RESUMEN
The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.
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Personal Militar , Humanos , Personal Militar/psicología , Salud Mental , Ocupaciones , Tamizaje MasivoRESUMEN
Suicide rates in the United States (US) reached a peak in 2018 and declined in 2019 and 2020, with substantial and often growing disparities by age, sex, race/ethnicity, geography, veteran status, sexual minority status, socioeconomic status, and method employed (means disparity). In this narrative review and commentary, we highlight these many disparities in US suicide deaths, then examine the possible causes and potential solutions, with the overarching goal of reducing suicide death disparities to achieve health equity.The data implicate untreated, undertreated, or unidentified depression or other mental illness, and access to firearms, as two modifiable risk factors for suicide across all groups. The data also reveal firearm suicides increasing sharply and linearly with increasing county rurality, while suicide rates by falls (e.g., from tall structures) decrease linearly by increasing rurality, and suicide rates by other means remain fairly constant regardless of relative county urbanization. In addition, for all geographies, gun suicides are significantly higher in males than females, and highest in ages 51-85 + years old for both sexes. Of all US suicides from 1999-2019, 55% of male suicides and 29% of female suicides were by gun in metropolitan (metro) areas, versus 65% (Male) and 42% (Female) suicides by gun in non-metro areas. Guns accounted for 89% of suicides in non-metro males aged 71-85 + years old. Guns (i.e., employment of more lethal means) are also thought to be a major reason why males have, on average, 2-4 times higher suicide rates than women, despite having only 1/4-1/2 as many suicide attempts as women. Overall the literature and data strongly implicate firearm access as a risk factor for suicide across all populations, and even more so for male, rural, and older populations.To achieve the most significant results in suicide prevention across all groups, we need 1) more emphasis on policies and universal programs to reduce suicidal behaviors, and 2) enhanced population-based strategies for ameliorating the two most prominent modifiable targets for suicide prevention: depression and firearms.
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Armas de Fuego , Equidad en Salud , Anciano , Anciano de 80 o más Años , Etnicidad , Femenino , Homicidio , Humanos , Masculino , Persona de Mediana Edad , Población Rural , Estados Unidos/epidemiología , UrbanizaciónRESUMEN
The COVID-19 pandemic has led to record unemployment claims and a weakened U.S. economy. This column reviews results of past research to examine how a recession might affect behavioral health and the treatment of mental and substance use disorders and suggests potential policy solutions. Despite increases in suicide and substance use, losses in employment-related health insurance could dampen treatment seeking. Federal, state, and local officials should be vigilant regarding suicide prevention. Individuals who lose employee insurance coverage should be protected through insurance marketplaces and Medicaid outreach and enrollment. Public and private coverage of telehealth, which has already been expanded, should continue beyond the pandemic. Federal support for community behavioral health organizations should continue to offset state and local budget cuts and ensure provision of needed treatment. The capacity of social services should be expanded as well as systems that facilitate client connection to social services.
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COVID-19 , Pacientes no Asegurados/psicología , Trastornos Mentales , Salud Mental , Desempleo/psicología , Adulto , COVID-19/economía , COVID-19/epidemiología , Femenino , Humanos , Seguro de Salud , Masculino , Trastornos Mentales/economía , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Salud Mental/economía , Salud Mental/tendencias , Evaluación de Necesidades , SARS-CoV-2 , Asistencia Social en Psiquiatría/normas , Asistencia Social en Psiquiatría/tendencias , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVE:: There are increasing demands on emergency psychiatrists with higher numbers of mental health presentations, and longer stays in emergency departments (EDs). Australia, like other English speaking countries, funds considerably lower numbers of psychiatric beds than average for Organisation for Economic Co-operation and Development (OECD) countries. Consequently, acute bed occupancy is high, and a bed is frequently unavailable when a person needs admission. Patients with serious mental illness can wait days in busy and overstimulating EDs, become agitated and assaultive, and then require chemical and physical restraint. All patients have a right to safe high quality care, but the paucity of beds deprives patients of this right. The Australasian College of Emergency Medicine recommends reporting ED access block to health ministers, and human rights and/or health rights commissioners, and recommends increased funding for inpatient psychiatric care, emergency mental health and after-hours community services, together with more alcohol and other drug programs. CONCLUSIONS:: It is challenging for emergency physicians and psychiatrists to provide optimal care for acutely unwell patients who stay extended periods in the ED. Increasing the availability of inpatient care must be considered as part of a comprehensive solution for minimising ED lengths of stay in Australia.
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Servicio de Urgencia en Hospital/normas , Política de Salud , Derechos Humanos/normas , Servicios de Salud Mental/normas , Servicio de Psiquiatría en Hospital/normas , Australia , Accesibilidad a los Servicios de Salud/normas , HumanosAsunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Capacidad de Camas en Hospitales/estadística & datos numéricos , Servicio de Psiquiatría en Hospital/organización & administración , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Atención Ambulatoria/organización & administración , Atención Ambulatoria/estadística & datos numéricos , Atención Ambulatoria/tendencias , Antipsicóticos/uso terapéutico , Servicios Comunitarios de Salud Mental/organización & administración , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/tendencias , Estudios Transversales , Predicción , Política de Salud/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/organización & administración , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Defensa del Paciente/estadística & datos numéricos , Defensa del Paciente/tendencias , Prisiones/estadística & datos numéricos , Prisiones/tendencias , Servicio de Psiquiatría en Hospital/tendencias , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Estados UnidosAsunto(s)
Capacidad de Camas en Hospitales/estadística & datos numéricos , Hospitales Psiquiátricos/estadística & datos numéricos , Suicidio/estadística & datos numéricos , Factores de Edad , Capacidad de Camas en Hospitales/economía , Hospitalización , Hospitales Psiquiátricos/economía , Hospitales Psiquiátricos/tendencias , Humanos , Trastornos Mentales/epidemiología , Salud Mental/economía , Suicidio/tendencias , Estados Unidos/epidemiología , Prevención del SuicidioAsunto(s)
Ética Médica , Formulación de Políticas , Psiquiatría , Sociedades Médicas , Tortura , Humanos , Estados UnidosAsunto(s)
Atención a la Salud/tendencias , Servicios de Salud Mental/tendencias , Patient Protection and Affordable Care Act/tendencias , Atención a la Salud/legislación & jurisprudencia , Predicción , Humanos , Servicios de Salud Mental/legislación & jurisprudencia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Estados UnidosAsunto(s)
Trastornos Mentales/psicología , Enfermos Mentales/psicología , Autoimagen , Estigma Social , Humanos , EstereotipoRESUMEN
OBJECTIVE: The purpose of this study was to review the workload inventory of on-call psychiatry residents and to evaluate which activities were associated with reductions in on-call sleep. METHOD: A prospective cohort study was conducted, following 20 psychiatry residents at a 231-bed psychiatry hospital, from July 1, 2008 through June 30, 2009. On-call activities and hours of sleep received were recorded on log sheets. RESULTS: From the 2008-2009 academic year, 298 on-call log sheets were received (81.64% response rate). The mean hours of sleep per night received by participating residents was 3.52 hours. The mean number of pages received was 17.21 per night. The variance in hours of sleep was explained by the number of pages and the number of admissions. CONCLUSION: Given the new standards established by the Accreditation Council for Graduate Medical Education, residency directors can increase on-call sleep for residents by reducing the number of pages and admissions.
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Internado y Residencia/estadística & datos numéricos , Psiquiatría/educación , Privación de Sueño/epidemiología , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos , Baltimore/epidemiología , Estudios de Cohortes , Humanos , Admisión y Programación de Personal/estadística & datos numéricos , Estudios Prospectivos , Tolerancia al Trabajo Programado/psicologíaAsunto(s)
Internado y Residencia/economía , Psiquiatría/educación , Centros Médicos Académicos/economía , Centros Médicos Académicos/organización & administración , Centros Médicos Académicos/normas , Conducta Cooperativa , Control de Costos , Hospitales Psiquiátricos/economía , Hospitales Psiquiátricos/organización & administración , Hospitales Psiquiátricos/normas , Internado y Residencia/organización & administración , Internado y Residencia/normas , Maryland , Psiquiatría/economía , Psiquiatría/organización & administraciónRESUMEN
Driven by financial pressures, the sole focus of psychiatric inpatient treatment has become safety and crisis stabilization. Data are lacking on outcomes of ultrashort-stay hospitalizations; however, such stays may diminish opportunities for a sustained recovery. In the absence of an evidence base to guide clinicians and policy makers, mental health professionals have an ethical obligation to promote what they consider to be best practice. This Open Forum focuses on the need to reconsider the current model of inpatient hospitalization in order to maximize positive outcomes and emphasize appropriate transition to the community and less intensive levels of care. A model of care is presented based on rapid formulation of diagnosis, goals, and treatment modalities before treatment begins. Three phases are described--assessment, implementation, and resolution--with specific principles to guide length-of-stay decisions and requirements for staffing.