[NYAPRS Enews] 10 x 10 Update Highlights Health Improvement Initiatives, Research

[Matt Canuteson]

The 10 by 10 Campaign   Volume 5 - Oct / Nov  2008

Associate Director for Consumer Affairs  Center for Mental Health
Services, SAMHSA

 

A National Call to Action for Wellness of People with Mental Illnesses

 

        The early mortality rates of people with serious mental illness
- up to 25 years life lost - have recently received much-needed
attention. This disparity in life expectancy is unacceptable.People with
serious mental illnesses deserve to live long and healthy lives like
other Americans.

        As the National Association of State Mental Health Program
Directors (NASMHPD) Medical Director's Council recently reported, the
"increased morbidity and mortality are largely due to treatable medical
conditions caused by modifiable risk factors such as smoking, obesity,
substance abuse, and inadequate access to medical care."

 

For more information go to:
http://www.bu.edu/cpr/resources/wellness-summit/background.html

 

The Pledge for Wellness

        We envision a future in which people with mental illnesses
pursue optimal health, happiness, recovery, and a full and satisfying
life in the community via access to a range of effective services,
supports, and resources.

        We pledge to promote wellness for people with mental illnesses
by taking action to prevent and reduce early mortality by 10 years over
the next 10 year time period.  Over 50 organizations have signed onto
the pledge. Sing up now by email:  paolo.delvecchio at samhsa.hhs.gov.

 

Adherence to a Mediterranean diet can convey protection from chronic
disease and premature death, say Italian researchers.

        A team of researchers from the University of Florence assessed
12 international studies, involving more than 1.5 million participants
whose dietary habits and health were tracked for follow-up periods
ranging from three to 18 years.

        Using a statistical technique that collectively analyzes
independent studies, scientists discovered sticking to a full
Mediterranean diet provides substantial protection against major chronic
diseases including heart disease, cancer and Parkinson's and Alzheimer's
disease.

        All the studies examined the concept of using an 'adherence
score' to estimate how much people stuck to the diet.  The researchers
found that people who stuck strictly to a Mediterranean diet had
significant improvements in their health, including a 9 percent drop in
overall mortality, a 9 percent drop in mortality from cardiovascular
disease, a 13 percent reduction in incidence of Parkinson and
Alzheimer's disease, and a 6 percent reduction in cancer. 

        The findings confirm the current guidelines and recommendations
from all major scientific institutions that encourage a
Mediterranean-like dietary pattern for the prevention of major chronic
diseases.

        The researchers suggest that keeping an 'adherence score' based
on "a theoretically defined Mediterranean diet could be an effective
preventive tool for reducing the risk of mortality and morbidity in the
general population." Rich in olive oil, grains, fruits, nuts,
vegetables, and fish, but low in meat, dairy products and alcohol, the
Mediterranean diet from populations bordering the Mediterranean Sea has
a reputation for being a model of healthy eating and contributing to
better health and quality of life. It is .

        Previous research on the Mediterranean diet suggests that it has
a protective role in cardiovascular disease and cancer, but no study has
reviewed all the available data for a possible association between
sticking to the Mediterranean diet, premature death, and the occurrence
of chronic diseases in the general population.

        The results of this study have important implications for public
health, particularly for reducing the risk of premature death in the
general population, conclude the authors.

SOURCE: British Medical Journal at bmj.com

 

 

 

Self-Report Physical Activity Scale Shows Reliability For Schizophrenia

By Cher Thornhill 16 September 2008

        The Yale Physical Activity Scale (YPAS) is a reliable,
self-report measure for physical activity in schizophrenia patients, say
researchers.

But the team, led by Laurie Lindamer (University of California, San
Diego, USA), also advise that such self-report assessments should be
augmented by objective measurements.

        They note that current evidence suggests fewer people with
schizophrenia "engage in meaningful physical activity" than individuals
in the general population, but few studies have addressed how to
accurately measure physical activity in these patients or how to improve
it.

        In the current trial, Lindamer et al used three scales - the
YPAS, a scale of motivational readiness for physical activity, and
accelerometry - to measure physical activity in 54 schizophrenia
patients of middle age or older, and compared the results with those for
27 individuals with no psychiatric illness.

        Results obtained using the YPAS indicated that schizophrenia
patients performed an average of 11 hours of physical activity per week,
whereas controls were physically active for an average of 32 hours per
week.

        The scale of motivational readiness classified 30% of
schizophrenia patients as regularly active, compared with 62% of
controls.

        Accelerometry measures indicated that the schizophrenia patients
performed less light activity than controls, but a similar amount of
moderate and vigorous activity and sedentary behavior.

        Further analysis showed that the YPAS had high test-retest
reliability in both schizophrenia patients and controls, and concurrent
validity with the motivational readiness measure.

        But Lindamer et al also note that results based on the YPAS were
not significantly associated with accelerometer variables in the
schizophrenia group.

They comment: "Although the YPAS demonstrated concurrent validity with
other self-report measures, it did not demonstrate concurrent validity
when compared to physical activity measured by accelerometry in persons
with schizophrenia."

They conclude: "Use of the YPAS in this population should be augmented
with other more valid measures of PA."

 

 

 

SOURCE: Schizophr Res 2008; 104: 294-301

 




Publications on Financing Integrated Care

1.  Reimbursement of Mental Health Services in Primary Care

        The report highlights key action steps that would help to reduce
existing barriers to reimbursement for mental health services in primary
care settings. on a variety of stakeholders, including primary care
providers, state Medicaid officials, and others billing for mental
health services in the public sector.  The report was jointly funded by
SAMHSA and Research and Services Administration (HRSA), with the
technical expertise of Centers for Medicaid and Medicare Services (CMS).
website:http://download.ncadi.samhsa.gov/ken/pdf/SMA08-4324/SMA08-4324.p
df

 

2.  Issue Brief: Serving the Needs of Medicaid Enrollees with Integrated


Behavioral Health Services in Safety Net Primary Care Settings

        The National Association of State Medicaid Directors has posted
this issue on their website: www.nasmd.org <http://www.nasmd.org/> .
The Issue Brief identifies important partnerships whose efforts have
addressed the need for behavioral health services.  It highlights ways
in which safety net providers work with community mental health and
State Medicaid programs across the nation to provide high-quality
behavioral health care services to those who are most in need and least
able to afford services.

 

3.   Examples of State Billing Codes for Mental Health Services

        SAMHSA has posted a set of tools on mental health billing codes
and Medicaid by provider type. This information may be of interest to
safety net providers who want to work with their State Medicaid agencies
to billing for health services by specific provider types. The website
includes:

*         Mental Health Codes and Payers - a summary table of which
codes may be used by various providers of mental health services under
both Medicare and Medicaid.

*         A document explaining specific codes are used by different
mental health providers to bill under Medicaid; including: 1) a table of
the most frequent codes used to bill State Medicaid for mental health
services, and 2) a table listing billing codesused to bill state
Medicaid by provider type. For more information, please visit:
http://hipaa.samhsa.gov/hipaacodes2.htm.  CMS has developed a website
devoted to Medicaid and mental health services:
http://www.cms.hhs.gov/MHS.

------------------




SAMHSA Awards $27.5 Million in Project LAUNCH Grants to Promote the
Well-being of Young Children

        The Substance Abuse and Mental Health Services Administration
(SAMHSA) announced that more than $27.5 million in Project LAUNCH
(Linking Actions for Unmet Needs in Children's Health) grants funds have
been awarded to state and tribal programs over the next five years.

        Project LAUNCH is a new grant program designed to promote the
wellness of young children ages birth to 8 years of age by addressing
the physical, emotional, social, and behavioral aspects of their
development.

        Project LAUNCH is grounded in the public health approach,
working towards coordinated programs that take a comprehensive view of
health.  Grantees will implement a range of evidence-based public health
strategies to support young child wellness.  Seeking to preclude
negative outcomes, grantees will address risk factors at the community
level.  They will also promote protective factors that support
resilience and healthy development.

 

The purpose of this program is to provide partial support for
non-Federal conferences in the areas of health promotion and disease
prevention, educational programs, and applied research.  Funds will
support the "Healthy People 2010" focus areas of Access to Quality
Health Services; Arthritis, Osteoporosis and Chronic Back Conditions;
Cancer; Diabetes; Disability and Secondary Conditions; Educational and
Community-Based Programs; Environmental Health; Food Safety; Health
Communication; Heart Disease and Stroke; Injury and Violence Prevention;
Maternal, Infant and Child Health; Mental Health and Mental Disorders;
Nutrition and Overweight; Physical Activity and Fitness; Public Health
Infrastructure; Respiratory Diseases; Tobacco Use; and Vision and
Hearing.

For more information, visit:
http://www.grants.gov/search/search.do?&mode=VIEW&flag2006=

true&oppId=18319. SOURCE: Journal of the American Geriatric Society.
;56(4):661-66. (c)2008Publishing.  To view the article with Web
enhancements, go to: http://www.medscape.com/viewarticle/ 578201

 




Antipsychotic Drug Use and Risk of Pneumonia in Elderly People

 

Wilma Knol, MD; Rob J. van Marum, MD, PhD; Paul A. F. Jansen, MD, PhD;
Patrick C. Souverein, PhD; Alfred F. A. M.; Schobben, PharmD, PhD;
Antoine C. G. Egberts, PharmD, PhD  11 September 2008

Objectives: To investigate the association between antipsychotic drug
use and risk of pneumonia in elderly people.

Design: A nested case-control analysis.

Setting: Data were used from the PHARMO database, which collates
information from community pharmacies and hospital discharge records.

Participants: A cohort of 22,944 elderly people with at least one
antipsychotic prescription; 543 cases of hospital admission for
pneumonia were identified. Cases were compared with four randomly
selected controls matched on index date.

Measurements: Antipsychotic drug use in the year before the index date
was classified as current, recent, or past use. No prescription for an
antipsychotic in the year before the index date was classified as no
use. The strength of the association between use of antipsychotics and
the development of pneumonia was estimated using multivariate logistic
regression analysis and expressed as odds ratios (ORs) with 95%
confidence intervals (CIs).

Results: Current use of antipsychotics was associated with an almost 60%
increase in the risk of pneumonia (adjusted OR = 1.6, 95% CI = 1.3-2.1).
The risk was highest during the first week after initiation of an
antipsychotic (adjusted OR = 4.5, 95% CI = 2.8-7.3). Similar
associations were found after exclusion of elderly people with a
diagnosis of delirium. Current users of atypical agents showed a higher
risk of pneumonia (adjusted OR = 3.1, 95% CI = 1.9-5.1) than users of
conventional agents (adjusted OR = 1.5, 95% CI = 1.2-1.9). There was no
clear dose-response relationship.

Conclusion: Use of antipsychotics in elderly people is associated with
greater risk of pneumonia. This risk is highest shortly after the
initiation of treatment, with the greatest increase in risk found for
atypical antipsychotics.

Antipsychotic drugs are frequently being prescribed to elderly patients.
Recent Canadian and European studies reported a prevalence of
antipsychotic drug use of 0.5% in a community-based population aged 65
and older.  A Swedish study of noninstitutionalized subjects aged 80 and
older found antipsychotic drug use of 1.7% of elderly people without
dementia and 12.8% of elderly people with dementia. In nursing homes, up
to 40% of the residents may be prescribed antipsychotics. It has been
suggested that, of residents of nursing homes who receive antipsychotic
therapy, more than half are prescribed for inappropriate reasons.

        Study results suggest that use of antipsychotics is associated
with greater risk of pneumonia in elderly people. The risk is highest
shortly after the initiation of the antipsychotic treatment, and the
greatest risk is found in users of atypical agents. The results suggest
that antipsychotics should not be overlooked as a potential cause of
pneumonia, and although the underlying mechanism remains speculative,
clinicians may need to monitor patients for swallowing disorders and
sedation. At this time, a careful weighing of the possible risks against
the benefits is recommended before starting antipsychotic treatment in
elderly people.

 

Loneliness Harms Health

By Rick Nauert, PhD, Senior News Editor
Reviewed by John M. Grohol, PsyD 9 September 2008

Feeling a connection to others is a critical component of a person's
mental and physical health.  New studies show that a sense of rejection
or isolation disrupts not only will power and perseverance, but also key
cellular processes deep within the human body.  Chronic loneliness
belongs among health risk factors such as smoking, obesity or lack of
exercise.  Feeling connected to others is vital to a person's mental
well-being, as well as physical health, research at the University of
Chicago shows.

        The studies, reported in a new book, Loneliness: Human Nature
and the Need for Social Connection, suggest that chronic loneliness
belongs among health risk factors such as smoking, obesity or lack of
exercise, according to lead author John Cacioppo, the Tiffany & Margaret
Blake Distinguished Service Professor in Psychology at the University.

        "Loneliness not only alters behavior, but loneliness is related
to greater resistance to blood flow through your cardiovascular system,"
Cacioppo said.  "Loneliness leads to higher rises in morning levels of
the stress hormone cortisol, altered gene expression in immune cells,
poorer immune function, higher blood pressure and an increased level of
depression." 

        Loneliness also is related to difficulty getting a deep sleep
and a faster progression of Alzheimer's disease, said Cacioppo.   One of
the founders of a new discipline called social neuroscience, Cacioppo
used functional Magnetic Resonance Imaging (fMRI) brain scans and
advanced scientific techniques to document the roles of loneliness and
social connection as central regulatory mechanisms in human physiology
and behavior. 

 

"There are three core dimensions to feeling lonely-intimate isolation,
which comes from not having anyone in your life you feel affirms who you
are; relational isolation, which comes from not having face-to-face
contacts that are rewarding; and collective isolation, which comes from
not feeling that you're part of a group or collective beyond individual
existence," he said.

        The problem of social isolation will likely grow as conventional
societal structures fade. The average household size is decreasing, and
by 2010, 31 million Americans-roughly 10 percent of the population-will
live alone. Sociologists also have found that people report
significantly fewer close friends and confidants than those a generation
ago.  

        Yet It is not solitude or physical isolation itself, but rather
the subjective sense of isolation that Cacioppo's work shows to be so
profoundly disruptive. By learning more about what underlies this
experience, then learning to reframe their response, lonely individuals
can reverse the feedback loop, overcome fear and find ways to reconnect.


        "We try to offer some help for those who've become stuck," said
Patrick. "The process begins in rediscovering those positive,
physiological sensations that come during the simplest moments of human
contact. But that means overcoming the fear and reaching out."

        "Lonely people feel a hunger," Cacioppo added. "The key is to
realize that the solution lies not in being fed, but in cooking for and
enjoying a meal with others." 

SOURCE: University of Chicago




For more information on CMHS Wellness Efforts, please contact: 

Paolo del Vecchio

Associate Director for Consumer Affairs

CMHS, SAMHSA

1 Choke Cherry Rd. Rockville, MD 20857

Phone: (240) 276-1946

Fax: (240) 276-1340

E-mail: paolo.delvecchio at samhsa.hhs.gov

Website:  http://mentalhealth.samhsa.gov/

consumersurvivor/about.asp

 

 

Words Of Wellness, the newsletter of the Collaborative Support Programs
of New Jersey, dedicates its contents to recovery and wellness issues.
People who seek a broader understanding of community issues that impact
the mental health consumer can find information here.  Learn about
initiatives that impact the recovery movement.  Discover programs, and
trainings that enhance the resiliency-building experience.  

Read this informative newsletter monthly!  

Recent editions can be found at 

http://www.cspnj.org/services/wrinstitute/newsletters.html

 

 

 

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