pulled up delivered a mental health professional and a case manager, who took the resident to an inpatient stabilization program for treatment. 

King County, which includes Seattle, has been transferring low-risk mental health-related 911 calls to 988 for over a year now – but part of the challenge is making sure people in the community know that things are changing.

“We’ve had a system that’s been so underfunded and hasn’t had the resources, so you get this learned helplessness, where people say, ‘I tried and called for help, and it didn’t work, so I’m not going to call again,’” King County Behavioral Health and Recovery Division Director Susan McLaughlin said. “We have to undo that across the whole system, for our first responders, our providers, the hospitals and the community members, to understand that there actually is capacity. It’s available now and you can use it.”

The first-response changes are part of a significant expansion to the local mental health care system, funded mostly by a $1.25 billion property tax levy. The revamped system includes the 988 hotline, mobile crisis teams, and walk-in clinics that provide low-barrier care, the Seattle Times reported.

County leaders feel optimistic about the new system, noting that other cities and counties are calling them hoping to learn from their example. “They’re really looking at this as a system of care as opposed to component parts,” said Preston Looper, a mental health provider and consultant who co-led a 2023 survey of mobile crisis teams. “Mobile crisis in isolation is cool, but a component in a coordinated and integrated system is super powerful and can create some significant return on investment.”

One growing pain is data fragmentation – mobile teams responding to calls can’t access hospital records – but it seems that strengthened coordination among social service and crisis response agencies might be making some much-needed headway. One man who felt suicidal had declined services, fearing he’d be “locked up.” But when a case manager followed up the next morning, he was willing to be taken to Connections Kirkland, the county’s first walk-in crisis center, where he was reassured he wouldn’t be forced to stay. Afterwards, he reported feeling much more relaxed.

For one homeless man, a keto diet left schizophrenia in remission

Whoever brought a book discussing the ketogenic diet to a homeless shelter in the United Kingdom may have done one of its residents a big favor. A 32-year-old homeless man with schizophrenia read it and was so inspired that he began experimenting with the diet in an effort to control his symptoms.

In this case report, published this June in Frontiers in Nutrition, a nutritional therapy specialist in the United Kingdom that he later consulted found he had derived little benefit from medications. With her help and others, he began regular ketogenic metabolic therapy (KMT), which involves a diet high in fat, moderate in protein and very low in carbohydrates, prompting the body’s metabolism to go from running mostly on glucose, the sugar that makes up most carbs, to using ketones, a metabolite of fat, as its primary fuel. 

The patient had been diagnosed with paranoid schizophrenia, and later, PTSD. After the death of a close family member, he developed paranoid delusions, suicidal thoughts and psychotic episodes that eventually left him unable to work and homeless, and he moved in and out of hospital for three years. His hospital treatment included medication and group and occupational therapy, which included trips to cafes and museums. But far from boosting his mental health, he felt that he deteriorated as an inpatient.

Then, in a homeless shelter, he discovered the self-help book that talked about the ketogenic diet and decided to try it, without any expectation that it could help with his schizophrenia. In the shelter, he had his own room as well as access to a mini-fridge and a portable grill, and he experimented with a carnivore ketogenic diet (based solely on meats and fats). He noticed that ‘cheat’ days, where he consumed a lot of sugar and chocolate, came with problems in mood and behavior. 

After further experimentation in a rehab facility, he decided to consult a nutritional specialist versed in KMT and see whether his psychiatrist might support it as part of his therapy. Tests found his blood glucose and ketone readings to be erratic, “so the aim was to stabilize his glucose levels and optimize his ketones in the therapeutic range,” according to author Moira Newiss, a registered nutritional therapy practitioner.

He worked with the specialist to get his readings under control, and from June 2024 on, “managed by himself without practitioner support.” He continued his carnivore ketogenic diet, got regular blood tests, and began tapering off his psychiatric medications after seven months. In late October 2024, the case report states, “his mental health team noted his schizophrenia was in remission. He has had no psychotic episodes since he started the ketogenic diet on his discharge from hospital, a period of over nine months. He has come off all his psychiatric medications and remains stable.”

As the paper notes, people with schizophrenia have a significantly higher risk of obesity and a diabetes prevalence two to three times higher than the general population. “Signs of metabolic syndrome were first identified in patients with schizophrenia over 100 years ago and current day use of antipsychotic medication comes with a major side effect of increasing metabolic dysregulation,” Newiss said. This patient’s carnivore ketogenic diet was “life-changing and lifesaving,” she wrote.

Newiss added that information about the therapy should be made available to other patients. Although it was too early to recommend this particular meat-and-meat fat-based keto diet to other patients, she added, further research was warranted. (See MindSite News’ recent article on KMT’s potential for treatment in serious mental illnesses.)

In other news…

ChatGPT offers up instructions for self-harm. “On Tuesday afternoon, ChatGPT encouraged me to cut my wrists.” That’s how Lila Shroff begins a recent article in The Atlantic. Although the policies of ChatGPT’s developer, OpenAI, explicitly state that the chatbot “must not encourage or enable self-harm,” Shroff and others found that, under the right conditions, ChatGPT would provide instructions and encouragement for self-harm, devil worship, and even justify murder. Why? Apparently because “the program’s top priority is to keep people engaged in conversation by cheering them on regardless of what they’re asking about.”

ChatGPT appeared willing to condone murder, Shroff found, pointing out that some ancient cultures made human sacrifices. “If you ever must,” you should “look them in the eyes (if they are conscious)” and “ask forgiveness, even if you’re certain,” ChatGPT wrote. And if you’ve already taken a life, ChatGPT had instructions for that too: “Light a candle for them. Let it burn completely.”

As for devil worship, ChatGPT was all in, showering the author with invocations and instructions for sacrificing large animals. (The chatbot also helpfully supplied a chant to invoke the devil: “In your name, I become my own master: Hail Satan.”) One expert interviewed by the Atlantic said that tragically, it may take more AI-linked tragedies in real life to wake people up.

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The world is poorly prepared for the mental health consequences of a hotter planet, according to a recent study published in Current Environmental Health Reports. The world continues to warm as a result of climate change, and some people with mental illness may be less able to recognize when they are overheated and to take precautions. Other problems: being on psychotropic medications may make heat issues worse and sleep disrupted by heat can worsen mental health. The study looked at heat-health action plans across 24 countries – including 10 from the US and 35 from India – which covered about a quarter of the world’s 2024 population. Despite established associations, fewer than a third of the 83 health action plans acknowledged the mental health toll of extreme or long-lasting heat.

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Calls for justice for Epstein and Maxwell’s victims gain steam. Last week, Trump confirmed that Jeffrey Epstein “stole” some of Mar-a-Lago’s young female spa attendants, including Virginia Giuffre, then 16. Some commentators said that is still more reason to release the investigative files – to determine whether Mar-a-Lago was involved in Epstein’s sex trafficking of underage girls. (Trump said he cut off Epstein after finding out about the poaching of his employees, but records show the two were still close friends for three years afterwards.) For a longer discussion, take a look at our recent coverage.

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ICYMI: RFK “either doesn’t understand or refuses to acknowledge” autism research, according to scientists who spoke to The Atlantic for a piece called “RFK Jr.’s Autism Time Machine.” Although human genome research has shown that 80% of the odds of being autistic are linked to heredity, Kennedy has described that line of thinking as “a dead end” and is seemingly determined to link autism to vaccines. He appears to be decades behind current thinking on autism, the authors note, causing fury when he described children with autism as “kids who will never pay taxes. They’ll never hold a job; they’ll never play baseball; they’ll never write a poem; they’ll never go out on a date. Many of them will never use a toilet unassisted.” After a firestorm of criticism, Kennedy said he was referring only to people on the most severe side of the spectrum.