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Medical News Today: Thousands of LA jail inmates should receive community mental health support

A new report has found that more than half of the people with mental health conditions currently confined in Los Angeles county jails would benefit from mental health treatment in specialized community centers instead of incarceration.

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Thousands of LA jail inmates would benefit from receiving mental health support away from prison, a new report suggests.

The Los Angeles (LA) county jail system holds thousands of inmates at any one time, and past reports have suggested that these include many people who were previously homeless and who experience mental health issues.

As a result, if they do not receive appropriate support, these people have a high chance of recidivism, as well as a high likelihood of experiencing homelessness once more after their release from jail.

For this reason, last year, the LA County Board of Supervisors decided to focus more on the possibility of offering mental health support in community-based centers to inmates who may qualify for it.

To this end, LA County commissioned RAND Corporation — a not-for-profit, global policy-oriented research organization — to find out how many current county jail inmates would benefit from moving to community-based facilities to receive mental health treatment.

The 31 page report used data about the jail population from June 2019, which revealed that at that time, 5,544 inmates were living in special mental health housing units or receiving psychotropic drugs, or both.

A pathway to 'smart policy making'

The researchers who conducted this study had to develop a set of considerations to find out how many and which of these inmates would benefit from diversion to community-based mental healthcare.

Eligible individuals, the researchers say, are those who experience a serious mental illness that requires targeted therapy.

"Knowing how many people are appropriate for diversion is a first step toward understanding the types of programs, staff, and funding that would be needed to treat those individuals in the community," says lead author Stephanie Brooks Holliday.

The researchers estimated that 3,368 — or 61% — of these LA county jail inmates were definitely eligible for diversion to community-based clinical services, while an additional 414 (7%) were potentially eligible.

The remaining 32% of the people in this prison subpopulation (1,762 individuals) were definitely not eligible for diversion, according to the new report.

When applying the eligibility criteria to a representative sample of 500 participants living in county jails who also experienced mental health problems, the researchers found that 59% of the men and 74% of the women were eligible for diversion to a mental health program.

"Diversion is stopping the cycle between jail and homelessness," emphasizes county supervisor Mark Ridley-Thomas, who was not involved in the study on which the report was based.

"Just in the last 3 years, the Office of Diversion and Reentry has safely diverted over 4,400 people from the county jails to more appropriate settings where they can get treatment, instead of the costly alternative of serving additional time in jail and being released with no supports, too often ending up homeless. This is smart policy making."

Mark Ridley-Thomas

"RAND's research underscores the need to double down on diversion to reach all those who could benefit," the LA county supervisor adds.

The researchers involved in the RAND study also make some recommendations in their report. One of these is that the relevant authorities should increase the number and capacity of community-based programs for diversion.

Another recommendation is that LA County officials should improve the quality of data collection processes to get more information about jail inmates eligible for diversion.

"[E]ven with increases in diversion, there will continue to be a large number of individuals with mental health needs who remain in the jails," Holliday cautions.

That is why, she adds, "[i]t is important that there are services in place to care for people who are incarcerated and provide continuing services once they are released back into the community."

Original Article

Medical News Today: How the ‘rubber hand illusion’ may help those with OCD

New research shows how the use of a multisensory illusion may help treat obsessive-compulsive disorder (OCD). The new method could bypass the disadvantages of exposure therapy.

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Contamination fears may cause people with OCD to wash their hands excessively.

In 1998, researchers Matthew Botvinick and Jonathan Cohen of the University of Pittsburgh, PA, detailed an experiment that people would later refer to as the "rubber hand illusion" (RHI).

In the experiment, 10 people sat down, resting their left arm on a table. A screen hid each participant's arm from view, and instead, they could see a life-sized rubber hand model.

The researchers placed the hand right in front of the person so that they could see it from the same angle as they would their own hand.

After asking each participant to fix their gaze on the rubber hand, the experimenters used two small paintbrushes to stroke the rubber hand and the participant's actual hand at the same time.

After 10 minutes, the participants reported feeling the rubber hand as though it were their own.

Now, new research has used the RHI to help people with contamination-related OCD overcome their fears.

Baland Jalal, a neuroscientist in the department of psychiatry at the University of Cambridge, United Kingdom, is the first author of the new paper, which appears in the journal Frontiers in Human Neuroscience.

In contamination-related OCD, the fear of touching a doorknob, for example, may cause people with the condition to spend hours washing and scrubbing their hands to an excessive degree afterward.

Doctors and mental health professionals often recommend "exposure therapy" to treat this and other forms of OCD.

Exposure therapy encourages people with OCD to start touching potentially contaminating surfaces without washing their hands afterward.

However, says Jalal, "exposure therapy can be very stressful and so is not always effective or even feasible for many patients."

This limitation is what made him and his colleagues want to explore other options, such as contaminating a fake hand instead.

Using a fake hand to treat OCD

The new research builds on previous RHI experiments that Jalal carried out together with fellow neuroscientist Vilayanur S. Ramachandran, who is a co-author of the new study.

In these previous studies, Jalal and Ramachandran contaminated the fake hand with fake feces, and the participants reported feeling disgusted in the same way that they would if they had used their own hand.

For the new study, the researchers recruited 29 people with OCD from the McLean Hospital Obsessive Compulsive Disorder Institute in Belmont, MA.

Of these participants, 16 experienced the paintbrush stroking on both their real hand and the dummy hand at exactly the same time, whereas 13 controls experienced the stroking out of synch.

After 5 minutes, the experimenters asked how real the dummy hand felt to the participants. Then, they used a tissue to smear the dummy hand with fake feces while simultaneously touching the real, hidden hand with a damp paper towel to mimick the feeling of them having feces on their hand.

The experimenters again asked the participants to rate their level of disgust, as well as how anxious they were and how strongly they felt the urge to go and wash their hand.

RHI may ease OCD contamination fears

At first, both groups reported feeling the illusion, regardless of whether or not the stroking of the two hands was simultaneous.

Then, the researchers took away both the clean paper towel and the fake feces tissue, leaving fake feces on the dummy hand. After this, they stroked the rubber hand and the real hand for another 5 minutes, still either synchronously or asynchronously.

In this condition, the participants in the intervention group reported feeling more disgusted than those in the control group.

In the next step, the stroking stopped, and the researchers placed fake feces on the real right hand of each of the participants.

This time, the people in the control group rated their anxiety, disgust, and urge to wash at seven on a 10-point Likert scale, whereas the intervention group reported these factors as a nine.

"Over time, stroking the real and fake hands in synchrony appears to create a stronger and stronger and stronger illusion to the extent that it eventually felt very much like their own hand," reports Jalal.

"This meant that after 10 minutes, the reaction to contamination was more extreme."

"Although this was the point our experiment ended, research has shown that continued exposure leads to a decline in contamination feelings — which is the basis of traditional exposure therapy."

Baland Jalal

Replacing traditional exposure therapy

In other words, the researcher believes that it is safe to conclude from these findings that after 30 minutes, participants would experience a drop in feelings of anxiety, disgust, and washing urge, based on the proven success of exposure therapy.

"If you can provide an indirect treatment that is reasonably realistic, where you contaminate a rubber hand instead of a real hand, this might provide a bridge that will allow more people to tolerate exposure therapy or even to replace exposure therapy altogether," continues the scientist.

He adds, "Whereas traditional exposure therapy can be stressful, the rubber hand illusion often makes people laugh at first, helping put them at ease."

"It is also straightforward and cheap compared to virtual reality, and so can easily reach patients in distress no matter where they are, such as poorly resourced and emergency settings."

In the near future, the researchers plan to compare this technique with existing treatments in randomized clinical trials.

Ramachandran agrees that the findings are strong, but also points out that more research is necessary before moving on to clinical trials.

"These results are compelling but not conclusive," he says. "We need larger samples and to iron out some methodological wrinkles."

Original Article

Medical News Today: A tiny wage increase could have prevented 13,800 deaths in 6 years

The world has been facing a suicide crisis over the past few years. In the United States alone, tens of thousands of people die by suicide each year. But new research shows that a $1 increase in the minimum wage might prevent thousands of deaths.

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As little as a $1 increase to the minimum wage could prevent thousands of people from attempting suicide, a new study suggests.

According to the National Institute for Mental Health, in 2017, the latest year for which data is available, "[s]uicide was the 10th leading cause of death overall in the United States," accounting for more than 47,000 deaths.

People can experience suicidal thoughts or be at risk of attempting suicide for a variety of reasons, including physical and mental illness, social isolation, substance abuse, and traumatic experiences.

For many people who consider suicide, the common point is a pervading feeling of hopelessness, often as a result of facing problems from which they can see no way out. One of these problems is, perhaps unsurprisingly, experiencing financial difficulties.

Recently, a team of researchers from Emory University in Atlanta, GA, has sought to find out whether an increase in national minimum wages could make a real difference in terms of lowering the number of suicides per year.

The team's findings — featured in the Journal of Epidemiology & Community Health — point to an answer very much in the affirmative. A tiny increase of just $1 in the minimum wage could have saved thousands of lives lost to suicide over the past year.

Just $1 could make a huge difference

The researchers started by considering the difference between the federal minimum hourly wage versus the state minimum hourly wage for all 50 states plus Washington, D.C., in conjunction with both unemployment and suicide rates among people aged 18–64 between 1990–2015.

During this period, the team notes, there were 478 amendments of the state minimum wage across all of the U.S. states. The researchers calculated that the average difference in minimum wage between state minimum wages and the federal minimum wage was $2,200 per year for a person working full time.

Moreover, while in 1990, as many as 36 of the U.S. states ratified minimum wages that were equal to the federal minimum wage, by 2015, only 21 states still offered this rate.

When they looked at suicide rates, the investigators observed that between 1990–2015, 399,206 people who were either high school educated or had lower levels of formal education had died by suicide.

By comparison, 140,176 people with a college degree or a higher level of formal education died by suicide during that same period.

Thus, the research team estimates there would have been a 3.5–6% drop in suicide rates for each $1 increase in the minimum wage — at least in the case of people with a high school or lower degree of formal education.

The same decrease did not appear to be likely in the case of individuals with at least a college degree.

State level unemployment also seemed to affect suicide rates during this period, the study authors note. When state unemployment rates were high, at 6.5% or above, higher minimum wages showed a link to lower suicide rates.

Yet when unemployment rates were low, there was a weaker association between minimum wage values and suicide rates.

Following on from these findings, the researchers went on to estimate that in the 6 years after the great recession of 2009 — in which unemployment rates were at a historic high — as many as 13,800 suicides could have been prevented among people with a high-school or lower degree of formal education if only the state minimum wage had increased by $1.

And adding $2 to the state minimum wage could well have prevented 25,900 deaths by suicide.

This evaluation means that between 1990–2015, a $1 increase could have prevented 27,550 suicides, and a $2 increase could have saved 57,350 lives.

Although this is an observational study that has only found an association, the researchers still emphasize that a tiny increase in a person's earnings could have an inestimable value in terms of their well-being.

In their study paper, the first author of which is John Kaufman, the researchers write:

"Our findings are consistent with the notion that policies designed to improve the livelihoods of individuals with less education, who are more likely to work at lower wages and at higher risk for adverse mental health outcomes, can reduce the suicide risk in this group."

"Our findings also suggest that the potential protective effects of a higher minimum wage are more important during times of high unemployment," the investigators go on to add.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Original Article

Medical News Today: Does diet influence mental health? Assessing the evidence

Can diet impact mental health? A new review takes a look at the evidence. Overall, the authors conclude that although nutrition certainly does appear to have an impact, there are still many gaps in our knowledge.

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A recent review looks into food and its effect on mental health.

Nutrition is big business, and the public is growing increasingly interested in how food affects health. At the same time, mental health has become a huge focus for scientists and the general population alike.

It is no surprise, then, that interest in the impact of food on mental health, or "nutritional psychiatry," is also gathering momentum.

Supermarkets and advertisements inform us all, at great volume, about superfoods, probiotics, prebiotics, fad diets, and supplements. All of the above, they tell us, will boost our body and our mind.

Despite the confidence of marketing executives and food manufacturers, the evidence linking the food we eat to our state of mind is less clear-cut and nowhere near as definitive as some advertising slogans would have us believe.

At the same time, the authors of the new review explain, "neuropsychiatric disorders represent some of the most pressing societal challenges of our time." If it is possible to prevent or treat these conditions with simple dietary changes, it would be life changing for millions of people.

This topic is complex and convoluted, but trying to understand the nuances is vital work.

Recently, a group of researchers reviewed the existing research into nutrition and mental health. They have now published their findings in the journal European Neuropsychopharmacology.

The authors assessed the current evidence to gain a clearer understanding of the true influence of food on mental health. They also looked for holes in our knowledge, uncovering areas that need increased scientific attention.

It makes sense

That diet might affect mood makes good sense. First and foremost, our brains need nutrients to function. Also, the food we eat directly influences other factors that can impact mood and cognition, such as gut bacteria, hormones, neuropeptides, and neurotransmitters.

However, gleaning information about how specific types of diet influence specific mental health issues is incredibly challenging.

The reviewers found, for instance, that a number of large cross-sectional population studies demonstrate a relationship between certain nutrients and mental health. However, it is impossible, from this type of study, to determine whether or not food itself is driving these changes in mental health.

At the other end of the scale, well-controlled dietary intervention studies that are better at proving causation tend to recruit smaller numbers of participants and only run for a short period of time.

Lead author Prof. Suzanne Dickson, from the University of Gothenburg in Sweden, explains the overarching theme of the team's findings:

"We have found that there is increasing evidence of a link between a poor diet and the worsening of mood disorders, including anxiety and depression. However, many common beliefs about the health effects of certain foods are not supported by solid evidence."

Some specifics

One diet that has received a great deal of attention during the past few years is the Mediterranean diet. According to the recent review, there is some relatively strong evidence to suggest that the Mediterranean diet can benefit mental health.

In their review, the authors explain how "a systematic review combining a total of 20 longitudinal and 21 cross-sectional studies provided compelling evidence that a Mediterranean diet can confer a protective effect against depression."

They also found strong evidence to suggest that making some dietary changes can help people with certain conditions. For instance, children with drug resistant epilepsy have fewer seizures when they follow a ketogenic diet, which is high in fat and low in carbohydrates.

Also, people with vitamin B-12 deficiencies experience lethargy, fatigue, and memory problems. These deficiencies are also linked with psychosis and mania. For these people, vitamin B-12 supplementation can significantly improve mental well-being.

However, as the authors point out, it is not at all clear if vitamin B-12 would make a significant difference to people who are not clinically defined as deficient.

Much left to learn

For many of the questions the researchers explored in this review, it was not possible to reach firm conclusions. For instance, in the case of vitamin D, some research has concluded that supplementation improves working memory and attention in older adults. Other studies have found that using vitamin D supplements might reduce the risk of depression.

However, many of these studies were small, and other, similar studies have concluded that vitamin D does not have any impact on mental health.

As the review's authors point out, because "a substantial proportion of the general population has a vitamin D deficiency," understanding its role in mental health is important.

Similarly, the evidence for a nutritional role in attention deficit hyperactivity disorder (ADHD) was quite mixed.

As Prof. Dickson outlines: "[W]e can see [that] an increase in the quantity of refined sugar in the diet seems to increase ADHD and hyperactivity, whereas eating more fresh fruit and vegetables seems to protect against these conditions. But there are comparatively few studies, and many of them don't last long enough to show long-term effects."

"There is a general belief that dietary advice for mental health is based on solid scientific evidence. In reality, it is very difficult to prove that specific diets or specific dietary components contribute to mental health."

Prof. Suzanne Dickson

The authors go on to explain some of the inherent difficulties in studying the impact of diet on mental health, and they offer some ideas for the future. Overall, Prof. Dickson concludes:

"Nutritional psychiatry is a new field. The message of this paper is that the effects of diet on mental health are real, but that we need to be careful about jumping to conclusions on the base of provisional evidence. We need more studies on the long-term effects of everyday diets."

Original Article