Society’s Tonic – Safe Disposal of Unused Medications

Posted on February 25, 2010 by astrauss

SMARxT DISPOSAL  is a conjoint project of the US Fish and Wildlife Service,  The American Pharmacists Association, and the Pharmaceutical Research and Manufactures of America. They list recommendations for the safe disposal of unused medications.

Basically, medications should not – with rare exception — be flushed or poured down a drain.  Solid data is appearing how medications are showing up in wildlife, and a real environmental danger is brewing that can, in many ways, be avoided or markedly reduced.

Recently antipsychotics have been found in mussels. And anticholesteral medications may limit the grow patterns of fish.

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Society’s Tonics – Mental Health Parity Update Feb 2010

Posted on February 13, 2010 by astrauss

 The Wellstone-Domenici Mental Health Parity and Addictions Law passed Congress in 2008. Some people considered this as equal to a civil rights victory for the mentally ill. But implementation issues needed clarification. Much talk exists that the ultimate interpretations will be made in the courts as patients and their advocates challenge insurance companies about the ‘true intent’ of the law. The initial grassroots regulations of how to implement parity comes from the US Departments of Health and Human Services, Labor and Treasury (see below link).

In my mind — did the bill writers, supporters, and debaters not consult with insurance minded people to anticipate these issues? Or perhaps it was intentional, to either delay the implementation or to force these issues into the courts.

These rules will be effective April 5, 2010 and generally apply to group health plans and group health insurance issuers for plan years beginning on or after July 1, 2010.

The below DOL link is important to at least review. Also, the DSM-5 draft is available for review and comment at http://www.dsm5.org/ from February 10 to April 20, 2010.

Below is the 2-2-2010 link of these regulations that just appeared. Here are the four major issues:

1. Defining what is a medical versus a psychiatric disorder. If insurers call an entity a medical disorder, it will be exempt from parity coverage. Autism and PDD are widely viewed as medical, not psychiatric disorders. If schizophrenia only needed medications to treat, then it would be a medical disorder. But it requires a range of psychosocial interventions as well. However, diabetes also requires a range of psychosocial interventions as well, but it is considered a medical disorder. Clearly this labeling process has political and scientific elements, and it remains copiously unresolved and unfinished. We will see what the DSM-V does to this progression.

2. Insurers are exploring if there can be separate deductibles for mental health & substance abuse versus general medical disorders. Many argue the deductibles should be combined as in Medicare. The 1996 parity law allowed for separate lifetime benefit benefits. Separate deductibles are considered discriminatory. The below rules clarify that separate deductables are not allowed.

3. Management – related to complicated needs for treatment authorizations. The law seems to suggest that management/authorizations can be more stringent than for medical/surgical benefits. Fail first requirements are all possible – that failure of less costly treatments may be needed before referral to more costly ones (does this mean failed antidepressant use by an internist before referral to a mental health provider?) Having a parity level benefit on paper and having clinical access to that benefit are two different events.

4. Scope of coverage – if a plan allows for treatment of a particular mental health disorder, what limits can they impose on levels or types of care. This is called ‘treatment limitations.” The law is not specific enough. Insurance companies cover illnesses based on their choice of coverages, and then on documented evidence of a necessity to provide coverage. In mental health, absolute and immovable evidence-based treatments do not yet exist, so will treatment be limited to medications, CBT, ECT, but not marital or analytic therapy? Or will 4, or 8 or 12 psychotherapy sessions be allowed. It’s known that insurance companies fear endless verbal psychotherapy, but all mental health professionals know that prolonged verbal and cognitive therapy is, at times, needed. A suggestion exists that mental health providers may choose a primary diagnosis that is covered, and then add a host of secondary diagnoses – this is not a new practice to medicine. Also, as patients learn more about their parity benefits, more and more may seek treatment. That will increase costs at some levels, but it will also be better for the community as more mental illness is treated, people will miss fewer work days, hopefully fewer people will have associated legal problems, etc.

This is to the latest set of proposed government rules:

http://www.dol.gov/federalregister/HtmlDisplay.aspx?DocId=23511&AgencyId=8&DocumentType=2

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Psychotherapy Notes — Food Insecurity

Posted on November 17, 2009 by astrauss

Consider this: that 1 in 7  families in the US face ‘food insecurity.’  This means that 14% of all American households struggled to put enough food on  the table in 2008.  U.S. Agriculture Secretary Tom Vilsack  said it could be even higher in 2009. “Food insecurity” sounds a little like it ought to be a psychiatric term. It is not, but it can have psychiatric ramifications.

For example, we too often assume that kids have enough food to eat. But the elderly also have food insecurity. Many have to choose between food, medications or rent.  I suspect that these 14%  of American  families are in specific geographical clusters. But poor areas  often dwell within in rich counties.

The problem is world-wide too. The causes are politically complex.  Yet a quick local fix is possible — share our food. Look at what you throw away! Many restaurants and stores donate left over food.

Soup kitchens and food banks have long histories. Go to a kitchen or food bank. Meet the people. Imagine what their lives are like. Learn how they survive. Learn about the ones who do not. Ask how living with hunger might color their moods. Imagine the combination of a depression or anxiety disorder co-existing with hunger?  Imagine a kids’  body not growing up with enough food.

Bring your kids to the kitchens. Do it regularly.  Ask  teachers to make it a school project.  Let them see what most of them cannot imagine.  This is an environmental issue  — it is the growing of  and  maintainance of 14% of us.

Holiday donations are fine, but people eat all year-round.

And by the way, on the days you visit or take the kids to the kitchens, skip breakfast. It’s akin to being irreligious to be physically and psychologically well fed in front of people who are not. Share your food with them, and let them share their lives with you.

Then as a family write the government officials to address food insecurity.

Filed under: Environment & Health, Hunger, Mental Health Podcasts, Psychotherapy Notes, Society's Tonics | Tagged: , , , , , | 2 Comments »

Society’s Tonics – Melting Ice, Rising Seas, Our World, Our Choices

Posted on November 14, 2009 by astrauss

A December 2009 international conference in Copenhagen focuses  on the issues of global warming.  The effect of melting ice melting on sea levels is one of the issues. The below link  is an excellent summary of a study about  ice melting in Greenland and how it is increasing sea levels.

From Reuters on Greenland’s melting ice.

From the BBC  -  Q & A on the Copenhagen conference in December 2009.

What preparations are being made if the rising seas cannot be stopped, and what if all that exists along our coasts will be flooded?  The rate of the rising sea levels seem so minimal right now that they don’t feel scary, but the projections are serious. We cannot merely hope that science will solve the problem before the projected ill-effects become unfixable. Governments need to address the projections by policy changes. We need to address the projections by each changing our life styles.

Even if the warming is partly a natural environmental cycle, the effects will still be incredible. We need to reduce our contributions to the warming. We simply need to prepare for the end effects, regardless of the cause.  How will our children look back at us? Will they rightly blame us for spending more time arguing so much about the cause that we missed the opportunity to prepare for what more and more science  projects will happen to their world?

Some say it is only a gloomy projection. That is a weak argument. But even if, by some chance, all the global climate changes turn out to be not dangerous, we should nonetheless respect our planet more. We need to help it provide us with a safe place to live. The earth is not endlessly forgiving of our choices. This is a prime example of the precautionary principle. But the precautionary principle takes self-discipline and personal responsibility.

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Psychotherapy Notes: ‘No’ is a safe place to be

Posted on November 1, 2009 by astrauss

One of the more frustrating hurdles in psychotherapy is getting a patient to try something new, with the hopes that the ’something new’ is healthier or more productive than their older ways of doing things. I was struck by a spontaneous comment from a 39-year-old man, who in his own way is quite creative and insightful, but who didn’t expect the breath of fresh air that came into our therapy as a result of his comment. I said to him that he so often says no to suggestions. He would intellectually acknowledge the logic behind the suggestions, but his actions said no. I said why?  And he just spilled out the comment that “no is a lot safer.”

‘No’ was his sentinel against anxiety and fears of failures. In subsequent sessions, he said that he was seeing how ‘no’ was a defense mechanism and it was as frustrating to him as it was to his family when he hid behind the wall of  ‘no’.  That is why he came into verbal therapy. His style of fears had been called phobias before, but medications did little to soften them.  So as we refocused our efforts, and looked at the things to which he had historically said “no, I don’t like that” or “no, that’s not for me”, our sessions took those responses as the first part of this sentence: “so if you say no, let’s dig a bit further, and what are you afraid of?” It took some time to unravel where these fears came from, and we are still working on the malevolent and unconstructive comfort that comes from maintaining the word ‘no’ as his guard. He joked with me, saying that “ ’no’ is really a very safe place to be.”

How so often true.

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Psychotherapy Notes — High Dose Psychotherapy

Posted on October 15, 2009 by astrauss

Two patients came from extraordinarily dysfunctional families.

Both of them simply didn’t know how to live a life that the rest of us would have considered even ‘somewhat normal.’  Both went in and out of numerous therapeutic relationships, tried countless legal and illegal drugs, but they never could break away from their legacies. It was as if they graduated from adolescence without ever having been taught how to be an adult. Eventually both of them ended up on disability under Medicare or Medicaid. It quickly emerged that neither of them could benefit from a once or twice a week therapy session because they didn’t have the ego tools to carry the concepts developed in therapy into the rest of their lives. One of the patients was so impaired that I conceptualized her as having no functioning ego. The other patient had such a massive superego and came from a family where his mother kept him, for her own needs, more of a child such that she did not let him grow up. When she died, he had no idea of what to do in life.

These two patients benefited from what can be called ‘high dose psychotherapy.’ The usual quantities of therapeutic contact were insufficient. The insurance companies complained because they were outliers. The world wanted them to be needing only of average doses of psychotherapy. That wasn’t sufficient. In days by gone, hospitals would accept people for months and months, with intensive therapy on almost a daily basis. A few hospitals still use that model, but they are costly.

The analogy here is to medication. Some people simply need more than others. So too for psychotherapy. These two patients needed a massive restructuring of almost every element of their biopsychosocial worlds. It took a lot of weekly time and an effort that spanned years. Though they were, frankly, at times exasperating and annoying because of the intensity of their needs, they nonetheless slowly creeped towards better mental health because of high dose psychotherapy. We also needed to be aware of the negative countertranferance that could have developed. There was some contact with them almost every day, perhaps for only a minute or two, but that was sufficient to reassure their psyche’s that they were okay, or that the tensions that they were feeling were not lethal, and that they were not emotionally alone in the world.  Sometimes psychotherapy is actually the experiencing, and hence learning, of core emotional skills in a safe manner that allows for growth.

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Society’s Tonics – The Cocaine Vaccine

Posted on October 8, 2009 by astrauss

So wouldn’t it be wonderful if we could control cocaine the way we control polio or smallpox. The recent discussions about a vaccine for cocaine need some close examination. Traditionally a vaccine  is something that is the product of modified microorganism that would cause the body to develop antibodies against a particular bacteria or virus, and then when the bacteria or virus came into the person’s body, they could fight it off. We  often talk about it in the terms that someone was immunized against the virus. It’s a little different when it comes to items like cocaine. We’re not trying to immunize someone against the effects of the disease, but rather to immunize them against the effects of a molecule. The cocaine molecule is so tiny that the body cannot fight it by making antibodies. So the body has to be tricked. Researchers take cocaine and attach it to the inactivated cholera protein. Don’t worry, it’s impossible to get cholera from this combination. The body however makes antibodies to the combined cholera and the cocaine unit. The spin off is that this enables to body to make antibodies to the cocaine. What this meant is that if a person then takes cocaine after they have these cocaine antibodies in their system, the antibodies stop the cocaine from going into the brain. This has the effect of blocking the  rush that cocaine addicts like. The cocaine, from a technical point of view, becomes stuck, or bound up with, to one use the full technical term, to fairly large cocaine antibodies. These antibodies are too big to through what is known as the blood brain barrier. So in effect the antibodies sponge up the cocaine and keep it outside of the brain. The hope is that with enough time the addicts get used to not getting the rush and it will deter continued cocaine use because there will be no response from the drug.  But it’s very important point to note that as the cocaine use stops, there has to also be a lot of rehabilitation, and psychological work to go along with it as well.

This vaccine may lead to vaccines for nicotine users as well.

More on the podcast

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Psychotherapy Notes — It’s where I’m going that’s scary

Posted on October 5, 2009 by astrauss

She’s the victim of incredible emotional abuse and multiple real illnesses. For years she used cocaine to lift her spirits. 

We spoke about how she’s got to leave the past, to accept the fact that sometimes in life justice isn’t available the way we would like it to be, and that she has to revise her priorities. She had to give up trying to get her family to be different from how they are. She never knew who to trust and who to emulate.  Her models were all short-sighted. She went looking to justify her own needy feelings rather than seek a teacher who would teach her better skills.

Now, in her mid 40’s, she came to the very insightful realization that she didn’t know how to live differently.  As simple and as obvious as it is, she realized that psychotherapy is undoing the bad lessons learned in adolescence and young adulthood. But via that she was also giving up  the familarity of so many notions that she acquired through her life’s distorted experiences. She came realize that ‘day one’  in life is to teach us how to go through ‘day two’, and so on. She realized she stayed in day one because she didn’t know how to survive in  day two.  ”It’s not where I was leaving that was scary; it’s where I have to go that is scary.”

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Psychotherapy Notes — Choosing my own thoughts

Posted on July 29, 2009 by astrauss

A young man reveled in his new ability to focus once the attention deficit disorder was under control. He felt life had  a new dimension — he could attend to family matters, he could sit through a movie, he could even sit through a meal without feeling the need to go on to some other activity. He described his pre-medication life as if he were sitting in a room with multiple suitors, all of whom wanted his attention. He remembers that he could not control what thoughts went through his mind, and he couldn’t even compel himself to grab onto one long enough to complete whatever  was needed for it to be completed.

For the first time he could sit and ponder a thought. He described it as the  ability to  “choose my own thoughts.”  We spoke about  how this  condensation of thought into the phrase of  ”choosing my own thought” captured the reality of his life before the medications. “Now I feel released from the onslaught of  too many simultaneous attractions.”

I told him I would gladly, yet anonymously, credit him when I plagiarized the phrase. I wanted to turn this blurb into a clinical measuring stick for me. In the beginning of treatment I would ask patients  what sense of control did they have over choices, and then as treatment progressed I would ask how that control increased. I had a very simple but sensitive measure of progress as people gained the skills to move from non-selectable to selectable options in their lives. I’ve since asked this question to suffers of anxiety, OCD, and many other phobias — they like the concept and report how neatly it applies to them as well.

I told him “thanks for the tool.”  He smiled and said that now he hopes to fill the chest with other new tools.

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Psychotherapy Notes — The Difficult Part of Hard

Posted on July 22, 2009 by astrauss

What a great saying, “the difficult part of hard.” 

The patient entered treatment six months ago, suffering depression, repeated business failures, a lousy self-image, poor social interactions, and feeling rather hopeless. Looking at his cluster of symptoms, it was classic depression. He knew the process would be hard.  He responded nicely to medications, though it took some very careful slow dose changes to produce good results. In the course of all those dose changes, we also began old-fashioned psychotherapy. Now that the biologic symptoms are not issues, we can focus on how he would raised, his unusual intelligence and creativity, his anger at his parents for the way they mishandled their own marital problems and when he needed to come to his parents rescue, and how painfully shy and hesitant he is with women.  He longs to be lovingly touched by a woman. But it’s not happening because of his self-image, and not his biological depression.

So as we now migrate away from the biochemistry into what he calls the “psycho chemistry”, he off the cuff made the comment that we are now getting to the  “difficult part of hard” He said to me that this is the part when one has to swallow the bitter pill. But he also understood that the bitter pill for the psycho chemistry is his real therapy. He called the antidepressant the tasteless pill.

I delight when patients bring to the sessions clever little phrases and comments that really capture what’s going on.

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Psychotherapy Notes — The Humble Elitist

Posted on June 21, 2009 by astrauss

Six months into psychotherapy he asked to tell me a secret. “But of course,” I said. He told me that he is a humble elitist. That’s an odd juxtaposition of ideas because they seem contradictory. He told me that no, there is nothing odd about it, and it is so much of his inner turmoil.

 He is an extremely bright, creative and sensitive 40-year-old. He knows that he is blessed with artistic insights and skills that propel him above and beyond the average artist. But his upbringing was so emotionally disparaging and mercilessly critical that he hid his fears out of worry that being open would position him for more criticism. The criticism was not from peers but from family, and he couldn’t step out of the rut that the family emotional ties had over him. So he became shy. People thought he was humble. In fact he was scared.

 He was scared not only of the criticisms that he had come to expect so much from his family but also that others would exclude him from groups because he was so uniquely talented. He said that he didn’t know how to reveal his talent and be a common man at the same time. Of course this was the focus of much psychotherapy. And of course this involved him trying to figure out who was and where were his real peers..

 Whenever he was asked to do something, clearly his talents became evident. But he was usually kept them quiet insofar as how he spoke about them. He didn’t market himself – instead he kept waiting to be found. Advertising himself was too risky.  So therein sits his apparent humility. But in his heart and in his head he was an non-cocky elitist because he knew how superior he was. He just didn’t want to be called superior for fear it would evoke denunciations of elitism, which were old manifestation of his family’s criticisms. So he lived in a world of humility on the outside and inside, and he lived in a world of elitism on the inside.  Those worlds were not good neighbors. He loved to use his special skills to help people, but would be happy to do it without the overt recognition. Yet in that recognition he would feel better about himself and that would improve his vocational and social life. The notion of elitism was his family’s choice of words, and he carried it in large part from habit and not choice.

 His pain is that of the humble elitist. This is a rather good concept.

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Psychotherapy Notes — Those who see the forests, and those who see the trees

Posted on June 6, 2009 by astrauss

I watched a commercial in which an older teenage boy painted adjacent buildings with flowers. When his sickly bedridden sister woke up, he pulled open the curtains and she saw a note, surrounded by flowers, painted on the neighbors walls. The graffiti said “be brave.”  Then the words “sometimes it takes more than medications” rolled across the screen.

How touching and how true.

Most people who saw this responded with accolades of how impressive it was, how it touched the need for connections between people, that it relieved us of our overconfidence in medications to heal, and of the importance of touching. But one person commented that we should not be endorsing antisocial behaviors. The graffiti artist, he said, violated the property rights of those who owned the wall that he used as a canvas. I must say that initially I was really taken back by this. I felt the larger message was missed. But a friend told me that, technically, that the commentator was correct. And much to my initial resistance, I conceded. Of course I’d be happy to donate any amount of wall space if it made a child smile. But that’s me.

My lesson: we need those who see the trees, and we need those who see the forests. I saw the forest and not the trees. He saw the trees and not the forest. I wonder if he would see the same forest if different trees had been used.  An interesting set of thoughts.  A lesson to take into therapy too…

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Society’s Tonic – Dr. John Snow, toxic water and the 1854 cholera epidemic

Posted on June 3, 2009 by astrauss

The issues with water pollution are far from new. One of the more famous cases is in 1854 when Dr John Snow plotted the cases of cholera in London. He concluded that the water pump on Broad Street was the source.   He disabled the pump by removing the handle, and the epidemic ended. He is considered the founder of epidemiology and his germ theory of disease is accepted.

The contamination at Camp Lejuene is chemical and not biological, but the effects are indeed biological. Water vectors are still real safety issues.

 The Physicians for Social Responsiblity presents the Broad Street Award to those whose work reflects the spirit of John Snow.  PSR has a rich website worthy of our time.

More to follow about the  Camp Lejuene concerns…..

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Society’s Tonic – Camp Lejeune Marine Base and Toxic Water

Posted on June 2, 2009 by astrauss

A May 29, 2009 report from a Tampa newspaper notes that Marines for years drank, bathed and cooked with polluted water. The polluting chemicals were dumped by a dry cleaner and the Marine Corps itself.  The report claims the contamination was discovered in 1980 yet 4 years passted before the wells were closed.  The contamination was been called the largest mass exposure to a single bad water supply in the nation’s history. There are surely many medical sequalae to the exposure.

 As such, anyone living or working at Camp Lejuene  (1987 or before) –   the Marine Corps is planning a health study, or call 877-261-9782.

A private web site has additional information.

Concern is raised for those near the base who may have also been exposed via seepage to larger groundwater systems.  The beauty of a blog is how can evolve.  I’ll ask if and how others may also be victims of  the exposure, and then post the information.

Filed under: Climate Change, Environment & Health, Mental Health, The Doctor's Ear, water pollution | Tagged: , , , , , , , | Leave a Comment »

Society’s Tonic — Regardless of origin, climate changes are here.

Posted on May 31, 2009 by astrauss

A UN Report published in  TIMESONLINE,   May 29, 2009, notes that 300,000 people a year die as a result of global climate change.  Some  suggest the data is not rigorous enough to rank as ’scientific.’

Perhaps —  the science may not be rigorous enough. But the point is that something bad is happening. Too many similar reports exist from too many genuine and non-alarmist scientists. So we need to prepare for the changes.  If it is from our activities, then we must immediately further reduce our inputs. If it is natural phenomena distinct from human involvement, it still affects us, so we must also adjust and change our geopolitical and social systems. In either case, we need to reduce our pollution/carbon footprints if for nothing else than out of respect for our ecosystem and all living creatures.

The psychoscial effects of these changes are further detailed at The Doctor’s Ear.

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Psychotherapy Notes — The Hangover Metaphor

Posted on May 27, 2009 by astrauss

We were talking on  left over effects that events have on people.

 My colleague would frequently inquire how long it took someone to accept a lost, release an anger, reveal in a victory, undo an emotional event, and the like. Included ih this questioning was also the element of how the person displayed these reactions — some would announce to the world over and over about their successes, losses, or injustices they believe befell them. This information gave much insight into how one handles, exploits, or presents these spill over’s.  So initially we felt that should be called spill-over’s, but a student gave us a better label — he called them emotional hangovers.  He said the nature of  the hangover was a window into the person’s ego structure. 

It makes sense. I have a patient who was attacked at gun point. The actual danger is long past, but the hangover remains. He found this label simple but precise enough to help him explain the impact  of that  assault took.. We call his combination of fears, nightmares, anxiety, etc., as his hangover.  Child abuse or other traumas produce their own and often stubborn hangovers.

It’s a good clarifying  metaphor.

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Society’s Tonic – Years of child abuse in Irish religious residental care organizations

Posted on May 25, 2009 by astrauss

A disturbing report from Ireland now exists on years of child abuse by religious organizations. Known as the The Commission to Inquire About Child Abuse , it was released May 20, 2009.   The five volume report has a good executive summary.  “The Commission to Inquire into Child Abuse was established in 2000 with functions including the investigation of abuse of children in institutions in the State. It was dependent on people giving evidence which they did in large numbers.”

The report looks at 216 institions run by the Catholic Church from 1930 though 1990, and which were supposedly inspected by the Department of Education.

The summary has one astonishing story after another.  Such modern day mistreatment of children is so chilling that it catapults the report into a huge warning bell about our worlds. Irish media is covering this; some refer to this as their holocaust. 

It is so amazing,  so selfish,  so heartless.  What mind-set lets people act that way?  What end comes from abuse? And how could supervising agencies not know about, and stop, the abuse?  It is more unsettling because it’s not an individual psychopathy — it’s a huge group pathology, which flavors it ever the more nefarious. 

Visiting the website will also reveal concerns that these children might have improperly been used in vaccine clinical trials.

This is one article about the Catholic Church’s response.

We need to make noise that such abuse is unacceptable anywhere in the world. Thank goodness the Irish did this work. Unfortunately it took too long to start.  Today is the US Memorial Day when we thank those who died to defend us. We need a day to memorialize those who suffered from our inactions in preventing harm at home – those who we did not defend.

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Psychotherapy Notes – The showroom vs. workshop

Posted on May 24, 2009 by astrauss

A pleasant 32 year woman struggled with identity issues. She was exceptionally bright, and far more earthy than her social climbing and narcissistic  mother.  She felt as if her intellectual accomplishments were displayed, like a personal and prized possession, in front of  her mother’s friends.   “It was beyond being a proud parent. My mother displayed the bounty of others’efforts as if they were her’s. My mother made sure people knew I would never be what I am had it not been but for her sacrifice.  She never shared the halo.”

Her mother let every one know it was “my daughter’s work”, yet the daughter was kept  ‘off stage’.  The patient found a good laugh, some solid wisdom and  insight,  and good relief when she stumbled on the notion that her mother preferred the showroom without exposing the real workshop, and the patient preferred a workshop that didn’t need that showroom. She re-named the showroom as her mother’s ego living room.

A good set of concepts…..

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Society’s Tonics – Mental Health Court in Palm Beach; 2008 Fl Jail/Prison Statistics

Posted on May 23, 2009 by astrauss

I learned this week that a Palm Beach County Mental Health Court is about to start. This is excellent. Attached are just two of many documents designed for Mental Health Court Judges. If you need a little time away from the 3 day weekend, they are worth reading so we have a bit more insight into what happens in these courts. If courts order out-patient treatment and not incarceration, then pops up is the old question of where  to go and who pays for it. The numbers can be daunting. 

Essentials of Mental Heath Court  and Mental Health Court Outcome Data

From: www.dc.state.fl.us/pub/jails/2008/12/index.html

An average of 60,760 inmates were in Florida’s county detention facilities during December 2008. Interestingly, 77.6%, of inmates had felony offenses, while 17.3% were detained for mis­de­mea­nor crimes. Most juveniles (95.8%) were charged with felonies.

Here are Fl details for 2008 — 60,760 in county jails, 98,192 in state prisons, 158,079 under community control. Total Fl population under some court control => 316,971   Florida’s incarceration rate up 5% in last year, up 19% in last 5 yrs. I’ve no data on how many on community control need, have been ordered to, or are getting mental health, substance abuse, anger management, etc., care.

In Feb 2008 the NY Times reported that 1% of the total US population is in jail or prison.  By my calculations, Florida has 1.6% of the population incarcerated or under community control.

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Gift Cards for Returning Unused Medications

Posted on May 12, 2009 by astrauss

April 2009 — Florida, Flager County –  A system has been set up whereby $10 gift cards were given to those who return outdated  medications. This is great effort to reduce the mis-use of unused drugs.  Key is that the news article addressed both the human and environmental impact of improperly disposed medications.

It thus far was a one time offer, but the concept needs expanding. It also needs to include the return for disposal for any medication which is no longer used.

Click here to read the full story.

SMARXT DISPOSAL  is a public-private partnership between the U.S. Fish and Wildlife Service, the American Pharmacists Association, and the Pharmaceutical Research and Manufacturers of America.  Prescribers need to take more involvement in medication management on the side away from prescribing them. Un-used meds are too often used in OD’s, medical use errors, PHARM parties, etc. This site should be given to all patients. Veterinary medications are also included in this project.

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