Did self-interest kill Colorado mental health reform?

April 25, 2022

By Don Sapatkin

Good morning, MindSite News readers. In today’s newsletter, we share the latest investigation by a Colorado collaborative reporting project into a failed effort to reform that state’s troubled mental health system – amid a renewed effort to transform it. We also look at a new report that questions how much benefit people really get from antidepressants. Plus, a look at the history of harm reduction efforts and what Pinocchio’s brain might have learned from his nose.

How lying affects your brain

Telling the truth is easy. Fibbing requires more work. That’s what Science News for Students explains in its story “Lying won’t stretch your nose, but it will steal some brainpower.”

That extra effort takes place in the prefrontal cortex, the part of the brain that controls working memory as well as executive function tasks like planning and problem-solving. Those are the skills that may get taxed as you think a step or two ahead to make sure your lie will withstand questioning. The article points out that if you lie and tell a teacher you were late for class because you stopped at the library to get a book, you open up a range of questions you better have answers to. The teacher might as what book it was, if it was the one assigned last week, or even invite you to read from it in class.

The bottom line: Using your executive function to support a lie takes a lot of brainpower. And that diverts energy from other needs, according to research published in the American Journal of Psychology. The drain is harder on younger people, says Jennifer Vendemia, a neuroscientist at the University of South Carolina and first author of the study, because the prefrontal cortex is not fully developed until around age 25. There are lots of other reasons not to lie, of course, and Science News for Students does a good job explaining them for all ages.

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Did politics and provider self-interest kill a mental health reform in Colorado?

Colorado is now embarking on a major effort to retool its mental health system, which “is failing so many of our families, friends and neighbors,” according to the state’s new behavioral health director. But this is not the first reform attempt, as Colorado News Collaborative, a nonprofit coalition of more than 170 newsrooms, reports in its latest story on the state’s troubled mental health system.

Ten years ago, a schizophrenic man who had tried to get mental health treatment opened fire in a movie theater in Aurora, killing 12 people and wounding 58 at a midnight showing of The Dark Knight Rises. In the aftermath of the massacre, the governor, legislative leaders and the human services department agreed to overhaul the state’s mental health system and bring in new ideas and, potentially, a new group of  providers and administrators. “If you keep putting more money into that system, you’re likely to get more of the same result,” Reggie Bicha, former head of the Colorado Department of Human Services, told COLab, the News Collaborative.

The state developed a blueprint, approved tens of millions of dollars in new spending and awarded a competitive bid to a new provider with an innovative plan. But the existing network of service providers fought back and filed a court challenge. When they lost in court, they used political influence to block change and hold onto their contracts. “There’s winners and losers, and the losers didn’t like losing and they were gonna make sure that they were not the losers,” a former state official told the CoLab reporting team.

The CoLab investigation describes the difficulty of reforming a system that has been managed for decades by a politically connected and deeply entrenched group of providers. It also looks at the impacts: Studies suggest that Colorado has the highest rate of adult mental illness in the nation and one of the lowest rates of access to care, according to the news site. Yet even support by elected leaders could not overcome the power of established providers’ intent, as the article described it, on “tightening their hold on mental health treatment in the state.”

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The benefits of antidepressants … or not

It’s stunning how much we still don’t know about antidepressants. More than one in eight Americans are taking them, many for more than five years, yet most clinical trials have followed people for only eight to 12 weeks. Even in the short term, the benefits aren’t much greater than those experienced by trial participants taking placebos. A new study tries to fill in some of the blanks by comparing changes in quality of life reported over two years by people with depression who took antidepressants and those with the same diagnosis who did not.

The findings didn’t help much, according to the New York Times’ Well newsletter. The paper, published in the journal PLOS One, found no significant differences in the quality of life changes reported by the two groups. But the study had notable flaws. For one thing, people who are prescribed antidepressants tend to be more depressed than those who aren’t. For another, the people who were taking the medication may have been doing so for a while, so their quality of life could have improved before the study began. More than 15 million Americans have been on antidepressants for at least five years, according to an earlier Times analysis; many people experience withdrawal symptoms when they try to stop. 

“There’s just so much that’s not known,” said Robert DeRubeis, a University of Pennsylvania psychologist who studies the causes and treatments of mood disorders. “It’s not at all clear that even in the short term, pharmacological approaches, on average, are more effective than psychological ones.”

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Tracing the origins of harm reduction

In 1967, as flower children and teenage runaways flocked to San Francisco by the thousands to experiment with drugs, sex and rock ‘n’ roll, the Haight Ashbury Free Medical Clinic opened with an ironclad belief that health care was a right, not a privilege. The kind of compassionate treatment that people received during the Summer of Love, like space to deal with bad trips and heroin withdrawal, eventually became what is now known as harm reduction, according to a comprehensive history of the movement in San Francisco on the website of public radio and TV station KQED.

The story traces the origins and use of harm reduction — a philosophy that advocates for making it safer to use drugs rather than criminalizing those who do — from its early years underground to its adoption as official public health policy by the San Francisco Health Commission in 2000 and now to President Biden’s commitment to expanding it as one of his drug-policy priorities. Through interviews with people who worked in the field, the story walks us through harm reduction’s various eras, focusing on AIDS, heroin, fentanyl and Narcan. It’s a compelling story.

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In other news…

As restaurants struggle to help their stressed-out workers and attract new ones, one group in Colorado has a creative solution, CNBC reports: an on-staff therapist.

Georgia’s Mental Health Parity Act was signed into law by Gov. Brian Kemp, requiring insurance companies to cover mental health the same way they do physical health, despite far-right conspiracists’ claims that it would change pedophilia from a crime to a covered medical diagnosis, NPR reports. 

To improve mental (and physical) health in large numbers of people, install extremely quiet fans in ventilation systems, according to a press release from Chalmers University in Sweden, where researchers designed such a fan and described it in a study published in Physics of Fluids,.

Irish novelist Patrick McCabe’s latest book, Poguemahone, recounts a demented bond between brother and sister, according to a New York Times review – in epic verse. (For other worthy works on mental health and related issues, check out the MindSite News Review of Books.)

If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.

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