A Baffled Look

The straight dope on mental health

Month: January, 2013

Foraging for treatment

Even though most mentally ill persons know something is wrong, the ones that don’t shouldn’t be foraging for food in garbage cans or be thrown in jail for being a nuisance. Mentally ill people have been mistreated in the US since the country’s inception. President Kennedy’s vision for community mental health treatment wasn’t realized because Congress didn’t fund it. Regardless, the states saw it as a way to stop funding state mental hospitals so discharged patients wound up on the streets. If Kennedy’s vision had been fulfilled we wouldn’t have as severe a homelessness problem. Community clinics should get a lot more funding. I don’t see that happening, though; cash strapped state legislatures don’t want to spend the money. Most homeless mentally ill people don’t vote. They’re too busy trying to survive and often they don’t have documents that will enable them to register to vote or get a state ID.

I worked at a drop-in center that served the mentally ill for almost two years. Many of their clients were homeless and received Social Security. They have case managers who are social workers from the county mental health provider that monitor their progress, but there’s little continuity in treatment because of the turnover of these case managers. Most of the drop-in center’s clients get only 5 minutes or so with either a nurse practitioner or a psychiatrist every 3 months for medication management. So if they need an adjustment on their meds they have no recourse except to go inpatient. It ends up costing more than seeing their psychiatrist more often.

But at least that’s better than nothing at all. According to a 2010 Orlando Sentinel article, my county mental health provider has been turning people away because of increased demand and limited funding. Their budget has been the same for 10 years. The only treatment they have access to is crisis stabilization units. They can’t get the help they need from the community in order to stay out of the hospital. Again, it ends up costing state government more. Some of the folks at the drop-in center are so ill they can’t get it together enough to apply for Social Security. They have no insight into their condition so they don’t know that they are sick enough to get Social Security and Medicaid. They commit petty crimes like shoplifting or drug possession as a means of survival. They have horrible lives and they use drugs and alcohol as an escape. It would be cheaper to treat these patients in the community because in the long run it would reduce hospitalizations and arrests.



Reefer Madness

Some studies suggest marijuana triggers psychosis in genetically vulnerable individuals. I’ve included a link to a Canadian documentary called The Downside of High that examines this. The evidence is contradictory. In one study in Britain 600,000 people from 16 – 44 were evaluated. Even though pot use increased considerably rates for schizophrenia were stable or declined. Another NIH study found no link between marijuana use and schizophrenia. Correlation is not causation. People with psychotic disorders also smoke cigarettes and cigarettes don’t cause psychosis. They actually help schizophrenics think more clearly. And schizophrenics use more alcohol and illicit drugs than the general population. So this may be a case of reverse causation. If you began to worry about losing your mind pot might appeal to you to ward off anxiety.

Still, an NIH study reports, “What does appear to be consistent is that in individuals with a predisposition for schizophrenia, ingesting cannabis exacerbates symptoms and worsens the schizophrenic prognosis…” But it also points out that a number of animal and clinical studies suggest that the non-psychoactive constituent cannabidiol (CBD) has antipsychotic properties and that it may protect against some pro-psychotic effects of THC. And, according to a study published in Translational Psychiatry, CBD has few side effects. A big obstacle in using it for treatment is that CBD is a natural compound, so it can’t be patented. Without a patent, drug companies have no incentive to develop it because without a patent they can’t make money. Some researchers are trying to develop synthetic versions of the compound. Let’s hope they succeed.