On May 9, the Labor Department also issued a series of frequently asked questions (FAQ) regarding the implementation of the Mental Health Parity and Addiction Equity Act of 2008. While these FAQs do not apply directly to the Affordable Care Act, they are likely to be used to interpret the mental health parity provisions of the ACA. The FAQs clarify that if a plan provides mental health and substance abuse benefits, it may not limit those benefits to inpatient services only. Plans may carve out mental health services and handle them through managed behavioral health organizations as long as standards applied are comparable to and not more stringent than those applied to other services. Indeed, this is the standard that plans must follow generally in applying non-quantitative treatment limitations to mental health and substance abuse services.

For example, many health insurance plans still refuse to cover lifesaving treatment for eating disorders. Others create discriminatory barriers to care, such as imposing stricter prior-authorization requirements for mental health and addiction treatment than for medical benefits. Sadly, as underscored in a recent report by the assistant secretary for planning and evaluation at the U.S. Department of Health and Human Services, levels of care for evidence-based behavioral treatments, such as residential psychiatric services for children, are being eliminated because of uncertainty about what is required.

The most recent National Survey on Drug Use and Health, published last year, found that fewer than half of the 45.9 million adults with a mental illness receive treatment or counseling and that only 10 percent of the more than 23 million people who need help for a substance-use problem received any specialized treatment in 2010. Even more troubling is the fact that people with either disease have shorter life expectancies than most Americans; a 2006 study put the difference at 25 years.

More than 23.2 million people 12 and older needed treatment for an illicit drug- or alcohol-use problem in 2007, according to the National Institute on Drug Abuse, or NIDA. Only 3.9 million received treatment at a substance-abuse facility. Lack of insurance and insufficient coverage were cited in the 2009 report as two principal causes for this disparity.
Between 40 percent and 60 percent of those who seek treatment relapse, the same report found.
Robin Barnett said recent legislation to promote parity between medical and mental-health coverage has largely been circumvented or ignored by insurers. As co-owner of [a treatment facility], she said keeping patients in treatment after detox is a constant, often futile battle.
“Insurance (companies) are the gatekeepers to the amount of treatment somebody is able to obtain"....
NIDA guidelines recommend 90 days or more of primary treatment...but most insurance companies cut off patients at two weeks. Because of the tremendous costs associated with that level of treatment, she said, there’s no incentive to see patients through.
Congress passed the Mental Health Parity and Addiction Equity Act in 2008, and there was hope of improved access to treatment...Insurers, however, quickly found new loopholes.
Barnett said coverage is often dropped as soon as the physical symptoms disappear, even though the psychological addiction remains.
“Someone can come in in acute distress and withdrawal, with sweating, shaking, exhaustion and body aches...As soon as those symptoms go away, and if there’s no major damage to the liver or other organs, or high blood pressure or physiological issues, they’ll say (the treatments) don’t meet medical necessity.”

During the decade from 1998 to 2007, the percentage of the general population who used psychotherapy remained stable. Over the same period, however, psychotherapy assumed a less prominent role in outpatient mental health care as a large and increasing proportion of mental health outpatients received psychotropic medication without psychotherapy.

Psychotherapy has traditionally been regarded as a central feature of mental health service in the United States. It is widely viewed as a core clinical activity of psychiatrists, psychologists, social workers, and other mental health care professionals (1). Some evidence suggests that the role of psychotherapy in community treatment has diminished in recent years. According to the National Ambulatory Medical Care Survey, visits to office-based psychiatrists that include psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (2). Although the survey includes clinical diagnoses reported by the treating physicians, it offers no information about psychotherapy delivered by other mental health specialists and no person-level data on psychotherapy use. As measured by the Medical Expenditure Panel Survey (MEPS), the percentage of Americans treated with antidepressants who also received psychotherapy decreased from 31.5% in 1996 to 19.9% in 2005 (3). There has also been a decrease in employer-sponsored health plans that cover outpatient psychotherapy (4). Over this period, however, Americans have become more comfortable talking with health care professionals about personal problems (5), and concerns about antidepressant-associated suicidality may have led more depressed adults to pursue psychotherapy (6).

There is a paucity of information about recent national trends in use of psychotherapy in the United States. The most recent national profile of psychotherapy use indicated that in 1997 approximately 3.6% of Americans received at least one psychotherapy visit and most of those who received psychotherapy (61%) were also treated with a psychotropic medication (7). The scarcity of data on basic patterns in psychotherapy use contrasts with a relative abundance of information on patterns of psychotropic medication use (8, 9).

Expenditures for Treatment of Mental Health Disorders among Young Adults Ages 18-26, 2007-2009: Estimates for the U.S. Civilian Noninstitutionalized Population
Statistical Brief #358
Top 10 Most Costly Conditions among Men and Women, 2008: Estimates for the U.S. Civilian Noninstitutionalized Adult Population, Age 18 and Older
Statistical Brief #331
Health Care Expenditures for Adults Ages 18-64 with a Mental Health or Substance Abuse Related Expense: 2007 versus 1997
Statistical Brief #319
Anxiety and Mood Disorders: Use and Expenditures for Adults 18 and Older, U.S. Civilian Noninstitutionalized Population, 2007
Statistical Brief #303
The Five Most Costly Medical Conditions, 1997 and 2002: Estimates for the U.S. Civilian Noninstitutionalized Population
Statistical Brief #80
Antidepressant Use in the U.S. Civilian Noninstitutionalized Population, 2002
Statistical Brief #77
Trends in Antidepressant Use by the U.S. Civilian Noninstitutionalized Population, 1997 and 2002
Statistical Brief #76
Outpatient Prescription Medicines: A Comparison of Expenditures by Household-Reported Condition, 1987 and 2001
Statistical Brief #43

About 3% of Americans had outpatient psychotherapy in 2007—roughly the same as in 1998—although the percentage taking antidepressants and other psychotropic drugs rose sharply, according to an analysis in the American Journal of Psychiatry last year. The same study found that the average number of visits dropped from nearly 10 in 1998 to eight in 2007.

Each percentage point decrease in A1C lowers the risk of long-term diabetes complications by 37%.
Diabetes is more common and often more severe in African Americans. To determine if people in this population could lower their A1C levels by talking regularly with others who had successfully controlled their blood glucose levels, researchers recruited 118 African Americans at the Philadelphia Veterans Affairs Medical Center who hadn’t been successful at lowering their A1C[:]
Those in the usual care group were provided with specific goals for A1C.
Participants in the financial incentive group were given $100 for lowering their A1C by one point (for example, from 7.9% to 6.9%) and $200 for lowering their A1C by two points or for hitting an A1C level of 6.5% or lower.
Those in the peer-mentoring group were connected with someone with diabetes who had once had poor blood glucose control but who had brought it to target levels (an average of 6.7%). The mentors were paid $20 and told to meet with their “mentees” at least once per week for the duration of the six-month study.
Mentors and mentees spoke an average of four times during the first month of the study and twice a month thereafter. The researchers were not sure whether this decrease in contact was due to reduced motivation or to a perceived lack of need for more frequent communication.
[Peer-mentoring participants] achieved the greatest reduction in A1C levels: Among those in the usual care group, A1C was reduced, on average, from 9.9% to 9.8%; among those in the financial incentive group, A1C was reduced from 9.5% to 9.1%; and among those in the peer-mentoring group, A1C was reduced from 9.8% to 8.7%.
“Perhaps the most obvious attraction of this type of peer mentoring is that it is virtually free, almost certainly enhancing its cost-effectiveness relative to more expensive interventions, such as nurse care management, telemedicine, and group medical appointments"...
The researchers note that all participants in the study were veterans, so the sense of camaraderie among them may not translate to other groups of people with diabetes, and they call for future studies that look into whether the blood glucose effects seen in this trial are sustainable....
{T]o find a diabetes mentor, check out the article “Peer Support, Education, and Mentoring,” [link] by certified diabetes educator Martha Mitchell Funnell.

In California, where Kaiser operates dozens of hospitals and hundreds of clinics, patients seeking treatment for mental health conditions are sometimes made to wait weeks for appointments, in violation of state law, a report from National Union of Healthcare Workers finds. When they finally get to see a doctor, they often receive brief consultations that only last half as long as the the recommended minimum amount of time, according to the report. And many patients end up in group therapy settings when one-on-one sessions with a clinician would be more appropriate.

The NUHW's findings come at a moment when mental health care service providers are becoming increasingly burdened due to budget cutbacks. Since 2009, 28 states have cut a combined $1.7 billion from their mental health budgets, according to the Associated Press. In the past year, California alone has reduced its mental health funding by $177.4 million, ABC News reports.

Mental health treatment may also be of particular concern in California due to that state's weak economy. California's unemployment rate is 11.9 percent -- well above the national level of 9.0 percent -- and its foreclosure rate is the second highest in the nation. Joblessness and foreclosure have been shown to take a serious toll on mental health, putting people at risk for depression, anxiety and compulsive behavior like alcoholism and gambling.

Kaiser's alleged habit of rushing its patients through the treatment process carries dire implications for the company's more than 6.6 million California members. Such practices are likely to lead to misdiagnoses, according to the report, and to patients not getting the kind of treatment that will best help them.

The report cites incidents where patients are "funneled" into group therapy sessions, involving one clinician and as many as 20 patients. Clinicians say that for many patients, individual sessions would be more appropriate, yet Kaiser's emphasis on consolidation means these patients often end up in a group setting.

The widespread use of group therapy seems to stem from Kaiser's insistence on doing more with less. One researcher writes that "Kaiser comes off exceptionally badly... in the way they overburden the treating clinicians with new cases. The requirement that therapists have to handle seven or more new intakes per week makes weekly psychotherapy, other than group, a virtual impossibility."

The same researcher writes that "at Kaiser, group psychotherapy is the way to pretend that patients are not kept on a waiting list."

People who rely on public mental health services should be directly involved in designing their own care plan. In what are termed self-directed care programs, individuals may choose from a wider array of services and supports than have traditionally been offered them. Further, they have the flexibility to spend some of the money allocated for their care in new ways, based on an individualized plan and budget.

In the Driver's Seat is designed to help consumers and other advocates obtain policies that give consumers a primary role in their recovery planning and greater control over how resources are spent to meet their needs. The booklet includes advocacy strategies and examples of existing programs’ approaches to self-directed care. Fact sheets summarize important aspects such as financing.

Purchase the booklet (shipping is included) or download a PDF.

[Inner-city, low-income] study participants who shopped in stores, co-ops or farmer's markets they considered convenient and offering high levels of quality and selection were more likely to eat three or more servings of fruit and vegetables daily....
[T]hose who listed cost as a barrier to purchasing fruits and vegetables ate the same amount of produce as those who did not....
The study [used] a secondary analysis of baseline data provided by 495 participants who took part in a social marketing intervention during the winter of 2007–2008.
Fruit and vegetable intake was unusually high in this primarily minority and low-income inner-city sample. [Eighty-five and a half percent] reported eating more than three servings of fruits and vegetables per day....[P]articipants who made six shopping trips per month ate more fruits and vegetables than those who shopped an average of once a week...
[T]he study findings suggest that efforts to promote healthy eating by increasing access to fresh fruits and vegetables should be guided by [understanding] the importance of personal, subjective assessments of the food shopping environment....
"Working with local retailers to improve shopping convenience and provide a good selection of quality food items may influence consumers' overall fruit and vegetable intake, independent of price and availability."

Children and adolescents participating in moderate to vigorous physical activity have a lower cardiometabolic risk profile. [Physical activity correlated with better waist circumference, blood pressure, triglycerides, HDL cholesterol, and insulin in study subjects] regardless of the amount of time they spend sedentary.
[Based on the findings,] children should be encouraged to increase their participation in physical activity] rather than decrease the amount of time they spend sedentary, "as this appears more important in relation to cardiometabolic health."
[In pooled data from 14 studies (1998-2009) connected to the International Children's Accelerometry Database.] the time spent in moderate to vigorous physical activity has a weak to moderate association with the amount of time children spend sedentary, and this had suggested that both variables might be independently associated with cardiometabolic risk.
[A]ctivities ingrained early in life set the stage for what individuals do in their later and older years. "We're living in an age right now where it's so easy to do no physical activity at all...kids can basically go through an entirely normal childhood existence where, unless they're forced or choose to play sports, they don't have to do anything. This study shows that the more activity that you do, even if it's outside the context of typical exercise, really does make a difference."
In the ICAD analysis, 20,871 children and adolescents from Australia, Brazil, Europe, and the US had [physical-activity levels] monitored for an average of 5.2 days using the accelerometer, and the mean daily time spent engaged in moderate to vigorous physical activity was 30 minutes. The mean daily time spent sedentary was 354 minutes.
Kids in the [most active] tertile spent more than 35 minutes per day engaged in moderate to vigorous physical activity, whereas those in the bottom tertile were moderately or vigorously active just 18 minutes per day. The mean difference in waist circumference between the most active and least active kids with the most sedentary time was 5.6 cm [and 3.6 cm] in those with less sedentary time. Similarly, the difference in systolic blood pressure between the most active and least active kids with the most sedentary time was 0.7 mm Hg[, while there was a 2.6-mm-Hg difference] between the most active and least active kids who reported less sedentary time. The variations in HDL cholesterol, insulin, and triglyceride levels were similar when analyzed by physical-activity levels and sedentary time.
Overall, the results showed that higher levels of physical activity were associated with better cardiometabolic risk factors across the tertiles of sedentary time. In contrast, sedentary time was not associated with any of metabolic outcomes independent of the time engaged in moderate and vigorous activities. The researchers note that they did not qualify what specific activities the children were engaged in while being sedentary. For this reason, reducing television viewing time is still considered an important goal of parents and public-health policy because TV watching is also associated with other unhealthy behaviors, such as snacking and drinking soda.

As of 2012-02-23, no effects research found—DMM

Racial disparities in hypertension control account for nearly 8,000 preventable deaths annually among African-Americans, making increased blood pressure control among African-Americans a “compelling goal"...
African-Americans commonly develop hypertension at a younger age, are less likely to have their blood pressure under control, and disproportionately suffer strokes and fatality when compared with their Caucasian counterparts[:] a 30% greater rate of non-fatal stroke, an 80% greater rate of fatal stroke, and a staggering 420% greater rate of end-stage kidney disease for African-Americans...
[Only 51% of all patients with hypertension adhere to their medications;] adherence rates are even lower for African-American patients.
Dr. Lewis identified self-efficacy, depression, and patient-provider communication among the factors in medication nonadherence. She called for further study, but advised that these factors are important for healthcare providers to consider when treating hypertensive African-American patients.
“Increasing blood pressure control requires a comprehensive approach...Given that self-efficacy and patient-provider communication are modifiable factors, they can be the focus of interventions to increase medication adherence. [Clinicians also] may want to screen their hypertensive patients for depression...”

[Having received an inappropriately substituted prescription in an effort to lower their copay, the patient and his wife] sat for two days at home without insulin administration, choosing not to test his glucose since they knew they didn't have a way to inject the insulin, until the Home Health nurse arrived.
The Home Health nurse reviewed syringe technique with the patient and they ultimately chose to go with the pen. The Home Health nurse expedited the original Rx and reviewed the sliding scale and glucose results from fingersticks. The patient is doing well....
Navigating what doctors prescribe and what insurance companies charge for co-pays can be a major problem. Copays can range from no cost to more than $100, depending on which tier the medication is in....
With the difficulty of navigating...benefits, co-pays and different tiers, following up with patients is imperative. The Home Health nurse visit truly averted disaster.

According to the World Health Organization, depression is the leading cause of disability and the fourth leading contributor to the global burden of disease, projected to reach second place by 2020. There is also strong evidence that it is an independent risk factor for heart disease, and several studies show that prolonged depression is associated with selective and possibly permanent damage to the hippocampus, a region of the brain critical to memory and learning.
Add the fact that 2 percent to 12 percent of depressed people eventually commit suicide, and the [supposed evolutionary] “advantages” of depression suddenly don’t look so good....
What is natural, the thinking goes, is best. If we are designed to suffer depression in response to life’s ills, there must be a good reason for it, and we should allow it to take its painful and natural course.
But unlike ordinary sadness, the natural course of depression can be devastating and lethal. And while sadness is useful, clinical depression signals a failure to adapt to stress or loss, because it impairs a person’s ability to solve the very dilemmas that triggered it.
Even if depression is “natural” and evolved from an emotional state that might once have given us some advantage, that doesn’t make it any more desirable than other maladies. Nature offers us cancer, infections and heart disease, which we happily avoid and do our best to treat. Depression is no different.

The judge rejected as "egregiously deficient" the remedy proposed by the State, saying that it “scarcely begins to address the violations identified...A proposal that affords a remedy to only 23% of those individuals whose civil rights are currently being violated...is grossly inadequate.”
The judge ruled “in order to rectify the violations found by the court, [state officials] must change the way they manage their mental health system so that [adult home residents] have a choice – a real and meaningful choice – to receive the services to which they are entitled in supported housing instead of an adult home.”
In doing so, the State must:
* Provide all qualified adult home residents the chance to move to supported housing within four years and ensure that appropriate services are in place...
* Create at least 1,500 supported housing units per year for three years, and create additional units as necessary after, to accommodate all current adult home residents and future individuals with mental illnesses being considered for adult home placement...
* Contract with supported housing providers to engage and educate adult home residents about their opportunities to live in their own housing with support services...This education is necessary to overcome the fear and self-doubt that have been instilled in many residents during years of living in adult homes with no other options.
* Employ “Peer Bridgers” (individuals in recovery from mental illnesses who are trained to assist others making the transition) to assist current and future adult home residents wishing to move....
"The court's order will stop the unnecessary warehousing of people with mental illnesses in institutional adult homes. For decades, people who can live in the community and receive services there have been stuck in these dismal institutions, when living in their own apartments and receiving services there would both enrich their lives and save the state money," said Cliff Zucker, executive director of Disability Advocates, Inc., plaintiff in the case.

There are 300 recipes for macaroni and cheese on the Food Network’s Web site. I’m using mac-n-cheese here as a symbol for all of those starch- and fat-laden comfort foods we love and like to occasionally indulge in.
Mac and cheese with two cheeses. Three cheeses. Four cheeses. SEVEN cheeses! Mac and cheese with ham…with bacon…with corned beef. With heavy cream (four cups in at least one recipe). With Tater Tots.
The recipes were from such celebrity chefs as Ina Garten (the Barefoot Contessa), Alton Brown, Giada De Laurentiis, Guy Fieri, and Emeril Lagasse (who once had an episode called “Pork Fat Rules.” BAM!). And, oh yeah, Paula Deen. Who, admittedly, deep-fries mac-n-cheese.
But people are only complaining about Paula Deen cooking starch- and fat-laden foods. Why? Unless you live in a cave, you probably heard last week that Deen was diagnosed with Type 2 diabetes. Three years ago. Therefore, she should have stopped cooking those decadent foods. Immediately! Fessed up. Admitted her sins.
And her critics are crawling out of the woodwork: “5 Paula Deen recipes that could give you diabetes” proclaims one headline. (Psst! Food does NOT give you diabetes!)

I may say some nasty and completely true things about the medical establishment.
I only started paying attention [to the ACCORD study] when the intensive blood sugar control arm was canceled. The more I found out about it, the angrier I got...ACCORD is a great example of most of what is wrong with American medicine, and with the way our media covers it....
From the beginning, ACCORD was a drug trial. The study called for participants to receive diet and exercise counseling if they wanted it, but set no guidelines for the counseling. There was no self-management group. It was all, repeat all, about the drugs.[Encouraging participating doctors to unsystematically and aggressively prescribe multiple drugs all but guaranteed drug interactions and adverse effects.]
In February, NHLBI stopped the intensive blood sugar control arm because more of the participants in that group were dying than in the normal care group.
Then came the outrageous part: NHLBI and media dummies came out saying that the intensive group’s blood sugars had been too low....
What kind of madness is this? You throw scads of drugs at sick people, treating only their numbers, not their bodies and lives as a whole. Then, when they die, you say it couldn’t have been the drugs. It must be the numbers. And you tell people with diabetes to get their blood sugars up.
You better believe that if ACCORD had shown a 10% decrease in cardiac deaths from intensive blood glucose management with drugs, those drugs would have become standard therapy for every person with Type 2 in the country. Nobody in the media would have said, “It wasn’t the drugs.” The drug companies would have made billions. That was the goal of the trial.

[David Agus, MD:] "Reimbursement for preventive medicine's always difficult in our country...[T]he problem is most people change health plans all the time. So if you're that health plan, why should you spend money on something that's not going to affect a person until a decade from now? And so one of things we really have to change is we have to push prevention... a heart attack costs hundreds of thousands of dollars. A couple hundred dollar tests along with a drug can prevent it. Obviously it's cost effective as a return on investment"....
[Bill Weir:] Since my HDL (good cholesterol) levels are in fine shape, he explained that I don't need a low-fat diet, but a "good-fat diet,"—olive oil, canola oil, [heart-smart] eggs and cold-water fish—eaten on a consistent schedule. When you have lunch at noon one day and 3 p.m. the next, you're releasing stress hormones that can hurt in the long run, Agus said.
Instead of hitting the gym hard in the morning and then sitting all day (which can be as bad for you as smoking), the doctor encourages more movement throughout the day....
And he ordered me to skip the fish oil capsules and multivitamin in favor of the freshest real food I can find.
"You're not vitamin deficient...You look at all the large studies with vitamins and most of them have caused problems rather than benefits. And you don't need to be on them. So real food, regular schedule, live healthy."

Asked to address the concerns of naysayers, who argue that there is little proof that reducing salt in the diet will have an effect on health outcomes and who say that the administration should not get involved in "nanny-state" activities like regulating the amount of sodium people consume, Bakris said that government-backed salt-reduction campaigns "have been very effective in the UK, in Finland (with a dramatic improvement in mortality) and in Japan, and there is absolutely no reason we should not do this.

"The reality is that there needs to be some guidance to the general public about this—most people do not read labels, most people don't pay attention, and they don't know how much salt is too much... Clearly, the FDA does have a role as a regulatory body to adjust sodium standards in foods so that they are in keeping with the current guidelines."

"It's certainly true that people who are in their 20's and teens don't need salt restriction for blood-pressure control, [but it is an acquired taste. If] you don't learn from a young age, it's going to catch up with you in your 40's, 50's, and 60's, when you actually will need some salt restriction..."

In response to what Bakris calls the "outcomes mafia, who say that unless we have an outcomes study it's impossible to make any conclusions," he remarked, "[C]ommon sense has to prevail. The FDA as a regulatory body has accepted the notion that lowering of blood pressure is a validated surrogate for a reduction in cardiovascular mortality and morbidity... To do an [outcomes] clinical trial...you would need well over 100 000 people, so it's not feasible. Let's be reasonable."

"If you are telling me that reducing BP by 5 to 7 mm Hg, which is what most of these salt restrictions will do, is not going to translate into a benefit, then I think we have to throw out all the clinical trials we have to date...[No meta-analysis of any clinical trials] fails to show that a reasonable reduction in blood pressure has not [sic] been associated with a benefit, certainly on stroke and to a lesser degree on coronary events...[T]he data are very consistent."

"I think the conflict of interest here needs to be established,...With all due respect, many of the people who are saying this are also consultants to the Salt Institute, they are lobbyists in their own right. They spin the data to make it suit what their needs are."

People who live in the states of North Carolina, South Carolina, Georgia, Alabama, Mississippi, Tennessee, Arkansas, and Louisiana are more likely to die from stroke than people living in other parts of the U.S., the researchers note.

Omega-3 fatty acids in fish, especially oily fish, favorably alter platelet aggregation, blood pressure, lipid profile, and endothelial function and may reduce the risk for ischemic stroke. However, when fish is fried, it loses natural omega-3 fatty acids. Moreover, in the U.S., most fish served fried tends to be from lean species that pack lower amounts of omega-3 fatty acids.

The researchers analyzed respondents' reported access to three primary health-care attributes:
Comprehensiveness, which includes the provision of care for new health problems, preventive care and referrals to other health-care professionals.
The availability of evening and weekend office hours.
Patient-centeredness, meaning that their health-care provider listened to and sought the patient's advice when deciding on treatments.
The researchers found that after adjusting for age, health status, weight, tobacco use and other health characteristics, greater reported access to the primary-care attributes was associated with significantly lower mortality (hazard ratio 0.79) during up to six years of follow-up....
The team also found evidence that racial/ethnic minorities, poorer and less educated individuals, and those lacking health insurance reported significantly lower access to the primary-care attributes than others.

A study published this week in the Annals of Internal Medicine shows that the average portion sizes in today’s cookbooks have increased by nearly 40 percent in calories per serving in the past 70 years for nearly every recipe reviewed, accounting for an extra 77 calories per serving.

In addition to surveying several cookbooks the study looked more in depth at one particular book that has been a mainstay of American kitchens since the 1930s. Of the 18 recipes that appear in all seven versions of the cookbook (including the most recent 2006 edition), 17 of them have increased in calories per serving. The increases are partly attributable to an increase in the total calories in each recipe (now an average of 567 calories) and to larger portion sizes. One chili recipe demonstrates both such increases: in 1936, the recipe made 14 servings at 228 calories each, while the "same" recipe in the 2006 edition makes 10 servings at 576 calories each.

Several recipes did not change ingredients at all, but portion sizes as much as doubled from the original 1930s recipe. For example, some brownie and cookie recipes that used to make 30 servings now make only 15 from the same amount of batter.

The increases in calorie content and portion size are likely related to the growing affluence of the United States since the 1930s. Recipes that formerly included cheaper, less calorie-dense ingredients like beans and rice now call for meats and fats. Portion sizes may have gotten larger as people became able to afford larger servings.

We learned early on to eat everything put in front of us when we sat down to meals. Then the size of the plates grew—and so did the amount of food we consumed.
It’s called portion inflation. [An analysis published in the Journal of the American Dietetic Association] found that typical restaurant portion sizes today are two to eight times as large as those in 1955. Back then, people who consumed a typical American meal (a hamburger, French fries, and a soda) had only one portion size to pick from. Today we can choose from multiple portion sizes: reasonable, big, bigger, and ridiculous....
[At McDonald’s, for example, choosing the largest size in each category means] consuming nearly triple the number of calories in a meal as you would if you chose the smallest portions....
Dietary surveys indicate that, on a per capita basis, Americans consumed 200 calories more per day in the 1990s than they did in the 1970s....Some experts calculate that people who add 150 calories a day to their diets, without increasing physical activity to burn those calories off, will gain as many as 15 pounds in a year.
I was thinking about all this recently when I read through the new U.S. Dietary Guidelines (the topic of a recent blog post by my colleague Pat Skerrett). The new guidelines include a key message for the two-thirds of Americans who are overweight or obese: Consume fewer calories. Or, as The New York Times recently headlined its own article: “Government’s Dietary Advice: Eat less.”

[Medicaid patients using mobile-phone-based healthware] for an average of 12 months reduced their ER visits and hospital stays by 58% compared to the 12 months prior to the program....[Diabetes Manager provides real-time coaching for patients and clinical decision support to their healthcare providers, extending care beyond traditional office visits. One year results of the first randomized controlled trial (RCT) of a mobile phone-based diabetes coaching and decision support intervention met the trial's primary endpoint of reducing blood glucose levels over a usual-care control group (Diabetes Care, 2011-09)]. Patients using the DiabetesManager had an average decline in A1C of 1.9 percentage points compared to a 0.7-percentage-point decline seen among [controls]. Results were similar regardless of baseline A1C.... WellDoc® [builds technology to help manage chronic disease by providing patients and their healthcare providers with real-time, actionable information they can use to increase engagement and adherence].

A study published in The New England Journal of Medicine by Seligman and Schilling in 2010 found that adults with the most severe food insecurity are more than twice as likely to have Type 2 diabetes.

After adjustment for other prognostic attributes, abnormal glucose tolerance (Cox hazard ratio HR, 95% CI: 5.920, 1.03 to 34.00; p = 0.046) but not diabetes (HR 3.46, 0.75 to 16.02; p = 0.112) predicted in-hospital mortality.

130 student/teacher edition or 180 digital download

A fact sheet of statistics on suicide with information on treatments and suicide prevention.

* Introduction
* What are the risk factors for suicide?
* Are women or men at higher risk?
* Is suicide common among children and young people?
* Are older adults at risk?
* Are Some Ethnic Groups or Races at Higher Risk?
* What are some risk factors for nonfatal suicide attempts?
* What can be done to prevent suicide?
* What should I do if I think someone is suicidal?
* For More Information About Suicide
* References


Suicide is a major, preventable public health problem. In 2007, it was the tenth leading cause of death in the U.S., accounting for 34,598 deaths.1 The overall rate was 11.3 suicide deaths per 100,000 people.1 An estimated 11 attempted suicides occur per every suicide death.1

Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.

8. Prevalence and Treatment of Mental Health Problems

This chapter presents findings on mental health problems in the United States, including the prevalence and treatment of serious psychological distress (SPD) and major depressive episode (MDE) and the association of these problems with substance use and substance dependence or abuse (substance use disorder).

SPD is an overall indicator of past year psychological distress that is derived from the K6 scale administered to adults aged 18 or older in the National Survey on Drug Use and Health (NSDUH). Numerical scores derived from responses to these six questions range from 0 to 24. For this report, a score of 13 or higher is considered SPD. It is notable that the data related to SPD in 2005 and 2006 are not directly comparable with data from earlier years because of study design changes. Further information on the measurement of SPD, the scoring algorithm, and the study design changes is provided in Section B.4.4 of Appendix B.

A module of questions designed to obtain measures of lifetime and past year prevalence of MDE, severity of the MDE as measured by role impairments, and treatment for depression was administered to adults aged 18 or older and youths aged 12 to 17 in 2006. Some questions in the adolescent depression module were modified slightly to make them more appropriate for youths. Given these differences, adult and youth depression estimates are presented separately in this chapter.

MDE is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had symptoms that met the criteria for major depressive disorder as described in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (American Psychiatric Association [APA], 1994). It should be noted that no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders.

Highlights of Recent Reports on Mental Health

bulletPrevalence of mental illness

bulletTreatment and mental health issues

bulletYouth and mental health issues

bulletChildren's mental health
bulletAll mental health reports and data

The economic costs of mental illness have never been easy to pin down.1 The costs of mental health care can be estimated much the way we estimate other health care costs. The Agency for Healthcare Research and Quality, cites a cost of $57.5B in 2006 for mental health care in the U.S., equivalent to the cost of cancer care.2 But unlike cancer, much of the economic burden of mental illness is not the cost of care, but the loss of income due to unemployment, expenses for social supports, and a range of indirect costs due to a chronic disability that begins early in life.

A report last week from the World Economic Forum (WEF) attempts to capture the costs of several classes of non-communicable diseases (NCDs) and projects the economic burden through 2030. Recognizing there is no ideal method, the authors adopted three approaches to estimate global economic burden: (a) a standard cost of illness method, (b) macroeconomic simulation, and (c) the value of a statistical life. The results of all three methods project staggering costs over the next two decades, with cardiovascular disease, chronic respiratory disease, cancer, diabetes, and mental health representing a cumulative output loss of $47T, roughly 75% of the global GDP in 2010.3

The WHO has already reported that mental illnesses are the leading causes of disability adjusted life years (DALYs) worldwide, accounting for 37% of healthy years lost from NCDs.4 Depression alone accounts for one third of this disability.5 The new report estimates the global cost of mental illness at nearly $2.5T (two-thirds in indirect costs) in 2010, with a projected increase to over $6T by 2030. What does $2.5T or $6T mean? The entire global health spending in 2009 was $5.1T. The annual GDP for low-income countries is less than $1T. The entire overseas development aid over the past 20 years is less than $2T.3

The WEF report also provides comparisons across NCDs to give some sense of the drivers of global economic burden. Mental health costs are the largest single source; larger than cardiovascular disease, chronic respiratory disease, cancer, or diabetes. Mental illness alone will account for more than half of the projected total economic burden from NCDs over the next two decades and 35% of the global lost output. Considering that those with mental illness are at high risk for developing cardiovascular disease, respiratory disease, and diabetes, the true costs of mental illness must be even higher.3

What makes these numbers especially important is the realization that they can be reduced. The WHO recently provided a list of "best buys" — low-cost interventions such as tobacco control and reductions in alcohol and substance use that can dramatically alter the prevalence and cost of NCDs. The WEF advises governments and corporations not medical practitioners and patients. But the message should be of broad interest: the economic health of both developing and developed nations will depend on controlling the staggering growth in costs from NCDs.

Mental Health & Substance Abuse
Comorbidity/Co-occurring Disorders/ Dual Diagnosis

SAMHSA's Office of Applied Studies provides national estimates on mental health problems. As of 2001, state-level estimates on mental health measures are available. Such data includes maps showing the prevalence ranks by States. The latest available national data on serious mental problems are for 2006 and the latest State level data are for 2005. See Mental Health Variables by State, 2005.

Mental health reports:

* All mental health reports from OAS
* Latest national data on mental health problems
* State level mental health data
* Mental health treatment

Special mental health topics:

* Children's mental health
* Co-occurring disorders
* Depression
* Education & mental health
* Employment & mental health
* Homeless
* Mental health in Hurricane Katrina/Rita areas
* Mental health in State treatment planning areas
* Race/ethnicity, education & employment and mental health
* Serious psychological distress
* Suicide
* Unmet mental health treatment need
* Violence
* Youth and mental health issues (highlights)



Mental health data tables:

* OAS data tables on mental health topics
* State treatment planning area mental health data tables
* National Outcome Measures (NOMs) for co-occurring disorders

Public use data files:

* Analyzing mental health data in SAMHSA's OAS data sets

Methodology:

* Methods used for mental health measures in OAS reports

Other resources:

* SAMHSA's Center for Mental Health Services (CMHS)
* Mental health statistics from SAMHSA's CMHS
* SAMHSA's National Clearinghouse on Mental health information (NMHIC)
* SAMHSA's Mental Health Services Locator
* Mental health objectives in Healthy People 2010
* Hurricane Katrina/Rita areas

As we begin a new decade, the need to control costs — while improving the quality of care — is vitally important to all sectors of health care. The annual economic costs of mental illness in the United States are enormous. The direct costs of mental health care represent around 6 percent of overall health care costs1. Among all Americans, 36.2 million people paid for mental health services totaling $57.5 billion in 2006 — the most recent year we have this type of data available2. This places mental health care expenditures as this nation’s third costliest medical conditions, behind heart conditions and trauma, and tied with cancer. Of course, the costs of mental health care are only a fraction of the costs of mental illness, which can result in substantial costs for co-morbid medical conditions as well as social costs due to disability, unemployment, and incarceration.

Cost control issues are central to the Patient Protection and Affordable Care Act (PPACA) of 2010, which set in motion a dramatic expansion of health insurance coverage and the creation of a new long-term care insurance program. It also calls for the evaluation of different approaches to restrain health care costs. Such sweeping changes and complex challenges cannot be successfully implemented without reliable research to tell us how to go about it. NIMH-supported research will be a key component in determining what can be done to control mental health care costs while expanding access to high-value care, fostering technological innovation, and maximizing public health.

Health care economics research is not new to NIMH. We have been facilitating mental health economics research since 1979, when, in response to President Carter’s Commission on Mental Health, the institute created a program to stimulate and support research on the economic aspects of the delivery, accessibility, use and cost of mental health services. This economic research has yielded important results. For example, it has been instrumental in understanding the impact of reimbursement policies which have influenced Medicare payment policy changes for inpatient psychiatric care3,4. It has been critical to the development of the theory of managed care and methods for adjusting payment for services based on individual risk factors. These methods guide mental health, substance use and general medical insurance benefit design in both private and public health care systems5. Empirical studies also demonstrated that the continuity of care for the severely mentally ill covered by the Medicare/Medicaid system would be negatively impacted by the “donut hole” coverage gap in the Medicare Part D medication benefit. These findings contributed to the closing of the donut hole as part of the PPACA by 20206.

in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations.

With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

* family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;
* cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
* interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems.

All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication study reported in the New England Journal of Medicine on March 28, 2007. The researchers compared patients’ time to recovery and their stability over one year.

Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy

Mental Health Treatment Gap

bulletAll mental health reports
bulletHighlights of all mental health treatment reports

bulletAll treatment gap detailed tables

bulletLatest mental health treatment gap highlights:

* In 2006, there were 10.5 million adults aged 18 or older (4.8 percent) who reported an unmet need for treatment or counseling for mental health problems in the past year. This included 4.8 million adults who did not receive mental health treatment and 5.6 million adults who did receive some type of treatment or counseling for a mental health problem in the past year. That is, about 20 percent of the 23.8 million adults that received treatment for a mental health problem in the past 12 months reported an unmet need. (Unmet need among adults who received treatment may reflect a delay in treatment or a perception of insufficient treatment.) (section on mental health treatment received and unmet need)

* Among the 4.8 million adults who reported an unmet need for treatment or counseling for mental health problems and did not receive treatment in the past year, several barriers to treatment were reported. These included an inability to afford treatment (41.5 percent), believing at the time that the problem could be handled without treatment (34.0 percent), not having the time to go for treatment (17.1 percent), and not knowing where to go for services (16.0 percent) (Figure 8.7).

bulletMental health treatment gap reports and data:

* new2006 National Survey on Drug Use & Health (HTML): provides the latest data on prevalence and correlates of substance use, serious mental illness, related problems, and treatment in the U.S.

o Chapter 8.1: Treatment for mental health problems and unmet treatment need among adults
o Detailed tables: Unmet Need for Mental Health Treatment/Counseling


* 2005: Treatment and Unmet Need for Treatment among Adults with Serious Psychological Distress

Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment with either CBT, the SSRI sertraline, the combination treatment, or a placebo. Independent evaluators, blind to their treatment status, assessed each patient every four weeks. Patients in the study were typical of patients seen in clinical practice. For example, while industry-sponsored trials commonly exclude patients with more than one condition, 80 percent of study participants had at least one additional psychiatric disorder.

Combining sertraline and CBT was more effective than treatment with just one or the other. CBT alone did prove superior to sertraline, which, in turn, was better than a placebo. By the end of the trial, the remission rates were 53.6 percent for combined treatment, 39.3 percent for CBT, 21.4 percent for sertraline, and 3.6 percent for placebo.

CBT alone was more effective in the University of Pennsylvania site than at Duke University site, but the combination treatment was equally effective at both sites, suggesting that it may be less susceptible to setting-specific variations. The strong showing of CBT at the University of Pennsylvania led the researchers to recommend it as "a first line option" for initial treatment. They point out, however, that "only a small minority" of children and adolescents with OCD receives such state-of- the-art care.

Participants were randomly assigned an antidepressant, psychotherapy, or referral to a community mental health service provider. "Structured care reduces major depression in these diverse and impoverished patients," said lead author Jeanne Miranda, Ph.D., University of California at Los Angeles Neuropsychiatric Institute. "This study broadens the knowledge base by evaluating depression treatments among young, predominantly minority women. It is the first study to let providers know that treating depression in this population can significantly improve the ability of these women to feel and function."

Results show that low-income women in minority populations benefit from depression treatment when it is paired with intensive outreach and encouragement to support the interventions. Not only did women achieve lower levels of depressive symptoms, but they also gained higher levels of functioning in daily life.

Outreach support—including transportation, child care, and spending considerable time to gain the trust of these participants—was an essential part of the study. Miranda and colleagues screened thousands of women for ethnicity, major depression, and exclusionary factors while they attended Women, Infants, and Children food subsidy programs and family planning clinics in four suburban counties near Washington, D.C.

Healthy People 2010 Progress Review
Focus Area 18: Mental Health & Mental Disorders

Goal: Improve mental health and ensure access to appropriate, quality mental health services.

bulletHealthy People 2010 Mental Health Objectives

bulletMental Health Data

bulletProgress Review

bulletChallenges & Strategies (PDF format)

bulletSummary Power Point Presentation

bulletTerminology

bulletCo-Lead Agencies:

* Substance Abuse and Mental Health Services Administration

* National Institutes of Health



Data: Mental Health



bulletHealthy People Mental Health Data in Excel Spreadsheets- each objective is in a separate worksheet, check the tabs at the bottom of the spreadsheet for the trend data on each objective number.

bulletOther Reports on Mental Health



Mental Health Objectives: Healthy People 2010



bulletHealthy People 2010 Mental Health Objectives: Specifics (Word Document)

bulletRelated Objectives from Other Focus Areas

Reports with mental health data and race/ethnicity

bulletMental health measures for racial and ethnic groups (2005 & 2004)

* Serious Psychological Distress
* Received Mental Health Counseling by Serious Psychological Distress
* Major Depressive Episode (age 12-17)
* Major Depressive Episode (age 18 or older)

bulletMental health measures for all racial and ethnic groups (2004 & 2003)

bulletSerious Mental Illness for Persons Age 18 and Older, 2001 (PDF format: Tables 8.2A - 8.2B)

bulletAll mental health reports

bulletAll reports on racial and ethnic groups



Reports with Race/Ethnicity & Mental Health Data


newThe NSDUH Report: Depression and the Initiation of Alcohol and Other Drug Use among Youths Aged 12 to 17

The DASIS Report: Adolescents with Co-Occurring Psychiatric Disorders: 2003

The NSDUH Report: Suicidal Thoughts among Youths Aged 12 to 17 with Major Depressive Episode

The DASIS Report: Admissions with Co-Occurring Disorders, 1995 and 2001

The NSDUH Report: Reasons for Not Receiving Treatment Among Adults with Serious Mental Illness

The NHSDA Report: Serious Mental Illness Among Adults

The NHSDA Report: Treatment Among Adults with Serious Mental Illness

Demographic and Socioeconomic Characteristics of Adults Receiving Mental Health Treatment in Patterns of Mental Health Service Utilization and Substance Use Among Adults, 2000 and 2001 (HTML)

Sometimes psychotherapy alone may be the best treatment for a person, depending on the illness and its severity. Other times, psychotherapy is combined with medications. Therapists work with an individual or families to devise an appropriate treatment plan. What are the different types of psychotherapy?



Many kinds of psychotherapy exist. There is no "one-size-fits-all" approach. In addition, some therapies have been scientifically tested more than others. Some people may have a treatment plan that includes only one type of psychotherapy. Others receive treatment that includes elements of several different types. The kind of psychotherapy a person receives depends on his or her needs.

Psychotherapy is a crucial part of treatment for many mental disorders, but it can be difficult to identify the right approach for an individual. To that end, NIMH is funding eight new projects designed to evaluate, refine and improve psychotherapy-based treatments. Projects range from developing and piloting novel approaches for treating specific mental disorders, to conducting large, multi-site clinical trials to test treatments and treatment combinations for both adults and children.

Evidence regarding mental health disparities paints a puzzling picture that is complicated by the interrelationships of race/ethnicity, SES, and geography across the life course. For example, although the prevalence of common mental disorders is higher in White Americans than in Black Americans and Latino Americans, the latter groups have a more pernicious course of illness, and poorer access to services.1 However, certain other mental disorders exhibit different patterns of prevalence and trajectory. Thus, it is necessary to understand how patterns of mental health disparities differ by disorder, along with the factors that create these patterns, including causes and mechanisms. Furthermore, it is critical to close gaps in treatment access and service provision affecting these populations. Collaborations with other federal agencies will be essential to strengthening links between research and practice.

At this point, all patients benefit from the virtual reality exposure therapy. The degree to which d-cycloserine coupled with virtual reality exposure therapy is more or less effective in reducing anxiety symptoms compared with placebo or alprazolam will not be known until the study is completed by the end of August, 2011.

The stimuli used for activation during the startle assessment consist of two-minute video clips of scenes depicting the Iraq theater of combat including that of a Humvee driving alone along a desert highway, a Humvee traveling within a convoy along a desert highway, and a soldier on foot patrol in an Iraqi city.

Acoustic startle, which measured hyperarousal symptoms, was assessed while patients were exposed to each of the three virtual environments at (1) pre-treatment, (2) post-treatment, (3) three months post-treatment, and (4) six months post-treatment. During treatment, the virtual reality exposure therapy was tailored to each of the patients such that they were repeatedly exposed to a virtual environment closely matched to that in which they were traumatized or injured.

At the time of pre-treatment, all subjects displayed a robust acoustic startle response within their relevant treatment environment. This robust startle magnitude decreased significantly, by 75 percent, during the course of treatment with its lowest levels at 6 months post-treatment. This reduction in acoustic startle magnitude observed in Rothbaum's study is consistent with a decrease in symptom severity in these patients as measured by scores on the Clinician Administered PTSD Scale.

"We think using virtual reality makes for a more potent and therapeutic exposure session by putting together the memories, sights, smells, feelings, and emotions and helping them to confront and cope with that complete memory," says Rothbaum. "We think that d-cycloserine specifically may facilitate the emotional learning process that takes place in exposure therapy and hopefully makes this process faster, more robust and long-lasting."

Data Tables with government assistance as a variable:
* Adult (age 18 and older) mental health treatment/counseling, 2000 & 2001 (PDF format) -- Number and percent of (1) any mental health treatment, (2) inpatient, outpatient, and prescription medication treatment, and (3) unmet need for mental health treatment/counseling by socioeconomic demographics & geographic variables, family income, government assistance, and any illicit drug use (Tables 8.35A - 8.40B).
* Substance use by adult mental health treatment/counseling , 2000 & 2001 (PDF format) -- Number & percent of past year users of any illicit drugs, marijuana, nonmedical use of prescription-type drugs, cigarettes, & alcohol by receipt & perceived need for mental health treatment/counseling by sociodemographics, government assistance, and geographic variables

This initiative aims to support innovative research that will generate the major scientific advances needed to make a significant impact on the lives of people living with neuropsychiatric disorders worldwide. The research supported will address barriers that, if removed, will have a significant impact on the prevention and treatment of mental disorders worldwide.
Rationale

The World Health Organization’s Global Burden of Disease Study identifies neuropsychiatric disorders as being responsible for 13 percent of the total global disease burden.i Moreover, across the world, the treatment gap (i.e., the difference between the number of people suffering from mental, neurological and substance use (MNS) disorders and the number who actually receive the treatment they need) for MNS disorders is large and leads to chronic disabilities and increased mortality. Yet despite the suffering and disability these disorders cause, relatively few resources are allocated worldwide to fund the necessary research to prevent and treat neuropsychiatric disorders effectively.

This initiative builds upon previous priority-setting exercises to identify what stands in the way of progress in neuropsychiatric research worldwide. The term ‘global mental health’ underscores the cross-national influences on neuropsychiatric disorders and relates the shared responsibility for promoting mental health in all countries. Its core focus on equity strives to reduce and, ultimately, eliminate health inequalities between and within countries.

The Medical Expenditure Panel Survey (MEPS) is a set of large-scale surveys of families and individuals, their medical providers, and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage. Learn more about MEPS.

The baseline NCS, fielded from the fall of 1990 to the spring of 1992, was the first nationally representative mental health survey in the U.S. to use a fully structured research diagnostic interview to assess the prevalences and correlates of DSM-III-R disorders. The baseline NCS respondents were reinterviewed in 2001-02 (NCS-2) to study patterns and predictors of the course of mental and substance use disorders and to evaluate the effects of primary mental disorders in predicting the onset and course of secondary substance disorders. In conjunction with this, an NCS Replication survey (NCS-R) was carried out in a new national sample of 10,000 respondents. The goals of the NCS-R are to study trends in a wide range of variables assessed in the baseline NCS and to obtain more information about a number of topics either not covered in the baseline NCS or covered in less depth than we currently desire. A survey of 10,000 adolescents (NCS-A) was carried out in parallel with the NCS-R and NCS-2 surveys. The goal of NCS-A is to produce nationally representative data on the prevalences and correlates of mental disorders among youth. The NCS-R and NCS-A, finally, are being replicated in a number of countries around the world. Centralized cross-national analysis of these surveys is being carried out by the NCS data analysis team under the auspices of the World Health Organization (WHO) World Mental Health Survey Initiative.

Overall, 13 percent of respondents met criteria for having at least one of the six mental disorders within the last year. About 1.8 percent of the respondents had more than one disorder, usually a combination of ADHD and conduct disorder. Among the specific disorders,

* 8.6 percent had ADHD, with males more likely than females to have the disorder;
* 3.7 percent had depression, with females more likely than males to have the disorder;
* 2.1 percent had conduct disorder;
* 0.7 percent had an anxiety disorder (GAD or panic disorder);
* 0.1 percent had an eating disorder (anorexia or bulimia).

"With the exception of ADHD, the prevalence rates reported here are generally lower than those reported in other published findings of mental disorders in children, but they are comparable to other studies that employed similar methods and criteria," said lead author Kathleen Merikangas, Ph.D., of NIMH.

Those of a lower socioeconomic status were more likely to report any disorder, particularly ADHD, while those of a higher socioeconomic status were more likely to report having an anxiety disorder. Mexican-Americans had significantly higher rates of mood disorders than whites or African-Americans, but overall, few ethnic differences in rates of disorders emerged.

Reviews applications that focus on clinical services and service systems, such as innovative service delivery systems; studies at the interface of service and interventions, such as studies of treatment guidelines and practice patterns; and policy, cost and dissemination research. For SRNS, the focus will particularly be on applications assessing service sites that are considered non-specialty mental health settings, such as primary or specialist medical care, schools, child welfare agencies, criminal justice settings, shelters, and other social service agencies where the primary focus of care is not mental health. Services studies may include data from human subjects of all age ranges and from all cultural and socio-economic backgrounds. Research may examine organizations, systems and/or communities. Research methods may include qualitative or quantitative techniques, including large data sets, such as national health data sets and Medicare claims data where those data focus on non-specialty mental health service use.

Online counseling is becoming more and more pervasive. Some see this trend as positive while others are concerned with the quality and ethical issues related to providing counseling online. This article reviews the pros and cons of providing counseling services online, and whether practitioners and researchers are for or against such practice. It recognizes that it is not only occurring, but it also will likely increase in prevalence regardless of the potential drawbacks. The case is made that since it is here to stay, we should study the phenomenon because, good or bad, it provides a unique opportunity to study counseling and psychotherapy.

rising curve?

This is the only independent consumer guide to therapists and counselors who provide help over the Internet - compiled by consumers, for consumers.
Is e-therapy the right choice for me?

How can I protect myself from quacks?

Will my online counseling be private?

How much does e-therapy cost?

How do I compare e-therapist qualifications?

Are there any issues I should know about? Before you consult a therapist online, there are some things you need to know. Well tell you what to consider when talking with a therapist online.
Click to start
or read on...
This directory is now maintained by Psych Central and is up to date as of Feb. 2007. Click here to jump to the directory of online therapists.

I have had several requests for the information in a paper I presented at the American Psychological Association's Convention in August of 1997. The paper is reproduced below in its entirety. It is much longer than most features which I write for this site, but much of the information is still timely.

You can't do Psychotherapy on the Net (yet)
Leonard G. Holmes, Ph.D.

Originally Presented at the American Psychological Association Annual Convention, August 1997

Abstract:
Psychotherapy is not possible on the Internet because of unresolved ethical issues, problems related to the current "bandwidth" of the net, and unresolved regulatory and licensing issues. This paper discusses the current state of the delivery of mental health services on the net and proposes some solutions. It should be possible to conduct psychotherapy on the Internet at some point in the future as bandwidth, regulatory, and ethical issues are resolved.

The counseling profession has addressed aspects of the importance of technology supported or delivered counseling through the development of standards of practice (ACA, 1999; NBCC, 1997) that have had varying levels of compliance. As reported by Heinlen, Welfel, Richmond and Rak (2003), low levels of compliance by webcounselors with the National Board for Certified Counselors (NBCC) Standards of Practice for the Ethical Practice of Webcounseling was found in a recent study reported in the Journal of Counseling & Development. A third set of standards of practice for internet delivered counseling is available through the International Society for Mental Health Online (ISMHO) and are available on the web (http://www.ismho.org). In addition, at this site, research into the efficacy of internet counseling is pursued through a case study method involving practicing internet counselors. In recognition that online counseling may well represent a semi-paradigm shift within the field of mental health care, it is essential that core issues be explored by potential providers prior to entering an arena that is qualitatively and quantitatively different than traditional models of providing counseling services.

Characteristics of the Online Counseling Consumer

Central to the appeal of online counseling to consumers of mental health and well being services are a set of characteristics that can be linked to decision making about entering a potentially challenging method of practice. A number of assumptions can be made about the characteristics of users of online counseling services.

There are several technical difficulties inherent in our efforts to transform face to face (f2f) healing relationships into online formats, across Internet-facilitated boundaries and modalities. This is not to say that an effort to develop such a one-to-one, point-for-point transformation of traditional psychotherapies into equivalent web-based versions is necessarily desirable, even were it conceptually possible. However, it does appear as if the Internet-based community, whoever and wherever that may be, is willing to make a shift in thinking about the various aspects of verbal, interpersonal communication which may be of a healing, "therapeutic" nature.

Clearly, many practitioners who are well-trained and well-experienced in providing "psychotherapy" or counseling of one type or another, are enthusiastically embracing the opportunity which Internet-facilitated communication affords. 1

It is also clear that a large number of people with Internet access continue to utilize the World Wide Web (WWW) in order to seek information about mental health topics, while to a lesser extent (and arguably much more vague in terms of numbers) it appears as if there is a growing "market" for direct online mental health services. With increasing access to an increasingly borderless online community, and fueled by the availability of several for-profit websites which are heavily promoting their own version of "e-therapy" (and for practitioners, easy office management), it seems inevitable that both qualified and wishful mental health professionals will continue to embrace the "easy" way to "do therapy", and a growing number of clients will partake of these services as they increase in accessibility and acceptability. This of course has major implications for both consumers and practitioners of "mental health online".

[>14 000 adolescents enrolled in the National Longitudinal Study of Adolescent Health (Add Health) were followed up into adulthood. W]e assess and contrast the trend in health indicators among racial/ethnic groups....

Diet, inactivity, obesity, health care access, substance use, and reproductive health worsened with age. Perceived health, mental health, and exposure to violence improved with age. On most health indicators, white and Asian subjects were at lowest and Native American subjects at highest risk. Although white subjects had more favorable health in adolescence, they experienced greatest declines by young adulthood. No single race/ethnic group consistently leads or falters in health across all indicators.

[For 15 of 20 indicators, health risk increased and access to health care decreased from the teen to] adult years for most US race/ethnic groups. [Relative rankings and patterns of change vary by sex and race/ethnicity, and] over time.

Replacing GoodForWhatAilsMe.blogspot.com: :

[references throughout]

That weight loss will improve health over the long-term for obese people is [an untested hypothesis—partly] because no methods have proven to reduce weight long-term for a significant number of people. Also, while normal weight people have lower disease incidence than obese individuals, it is unknown if weight loss in individuals already obese reduces disease risk to the same level as that observed in those who were never obese.

As indicated by research conducted by [many] investigators, most health indicators can be improved through changing health behaviors, regardless of whether weight is lost. For example, lifestyle changes can reduce blood pressure, largely or completely independent of changes in body weight. The same can be said for blood lipids. Improvements in insulin sensitivity and blood lipids as a result of aerobic exercise training have been documented even in individuals who gained body fat during the intervention.