Author Archives: Katti Gray

About Katti Gray

Katti Gray (@kattigray) is AHCJ's core topic leader for behavioral and mental health. A former Rosalynn Carter Mental Health Journalism Fellow, Gray is providing resources to help AHCJ members expand their coverage of mental health amid ongoing efforts to de-stigmatize mental illness and to place mental health care on par with all health care.

Community health workers are key to revamping U.S. mental health care system, AHCJ keynoter and Rand researchers say

Community health workers in Luxor, Egypt, practice their counseling skills through role play at a local clinic. (Photo courtesy of USAID Egypt via Flickr)

Several speakers at AHCJ’s Mental Health Summit lauded the Rand Corp.’s recently released “Transforming Mental Health Care in the United States,” a research brief whose 15 recommendations, among other things, call for:

  • More formalized mental health education for schoolkids.
  • More programs that keep homeless persons with mental illness in supportive housing.
  • Increased efforts to stem incarceration of the mentally ill.
  • Nationwide standards for prescribing and paying for mental and behavioral health services.
  • Financial and other incentives that expand the number of medical school-trained. psychiatrists, psychiatric nurses who can prescribe medication, and so forth, while also raising the count of on-the-ground community-health workers who are critical to filling gaps in mental health care access.

The report comes as the nation’s mental health care system continues to struggle to meet many goals of the Mental Health and Addiction Equity Act, passed in 2008 to expand the Mental Health Parity Act of 1996. 

Amid current bipartisan efforts aimed at shoring up that system, how to build and adequately compensate a lay workforce of community health workers and peer, support specialists, is a question that increasingly comes up, said public health researcher Ryan McBain, Ph.D., M.P.H.  

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Emory psychiatrist: Electroconvulsive therapy lacks patients and clinicians skilled in the treatment

Brandon Kitay, M.D., Ph.D. (Photo courtesy of The Yale School of Medicine.)

The words “electroconvulsive therapy” elicit visions of Randle McMurphy, the character Jack Nicholson played in the 1975 blockbuster “One Flew Over the Cuckoo’s Nest,” filmed at Oregon State Hospital — the actual mental institution at the center of the novel the film is based on.

In one key scene, lasting a few seconds, McMurphy undergoes electroconvulsive therapy (ECT). He turns beet red, seizes furiously, gasps and grimaces as several white-uniformed aides huddle overhead, making sure his jerking body doesn’t fall off the gurney.

However hyperbolic that fictionalized scene, Dr. Brandon Kitay, Emory Healthcare’s director of behavioral health integration, says it draws on some earlier misuses of 82-year-old ECT that have been, by far, more the exception than the rule.

The ECT that Kitty Dukakis, wife of former Massachusetts Gov. Michael Dukakis, underwent and championed in her 2006 book, “Shock,” co-authored with journalist Larry Tye, tells a truer story of ECT and how it achieved for her what 25 years of prescribed anti-depressants had not.

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Report: Pop-up clinics, other outreach, boosted vaccination of severely mentally ill

Photo by Alachua County via Flickr

Although people with schizophrenia, severe bipolar disorder and other serious psychiatric disorders worldwide have been less likely to get vaccinated against COVID-19, people with mental illness in one Georgia county got vaccinated at a higher rate than people without mental illness, according to a September 2021 survey conducted by the Washington D.C.-based Treatment Advocacy Center and Clubhouse International.

The latter, which does advocacy and programming for the mentally ill in 30 countries, marked that achievement in Floyd County, Ga. by persuading public health officials to do pop-up clinics at Clubhouse headquarters, said Lisa Dailey, executive director of The Treatment Advocacy Center. What Clubhouse accomplished in Floyd County — where 61% to 80% of Clubhouse members but 10.1% of all county residents were vaccinated as of mid-June 2021 — exemplifies what can happen when health officials and advocates for the mentally ill coalesce. Continue reading

Reporting on suicide among the elderly — a major public health issue even before the pandemic

Photo by Borja via Flickr

The pandemic’s assorted pressures have caused a spike in suicidal thoughts among subsets of people, including older Americans whose risk for suicidal ideation — and suicide itself — is linked to some of the particularities of aging.

According to a March 2021 analysis by geriatric researchers at Adelphi and Columbia Universities, 28% of U.S. adults who were at least 65 years old, or 14.7 million people, resided alone. That tally of older people living solo — and often enduring the gut punches of isolation and loneliness — only went up from there. Approximately 44% of women ages 75 and older lived alone.

There’s a kind of pile-on effect at play, researchers suggest, as societal and health problems circle in and out of each other. Social isolation can and does often worsen chronic illness, which disproportionately besets older people. The CDC calculates 85% of those age 65 and older have at least one chronic illness; 60% have two or more.

Men 75 and older had the highest risk for suicide, according to the CDC’s most recent data, with 39.9 such suicides per 100,000 Americans. The comparable figure for women in that age group was 4.3 per 100,000. For those ages 65 through 74, the respective rates were 26.4 and 5.9. (This 2018 analysis in Clinical Interventions in Aging put the rate for white men who were 65 and older at 48.7 per 100,000.)

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S. Dakota pilot project reduces number of inmates with mental health, behavioral issues

Photo: Chris Landsberger, courtesy of The OklahomanThis photo from Jaclyn Cosgrove’s series for The Oklahoman shows a male inmate in the Oklahoma County Jail’s mental health unit.

Amid a nationwide push to pare the number of incarcerated people with mental and/or behavioral disorders, a South Dakota pilot project giving law enforcement officials 24/7 online access to mental health clinicians has diverted from lockdown and into community-based care about 75% of people confronted by police during a mental/behavioral crisis.

Launched in January 2020, Virtual Crisis Care is among the first endeavors of its kind in rural America. It mirrors a comparatively small but slowly growing number of mainly urban projects that, along with virtually connecting police and probation officers with social workers, psychologists and other mental health clinicians, have sometimes placed those professionals in a cop car. Continue reading