At LA General, Unrestrained Use of Restraints

Monday, October 23, 2023

By Don Sapatkin

In Brooklyn, a neighborhood is splitting over what to do about an aggressive mentally ill man. Insurers howl over President Biden’s plan to force them to improve mental health coverage. And the next wave of marketing messages to parents may be for toys that make kids more emotionally resilient.

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L.A. General puts psychiatric patients in restraints at 50 times the national rate

Marcelus Laidler, a Los Angeles man with schizophrenia and bipolar disorder, has been put in restraints so frequently at Los Angeles General hospital that his ankles and wrists are scarred. “I have nightmares I’m being restrained,” he told the Los Angeles Times. The safety net hospital’s psychiatric unit restrains patients 50 times as often as the average rate for inpatient psych units across the country, a Times investigation found. (Note: the story is behind a paywall.) The numbers doubled from 2020 to 2021, while barely changing at some similar California facilities.

At least 200 times from 2018 to 2021, a patient has been restrained for 24 hours or more in the same month, according to reports submitted by the hospital to federal regulators. Nearly 40 spent the equivalent of a week or more in a single month in restraints, including one woman who was restrained for an entire month.

Hospital officials told the Times that a small number of extremely violent patients inflated restraint rates and that comparisons with other psychiatric units were unfair. The public hospital, located near L.A.’s Skid Row, takes the poorest and most vulnerable patients, officials said, and some have histories of assaults or have threatened to kill staff members. The medical center’s psych unit is also overloaded with patients who should be in state hospitals, they added.

But many experts contacted by the Times weren’t buying these explanations. The patient population is challenging, said Roderick Shaner, a former medical director of the county’s Department of Mental Health, but that doesn’t justify such massive use of restraints. “It justifies the need for sophisticated management of behavior,” he said. And Elyn Saks, a USC law professor who has studied the use of restraints, questioned the notion “that patients in L.A. are more seriously psychotic and dangerous than patients at a general hospital in San Francisco.”

The use of restraints is seen by mental health experts as a last resort that traumatizes patients with mental illness and weakens their trust in the very staff members who are trying to help them recover. Patients can be restrained in a variety of ways. Medical staff may strap patients’ arms and legs to a bed or tie their wrists and ankles so that they can still walk. L.A. General would not tell the Times the specific types of restraints that it uses. Federal law allows hospitals to restrain psychiatric patients only if needed to stop them from harming themselves or others.

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A man with mental illness is harming people. What’s a neighborhood to do?

Elizabeth Whitcomb had just noticed a man walking beside her in the Greenpoint neighborhood of Brooklyn last spring when he suddenly grabbed her shoulder and pushed her. Although not hurt, she was scared and confused. When she posted about the incident on Reddit the next morning, several people responded with similar experiences with the same man. Records show the seriously mentally ill man has been in and out of hospitals and jails multiple times and has been charged with harassment, groping and assault.

He has now become the subject of email chains, meetings with local officials and multiple Reddit threads as people in the gentrifying, working-class neighborhood debate what should be done. Assaults by and against him have forced some in the neighborhood to scrutinize their beliefs about the mental health and criminal justice systems. Reporters for the Gothamist interviewed more than a dozen people who live or work in Greenpoint, a neighborhood of 35,000 which was already grappling with the pressure of new development that has brought progressive newcomers into an older, conservative conclave.  

The story is repeated in neighborhoods around the city and elsewhere, as people grappling with mental illness, homelessness, or both cycle endlessly between jails, hospitals and the street. Gothamist breaks down Greenpoint’s fault lines and conveys the fears and frustrations of people who live there as they consider what should be done about a troubled man who grew up in the Greenpoint neighborhood.

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TalkingReallyFast could be a sign of a mental health condition

My wife thinks I sometimes interrupt and talk too much, barreling ahead to make points that I, at least, find fascinating. So I asked her what she thought of a Washington Post article about how overtalking could be rooted in mental health conditions like ADHD. (I’ve been diagnosed.) To my surprise, she didn’t think it was related. (Apparently, I’m just annoying for other reasons.)

Garrulousness could be just a personality trait, and it probably is in most cases. But two psychiatrists, a licensed clinical psychologist and a biologist working in autism told the Post it also could be a sign of generalized anxiety disorder, bipolar disorder, autism spectrum disorder and ADHD. They make clear that unusual talkativeness doesn’t necessarily indicate a problem and that other symptoms specific to each condition must be present for a clinician to make a diagnosis. Here are some ways verbosity and different conditions might fit together:

Not everyone with ADHD talks a lot, but the condition can cause some to think, act and speak impulsively.

People with generalized anxiety disorder worry a lot, can be very wordy and frequently need feedback, said Christian Kohler, a psychiatry professor at the University of Pennsylvania who said she talked too much in childhood and was diagnosed with ADHD as an adult.

The manic phase of bipolar disorder can cause people to speed-think and then express those thoughts at a matching rate.

And people with autism spectrum disorder may miss cues about taking turns – and effectively monopolize a conversation.

The piece also offers some advice for monitoring your own tendencies and urges tolerance. “I think it will benefit all of us to be patient and more open-minded and take our time to listen to each other,” said Shawn Horn, a Washington state psychologist.

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Insurers bash Biden plan to achieve parity in mental health coverage

The proposed rule would force most insurers, including Medicaid managed care plans, to analyze and collect data on some of the harder-to-measure gaps in mental health coverage. These include how far patients must drive to find an in-network therapist, for example, or which considerations go into determining that a psychiatric hospital stay requires pre-authorization. Without such data, policy experts say, it’s virtually impossible to enforce provisions in the federal law that requires insurers to field adequate provider networks and to make pre-authorization no more common in treating depression than in treating diabetes.

When the public comment period closed last week with more than 9,000 comments submitted, the insurance industry’s position became crystal clear, Politico Pulse reported: No way. The industry lobbying group AHIP said workforce shortages were the main barrier to mental health care. The Blue Cross Blue Shield Association argued that the proposed regulation would have “unintended consequences,” impeding access and putting safety at risk by forcing plans to accept lower-quality providers. And the president of a lobbying group for large employers called the proposed reg’s “unworkable.”

In Congress, the Republican chair of a key committee said the administration was going beyond its authority, while two Democrats on the committee said it should go further. Meanwhile, three Senators introduced a bill to crack down on “ghost networks” – the practice by many health insurers of claiming to offer robust numbers of mental health providers who actually turn out to be unavailable.

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In other news…

He  had neither the understanding nor the language to describe them, he wrote in his August memoir, “Adversity for Sale: Ya Gotta Believe.” He opened up about it last week on the “Tamron Hall Show,” as the Los Angeles Times reported. Jeezy’s words are a searing description of what researchers call Adverse Childhood Experiences, or ACEs.

Low levels of serotonin − a neurotransmitter that plays a role in regulating multiple bodily functions, including mood, memory and sleep – may explain some cases of long Covid, according to a New York Times report on new research. The study in the journal Cell suggested that remnants of the virus still in the gut triggered a reduction in serotonin. The molecule is best known as the target of antidepressants known as SSRIs that work to boost serotonin levels in the brain.

Never heard of post-weaning depression? The condition can develop after breastfeeding stops and may lead to intense mood swings, anxiety, insomnia and feelings of hopelessness. A combination of hormone changes and the stress of weaning are thought to cause it. Unlike postpartum depression, which is well-recognized and studied, there’s so little research on post-weaning depression that no one knows how many have or are at risk of developing it, according to the Washington Post.

Marketers for toy companies are moving toward MESH – mental, emotional and social health – as a designation for toys that teach kids skills like how to adjust to new challenges, solve problems, advocate for themselves and resolve conflict, the Associated Press reported. It’s a response to parents who are looking for ways to build emotional resilience in children struggling with mental health issues – and a way to sell more toys.

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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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