May 22, 2023

By Don Sapatkin

Good Monday morning! For all you therapy junkies, The New York Times brings you an entire Sunday magazine focused on therapy, and we’re here to offer a peek. Plus: The mental health crisis for North Carolina kids. Searching for happiness ’round the world. And drug overdose deaths were virtually unchanged last year – again claiming more than 100,000 lives.

“Does therapy really work?” “What your therapist doesn’t tell you,” and other stories

The Therapy Issue” of the New York Times Magazine contains more than a half-dozen first-person and sometimes outside-the-box stories (and even a poem: “wild and blue”). Susan Dominus unpacks the complicated question Does Therapy Really Work? in a reported essay that my colleague Courtney Wise wrote about earlier this week.

In Domestic Disturbance, Orna Guralnik, the therapist on Showtime’s documentary series “Couples Therapy” and a clinical psychologist and psychoanalyst at New York University, describes seismic changes in couples’ racial and sexual power dynamics influenced by the Black Lives Matter and #MeToo movements. Ismail Muhammad discusses how, growing up, therapy was not something Black boys did and how overcoming that cultural stricture strengthened him as a Black man.

My favorite is What Your Therapist Doesn’t Tell You, in which a dozen counselors share their unsaid thoughts with Amy X. Wang. (There are cartoons to match.) Things like:

“What is her husband’s name again?” I’m terrible at remembering names no matter how hard I try. –Jenn Hardy, PhD

“I suck as a therapist right now.” –Shani Tran, LPCC, LPC

“Yes! Break up with that person! Run as fast as you can!” But from a therapy perspective, I have to empower them to make that choice…Honestly, sometimes you do really just want to jump out and be like “Do not do this.” –T. Rochelle Tice, LCSW

Therapy itself, it’s a bit of a dance − you want to see what the other person is bringing, and you dance with them. If they’re doing a waltz, you can’t break out hip-hop, and there are times when people just don’t want to dance.  –Peter Chan, PsyD.

There has been a large adolescent pool coming in that is familiar with therapy topics — but a very new, broader, more nebulous definition of them…What’s been really difficult to navigate is when a parent drops off their kid like, ‘Here’s my kid, fix them for me,’ and the kid is like, “I’ve been gaslit by narcissists!” — Kyle Standiford, PsyD.

North Carolina’s mental health system is really broken

In a series of stories over the past month called Fractured, PBS’s Frontline and public radio station WFAE in Charlotte have examined the dysfunctional mental health system in North Carolina from various angles, most involving the criminal justice system. Now their focus is expanding to other areas, starting with the crisis in emergency rooms.

In January, an average of 350 state residents a day were “boarding” in hospital ERs because no psychiatric beds were available in a state hospital or a nonprofit or for-profit hospital. ERs are bright, noisy, sometimes chaotic and running 24/7 − especially bad environments for mentally ill children, who are also missing school, outdoor play and support from their families at home. Some kids are abandoned in the ER for weeks: of 27 kids who boarded in emergency rooms during the first three months of 2022, 11 were in custody of county social service departments and stayed an average 66 days.

The problem dates back decades to when North Carolina overhauled its mental health system, halving the number of state psychiatric beds and moving outpatient care to a privatized system that relies on Medicaid. But eligibility is strict, and 1.2 million residents are uninsured. Community hospitals often have psych beds available but won’t take uninsured patients. The legislature’s approval of Medicaid expansion two months ago should help, with an estimated 600,000 people newly eligible for benefits.

In New Hampshire, meanwhile, a federal judge ruled for hospitalized patients when she declared unconstitutional the practice of holding psychiatric patients in hospitals against their will for long periods, according to WMUR in Manchester. U.S. District Judge Landya McCafferty gave the state 12 months to end the practice. She also ordered hospital emergency departments to transfer patients to facilities for treatment within six hours of filing an involuntary emergency admission petition with the court.

Finding happiness in unexpected places

In “Rainn Wilson and the Geography of Bliss,” a five-episode documentary series  streaming on Peacock, the former star of “The Office” takes us along on his global search for happiness. Based on Eric Weiner’s bestselling book “The Geography of Bliss: One Grump’s Search for the Happiest Places in the World,” Wilson stops in countries that are ranked, for better or for worse, in the United Nations Sustainable Development Solutions Network’s World Happiness Report. (The U.S. is a surprisingly high No. 15).

In No. 3 Iceland, he told the New York Times Well newsletter, “they love to sit together in bubbly, hot springs” and also take cold-water plunges together for their mental health (not yet proven, although early studies are encouraging). In Ghana, ranked 94, “10 people will sometimes eat from the same bowl during a lively communal meal,” Wilson observes. He sees the real-life evidence from multiple study findings that relationships with friends, family and community are vital to well-being.

Even in Bulgaria, ranked 77, he observes “pockets of joy among the cracked Brutalist buildings” and absorbs a local novelist’s wisdom that “it’s part of the human condition to feel sorrow − and that it can be freeing to recognize that there is no joy without an acknowledgment of pain.” In an interview with Parade. Wilson reflected on his own mental health journey and struggles with anxiety and says he’s “never been happier.”

Overdose deaths top 100,000 for 2nd year in row

Drug overdose fatalities barely increased in 2022 – after a 15% year-to year rise in 2021 – but nevertheless rose way past the 100,000 threshold once again, according to the latest CDC provisional data on predicted mortality. There were huge variations among states, as usual, from Wyoming’s 22% increase to South Dakota’s 18% decrease, and no clear regional patterns. Nationally, the CDC projects there were 109,680 drug deaths, a rate of 33 per 100,000 people, according to my calculations. The slight annual increase in 2022 – less than half a percent – belies the long-term trend: Drug overdose fatalities have exploded by more than 50% over the three years from 2019 to 2022 and more than quadrupled over the past two decades.

CDC data shows predicted drug deaths (a projection based on incomplete reported deaths that has proven highly accurate over the years) totaling 109,680 for the 12 months ending December 2022, an increase of 501 deaths over the previous year.

Continuing the trend of recent years, cheap illicit fentanyl drove the upward trend in opioid deaths and has largely replaced heroin. Multiple substances are almost always found in overdose cases these days, but fentanyl was found in the bodies of more than 75,000 people last year while heroin was found in almost 6,000.

States are asking the Biden administration to speed up implementation of a law that would expand non-opioid pain treatments, Politico’s Pulse newsletter reported. New federal legislation is in the works to increase government payments to addiction treatment providers, fund more studies to determine the best overdose prevention strategies, and treat fentanyl like a chemical weapon, as are proposals to push Mexico to crack down on cartels. These actions have gained urgency since the discovery that xylazine, an animal sedative known on the street as tranq, is being added to fentanyl, making the powerful opioid far more deadly.

In other news…

Tradeoffs’ Research Corner newsletter examines the evidence for remote opioid addiction treatment and whether the pandemic policies that allowed video prescribing should be extended.

Schools should offer “lessons in bromance” to ease boys’ mental health crisis,  teacher and author Matt Pinkett argues in his new book, according to Study Finds, a media site that typically translates research studies into English. Pinkett’s “Boys Do Cry: Improving Boys’ Mental Health and Wellbeing in Schools,” available later this month,  suggests that building classes for teens around active listening, friendship and anger management might reduce male suicide rates.

Support for reinstitutionalization? Asked his views on how to deal with the mental health crisis, former V.P. Mike Pence told people at an event in New Hampshire, according to Manchester’s WMUR: At the end of the day, when it comes to people that might represent a threat to themselves or a danger to others, I think we’ve got to get back to institutional mental health care.” It was an echo of his former boss – and potential opponent – who said, in response to mass shootings: “We have to start building institutions again.”

In Alabama, legislation that would add a 98-cent surcharge to cell and landline bills to support 988 operations in that state was voted down in a House committee, reported. (Another proposal was approved by a committee in the Senate.)

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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Type of work:

Don SapatkinReporter

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...