Pandemic deaths soared for mentally ill

June 6, 2022

By Don Sapatkin

Good Monday morning! We can’t resist sharing a headline captured by our algorithm  while scraping the internet for mental health news: Studying schizophrenia in plants? Yale researchers are giving it a shot.

Read on for a MindSite News original about how the greatest increase in death rates during the early phase of the COVID-19 pandemic was among people with schizophrenia, followed by those with bipolar disorder, post-traumatic stress syndrome, and diseases of cognition such as Alzheimer’s. Plus: How the potential of vagus nerve stimulation is hidden behind social media hype. Why your primary care doctor can treat your flu in-network but might be out-of-network for depression. And why John Hinckley is about to go free.

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MINDSITE NEWS ORIGINALS

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NEWS FROM AROUND THE WEB

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Your doctor is in-network … but maybe not for mental health

Integrating mental health and primary care is increasingly seen as an effective, efficient way to help with mild or moderate anxiety, depression and other common conditions, especially after the pandemic vastly increased the pool of troubled people amid a shortage of mental health providers. The problem, Kaiser Health News reported in a story posted by USA Today, is that insurance isn’t set up that way. 

Cincinnati family physician William Sawyer described seeing a longtime patient who had anxiety and attention deficit hyperactivity disorder. He said he spent 30 minutes asking about the patient’s sleep and exercise habits, counseling him on breathing exercises and writing a prescription for ADHD medication. Then he submitted an insurance claim using four codes: one for the patient’s obesity, another for his skin condition, and one each for anxiety and ADHD.

The insurer said it wouldn’t pay for the visit because the services billed were for the treatment of a behavioral health condition, which the patient’s health plan subcontracts to another company, a common practice known as a behavioral health carve-out. Sawyer would have to submit the claims to that company. But the doctor was not in its  network, so the visit would not be fully reimbursed. The patient would have to pay the difference.

Sawyer and his staff instead decided to appeal the original denial of all four claims. They won, although no explanation was given, or assurance that similar claims wouldn’t be denied again. It’s not clear how often this happens, although some say there are more anecdotal reports of in-network providers facing out-of-network carve-outs since the pandemic began. “Everyone around the country is talking about integrating physical and mental health,” Sawyer said. “But if we’re not paid to do it, we can’t do it.”

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Social media alert: Can fiddling with the vagus nerve improve your mood?

“Vagus” is the Latin word for “wandering,” and the vagus nerve – the longest originating in the brain – wanders all the way from your brain to the small intestine. It consists of thousands of fibers that run in two bundles from the brain stem, down each side of the neck and on to the torso, spreading out like branches of a tree to reach virtually every internal organ. The fibers carry reports up to the brain about how organs are functioning and deliver signals throughout the body that help regulate digestion, heart rate, the immune system and mood. But until recently, it was not a household word.

Enter social media. Some influencers claim the nerve is the key to reducing anxiety and helping you relax, according to the New York Times “Well” newsletter. Search for the hashtag #vagusnerve and you’ll find more than 70,000 Instagram posts and TikTok videos viewed nearly 66 million times. Some with the most views show how to “tone” or “reset” the body’s longest nerve by dunking your face in ice water and doing eye exercises. Wellness companies have jumped on the bandwagon with pillow mists, vibrating bracelets and “vagus massage oil” to stimulate the nerve – none of them endorsed by the scientific community, although there’s no indication they’ll cause harm.

There is some evidence that stimulating the vagus nerve may benefit people with certain mental conditions. This is typically done using surgically implanted devices that send electrical impulses to the brain: Studies show such stimulation may help people with treatment-resistant depression and post-traumatic stress disorder as well as some medical conditions. Preliminary research even suggests a link between the vagus nerve and several long Covid symptoms, which opens another avenue of treatment. “It can sound sort of magical with all the things it does,” said Eric Porges, an assistant professor at the University of Florida. 

Researchers are now recruiting patients for a large randomized controlled trial of a device implanted under the skin to treat depression. Nerve stimulation might be particularly helpful for bipolar depression, which has few effective treatments. But until proven otherwise, the stuff touted on social media and sold in wellness aisles remains just wishful thinking. 

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Report warns that 988 suicide prevention number is nowhere near ready to launch

An extensive survey of public health officials involved with next month’s launch of the 988 National Suicide Prevention Lifeline number found that less than half were confident their jurisdiction was ready, the nonprofit Rand Corp. reported in a comprehensive working paper. “Our findings have confirmed what many advocates and experts feared: Communities throughout the U.S. have not had the time or resources to adequately prepare for the debut of the 988 hotline number,” said Ryan McBain, a Rand policy researcher, in a press release.

Rand interviewed 180 state, regional and county behavioral health directors, 45% of whom said they lacked the necessary staffing, financing or infrastructure. Although mandated by Congress, the national phone number is supposed to be funded largely by the states – most  of which have yet to provide enough money.

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Attention patients! What’s in your Mental Health Patient Bill of Rights?

In a post for Psychology Today, clinical psychologist Salene M.W. Jones discusses the Patient Bill of Rights for Mental Healthcare. The seven rights include getting services based on the best available evidence about what works, deciding whether a particular service aligns with your personal values and cultural needs and strengths, and “the right to ask for changes to the services to increase the chance they will work for you,” adds Jones, who goes beyond the bullet points to help patients understand what they mean.

The Mental Healthcare Patient Bill of Rights originated with a 2018 consensus statement signed by 37 organizations involved with mental health. Decades earlier, the notion that patients even have rights was a big deal, part of a culture shift that emerged from courts’ endorsements of informed consent and autonomy. The American Hospital Association in 1973 adopted the first, and much longer, Patient’s Bill of Rights. Now there are several such statements. In 2000, a divided Congress tried but failed to pass an official national version, unable to agree on a patients’ right to sue managed care organizations for denials of care. That led some states to pass their own.

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In other news….

Wyoming’s new mental health awareness signs are popping up in state parks, Wyoming Public Radio reported, while a multi-agency operation is busy placing suicide-prevention placards in suburban forest preserves around Chicago, according to Fox 32 – seemingly odd locations considering that simply being in nature is considered good for your mental health.

John Hinckley, the mentally ill man who shot President Ronald Reagan 41 years ago and was found not guilty by reason of insanity, has been granted full freedom effective June 15, the final step in a gradual loosening of restrictions over many years, the Associated Press reported. 

Firearms suicides among young people ages 10 to 24 increased 15% in 2020 compared with 2% for all ages, ABC News reported, citing research data from the advocacy group Everytown for Gun Safety. The comparatively small number of gun suicides among the youngest members of that group, ages 10 to 14, soared 31% during the pandemic’s first year. 

Raising the stakes on the transgender wars, Florida Gov. Ron DeSantis’s surgeon general asked the state medical board to consider banning transition care for minors, NBC News reported. The request came just hours after Florida’s Medicaid agency issued a report that challenged scientific findings endorsed by most major medical societies. Those findings broadly conclude that care that affirms the choices of transgender youth is best for their future health and mental health.

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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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