Archive for August, 2016
Posted by Dr. Vollmer on August 31, 2016
Posted by Dr. Vollmer on August 8, 2016
We prescribe antipsychotic medications which cause weight gain and serious metabolic side effects. Why don’t we weigh patients at every appointment to monitor the impact of our medications? It seems obvious that we should, but changing the model of care is slow and out of step with our shift towards a more medical model of treatment, and away from the more psychological, or history-driven emphasis of care. Psychiatrists were quick to embrace becoming “pill-mills” which meant shortening appointment times, lengthening the time between visits, and relying on non-MDs for the patient’s history, and yet, we, as a group, are slow to embrace the “data” available to us, which in this case means weight. Although it is a simple point, I think it speaks volumes about the inconsistencies in my profession. If we are to align ourselves with our internal medicine colleagues, then we should follow their lead in collecting as much patient data as we can. At the same time, we can maintain the strong principle of listening, allowing ourselves time to understand, as a means of healing. As I have posted previously, I take issue with our new model of care in which the psychiatrist prescribes in the dark, without understanding the meaning of the patient’s symptoms in the larger context of his history and his associations to his struggles. I now also go on record as objecting to the lack of data mining to monitor the impact of our prescribed medication. It is time to weigh our patients.
Posted by Dr. Vollmer on August 1, 2016
“Gallegos was caught in a historic transition in housing policy as the federal government wrestled with how to parcel out inadequate resources to the most needy. It’s a shift away from waiting lists toward what is essentially a homelessness grading system.”
The most vulnerable population gets hurt over and over again. Without advocacy, the mentally ill are often falling through the proverbial crack. In my experience, those well enough to “work the system” often get tremendous benefits, but those who have little insight into how a city distributes funding, or those who do not have loved ones who can help them, suffer the most. Systems can be “gamed” and those savvy enough to understand that get to the top of the line. Cynical, you say? Maybe, but maybe also true. The issue with mental illness is that, by definition, the illness impairs their ability to navigate systems of care and as such, they often lack the mental tools necessary to deal with changing rules, and as such, homelessness often results. The homeless mentally ill, by and large, do not vote, and as such they lack political power. Having said that, there are wonderful advocacy groups such as NAMI, http://www.nami.org/ which make a large impact on helping the helpless. Still, there is work to be done. This LA Times story of Rory brought tears to my eyes. How he could fall down on the list because the rules changed on him is simply tragic. This new system is based on a paper and pencil test, which more insightful folks, will fill out to gain priority, rather than honestly answering the questions, thereby tilting the program to the less-needy.
We know that “Housing First” programs work. http://www.endhomelessness.org/pages/housing_first . The lower the threshold to get housing, the faster people, including people with mental illness, will function independently. If we know that, why don’t we act on that? The answer is that there a huge housing shortage in LA County. Too many developers are gaining from building new apartments and homes for paying customers. They often create low-income housing along with new housing, but not enough to meet the growing need to house this population. Government must intervene to care for our most needy. As a psychiatrist, I want to shout about it. It is a baby step.