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Mental Health

Should Social Workers Use the DSM-5

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Among the 500,000 mental health professionals in the US who will use the DSM 5, the 250,000 social workers (Center for Health Workforce Studies, 2006) comprise by far the largest group, followed by 120,000 mental health counselors (American Counseling Association, 2011), 93,000 psychologists (American Psychological Association, 2011), and 38,000 psychiatrists (American Psychiatric Association, 2011).

For many social workers, DSM is a daily companion having a dramatic impact on how they assess patients, make a diagnosis, and plan treatment. The American Psychiatric Association (APA) is the sole group that revises the DSM, despite the fact that psychiatrists account for only 7% of all mental health professionals and only 10% of all physicians who prescribe psychotropic medications.

dsm-5In the past, social workers and other mental health professionals have relied on APA and the DSM for guidance in the diagnosis process. And while previous DSMs have failed to achieve universal admiration, none has failed to achieve universal acceptance.

Certainly, there have been numerous controversies about the overall reliability of the system; its seeming tilt toward a biological approach; the relative lack of participation of professional groups other than psychiatry; and the inclusion and/or definition of particular mental disorders.  But no one questioned whether DSM should be used at all or suggested that there was an alternative way forward.

DSM-5 has changed the landscape by being so closed in its process, flawed in its execution, unrealistically ambitious in its hopes, and dangerous in its product that many mental health professionals may choose not to use it.

The work on DSM-5 has been secretive, geared less to protecting the public trust than to generating publishing profits for the American Psychiatric Association (APA). Participants were forced to sign confidentiality agreements, the scientific review has been conducted behind closed doors, and APA rebuffed a petition endorsed by fifty-one professional organizations for an open and independent review of its suggestions.

Everything about DSM 5 was done in a disorganized way: constant missing deadlines, inconsistent methods for conducting literature reviews, poor research design for the field trials, and finally the cancellation of the crucial quality control step because time was running out (Frances, 2010, 2012; Jones, 2012). This process has not inspired confidence.

The DSM-5 product is frightening in its over-inclusiveness- with lowered diagnostic thresholds across a number of disorders and the addition of many new “subthreshold” disorders.  The changes blur the boundaries between pathology and normal behavior, resulting in increased overall prevalence rates of mental disorders and many new false epidemics.  Millions of normal people will be mislabeled as mentally ill and subjected to stigma and to unnecessary treatment and testing.

This will exacerbate what is already a serious problem in the United States – the medicalization of normal behavior. We are already in the midst of a national glut of excessive medication use causing harmful and unnecessary side effects and complications. What can social workers do if they don’t like the DSM-5 final product?  Ignore it.

There is nothing official about DSM 5. There are no DSM 5 codes- all codes used for reimbursement are ICD-9-CM codes which are available for free on the internet. You can bypass DSM-5 altogether and instead use the readily available diagnostic codes of the International Classification of Diseases (ICD). You can also continue to use DSM-IV diagnostic codes until oct 2014 when they will be replaced by ICD-10-CM which will also be available for free.

DSM is not mandatory for clinicians unless specifically required by their institutional settings (First, 2010).  In fact, the ICD is the only classification system approved by HIPAA (Department of Health and Human Services, 2009) – not the DSM classification.  As such, ICD codes meet all insurer-mandated and HIPAA coding requirements.

My advice- don’t buy DSM 5, don’t use it, don’t teach it.

References
American Counseling Association (ACA). (2011). 2011 statistics on mental health professions. Alexandria, VA: Author.
American Psychiatric Association (APA). (2011). American Psychiatric Association. Retrieved from http://www.psych.org/
American Psychological Association (APA). (2012). Support center: How many practicing psychologists are there in the United States?  Retrieved fromhttp://www.apa.org/support/about/psych/numbers-us.aspx#answer
Center for Health Workforce Studies School of Public Health University at Albany. (2006). Licensed social workers in the United States, 2004. Available at http://workforce.socialworkers.org
Department of Health and Human Services. (2009). HIPAA administrative simplification: Modifications to medical data code set standards to adopt ICD-10-CM and ICD-10-PCS. 45 CFR Part 162. Federal Register 74, no. 11 3328-62. Available at http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
First, M. B. (2010). Clinical utility in the revision of the diagnostic and statistical manual of mental disorders (DSM). Professional Psychology: Research and Practice, 41, 465-473.
Frances, A. J. (2012, November 13).  You can’t turn a sow’s ear into a silk purse. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/blog/frances/content/article/10168/2099456#
Jones, K. D. (2012). A critique of the DSM-5 field trials. Journal of Nervous and Mental Disease, 200, 517-519.
Regier, D. (2012, April). DSM-5 Field Trials: Reliability of the Categorical Diagnoses. Presentation at the Annual Meeting of the American Psychiatric Association, Philadelphia, PA.

Also View:
Can Congress Cure the Disorder in Mental Health 

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Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

          
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Mental Health

Life After Addiction Treatment: How to Fill the Void During Recovery

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The first year of recovery is difficult to manage. Triggers lie everywhere and applying the skills you learned in rehab is easier said than done. When a recovering addict first begins life after their addiction, they may discover a void left from their past life. Whether the void is their past experiences, low self-esteem, or avoiding bad feelings, addicts typically used drugs or alcohol to fill that void.

Now in the absence of those unhealthy “coping” mechanisms, addicts now face those voids alone. Maintaining recovery requires an addict to learn how to fill their life with positive things and not go backwards into their old ways.

The certified counselors at Cold Creek Behavioral Health have put together a list of recovery and coping skills in handling life after treatment.

Recovery Skills

Rehab isn’t the end of addiction, it’s only the beginning of recovery. Once an addict leaves treatment they soon realize that life and all the factors that brought them into their addiction are still there waiting for them.

Although you can’t change everything, you can learn how to handle things better and develop behaviors that’ll help you maintain your recovery.

Learn to Mourn

As strange as it may sound, it’s important to begin your recovery by first mourning the loss of your past addiction. Since your past addiction had been with you for a very long time, it’s important you mourn the loss of it. This can require not only giving up the addiction but saying goodbye to bad friends, places, and the unhealthy habits that led to your addiction. From where you used to hang out to who you were with regularly and on, it determined a lot of your day.

It’s important you recognize that loss but also recognize that although it was something you did—it didn’t define you. Recognize that loss and move past it. Then you can move on and maintain your recovery day to day, drug-free.

Avoid High-Risk Situations and Triggers

Some common high-risk situations are described in treatment as the acronym, HALT:

  • Hungry
  • Angry
  • Lonely
  • Tired

Recognize Your Emotions

Of course, you can’t always avoid HALT situations, but you can be more aware of them. If you take better care of yourself, you’ll be able to recognize your emotions before they send you spiraling. By develop healthy habits, use support groups, and more, many of these situations will be far and few between, rather than consistent occurrences.

Steer Clear of Boredom

For an addict, feeling a sense of boredom is dangerous. This is because it allows your mind to wander and not stay focused on maintaining your recovery. This can even go as far as triggering a relapse. For that reason, it’s important that you stay busy.

Fill your day with activities you enjoy. Find new interests. Keep busy. This will keep you busy and far from the feeling of boredom. It also helps you develop healthy habits. Remember: a routine is critical to helping you stay abstinent.

Fill Your Life with People and Love

A great way to start filling that void is to re-establish old friendships that may have been lost on your path of addiction. Surround yourself with supportive people both help you and make you feel cared for and loved.

Recovery is also a good time for an addict to mend fences with family and friends. Doing this will also help make you feel better about yourself because you’ll be righting your wrongs and maintaining your recovery.

Healthy Habits and Activities Are Crucial

There are many activities you can pick up on the road to recovery, as well. Some of these healthy activities include:

  • Making a to-do list so you can feel a sense of accomplishment as you mark things off.
  • Relaxing and trying to stay stress free
  • Playing video games to relax your mind
  • Reading
  • Doing crossword puzzles
  • Start becoming more proactive by starting a blog or doing volunteer work
  • Play sports
  • Take a class
  • Learn to coo

Other Coping Skills

Some other skills that are very helpful in maintaining your recovery include:

Stress Management

Learn how to handle your stress in healthy ways. Use tools listed above to help tackle your stress one day at a time.

Honesty

Make sure that you are completely honest with yourself and others. One of the key components of drug addiction is creating a culture of deceit—combat that with complete honesty and integrity.

Therapy

Maintaining a regular schedule of therapy sessions can really improve your chances of staying clean—especially in the first year.

No matter what you do, staying busy with some type of constructive activity and surrounding yourself with healthy relationships is a key component to staying sober and not letting old triggers creep back into your life. Maintain realistic expectations and remember: getting and staying sober is a process, a marathon; it’s not a sprint.

How to Prevent an Addict from Relapsing

Preventing a relapse is typically harder than it was getting sober. The reason for this is because maintaining recovery spans a lifetime. There is always a chance that a trigger lies right around the next corner and without support in defeating that trigger, an addict can start their former patterns all over again.

Tips for Helping a Recovering Addict

Fortunately, there are a number of ways to help. For example:

Finding a support group where the addict feels comfortable, can also provide a great deal of help. Being part of a group where members have gone through the same trials and tribulations helps an addict feel less alone in his or her struggle, and more like there is somewhere he or she belongs.

Family support is also of the utmost importance. The family structure is one of the key ways recovering addicts maintain their recovery, but it can also be a trigger source for some. Making sure you’re being as supportive as possible can help them immensely.

Just being around for non-judgmental listening can help tremendously. If an addict feels they can go to you for help when they are feeling triggered will help them in more ways than one and usually helps avert any crisis.

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Health

3 Ways to Keep a Positive Attitude and Be More Successful

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Your life is going to be full of setbacks, that’s just the nature of things. Life is full of ups and downs, and the best thing you can do is position yourself to make the most of those good times while hedging against the rough ones. Keeping a positive mindset is the best way to do this.

What do you do when things seem to go wrong? You have to be positive. You have to be optimistic. Think about it. If you don’t respond positively, then what is the alternative? And how has that alternative been worked out for you in the past? You have nothing to gain by focusing on the negatives. Everything you want in life is on the other side of failure, and the only way to get there is to stay positive and keep pushing forward.

Here are three simple ways to stay positive and weather the storms that life throws your way.

Surround Yourself with Positivity

One of the most effective ways to set yourself up for success is to engineer your environment and build productive habits that will move you toward success on autopilot. Since you become what you think about most of the time, it only makes sense to think about positive things in life.

Starting your day by reading some encouraging words can help set the tone for the whole day. Some great personal development authors include John Maxwell, Brian Tracy, John Covey, Tony Robbins and Gary Vaynerchuk. Put inspiring quotes all around your office, on your computer and phone desktops or even stuck up on the fridge at home. Commit to spending more time around positive people too, since their attitudes will rub off on you.

You can also automate your success through habits that can help you in life. Building a morning routine and a bedtime routine can help.

Take Care of Your Physical Health

You should also take good care of your physical health by making daily exercise a part of your routine. You don’t have to sign up for a marathon or anything to reap the benefits of exercise. As little as 20 minutes per day of moderate exercise can help improve how you look and feel.

Your diet is also important. Eat plenty of fresh veggies, fruits, legumes and whole grains to give your body the nutrients it needs for optimum health and performance. You might also want to incorporate superfoods into your meals, such as blueberries, garlic, turmeric, and oatmeal. These can help you fight off inflammation, boost your energy levels and improve your heart health.

Set Goals, Make Plans and Take Action

One of the best ways to build confidence and stay optimism is to accomplish goals that are important to you. Success breeds success. When you’re productive and find yourself achieving small goals, you feel good about yourself, and you become empowered to push harder to achieve even more.

Action is the key to success, but not all actions will help you in life. Some people are busy all day long, yet they never seem to get anywhere. The key is to know what you want to accomplish, to develop a plan that will make it happen and then to take action on that plan every day without allowing yourself to become distracted by non-essential tasks.

Some people think that time management is all about doing more things every day. But the opposite is actually true. Effective time management is about doing less things, not more things. You must discipline yourself to do the most important things – the things that will really make a difference and drive results. As you learn to do this, you will propel yourself toward your goals in a way that you cannot even imagine at this moment.

As you move rapidly toward your goals, you’ll begin to feel very excited and energized. This will then motivate you to push even harder and accelerate your progress, resulting in even greater levels of accomplishment, higher feelings of self-esteem and more positivity than you’ve ever experienced in the past.

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Mental Health

Senate Bill Introduce to Improve Access to the Mental Health Act

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Sen. Debbie Stabenow (second from left) meets with (from left) NASW Deputy Director of Programs Heidi McIntosh, NASW CEO Angelo McClain, and Julie Shroyer, senior policy adviser at Polsinelli PC, soon after introducing the Improving Access to Mental Health Act of 2015 in the Senate.

WASHINGTON, D.C. – The National Association of Social Workers (NASW) applauds Sen. Debbie Stabenow (D-MI) and Sen. John Barrasso (R-WY) for introducing the bipartisan Improving Access to Mental Health Act (S.2613), legislation that would increase public access to the vital mental health services that clinical social workers provide and offer clinical social workers more adequate Medicare reimbursement rates.

Their Senate bill is a companion to H.R. 1290, which was introduced in the House by Rep. Barbara Lee (D-CA). Stabenow and Lee are social workers and Barrasso is a physician. “Mental illness is an issue that touches so many families in some way and seniors are no exception,” said Senator Stabenow.

“Michigan seniors should be able to get quality care from the provider of their choice and this bill ensures that clinical social workers are among those essential providers.”

“Our nation’s share of people who are aging is growing rapidly and older Americans are in dire need of improved mental health services so they can enjoy a better quality of life and live as independently as possible,” said NASW CEO Angelo McClain, PhD, LICSW. “NASW congratulates Sen. Stabenow and Sen. Barrasso and Rep. Lee for using their combined expertise in social work, health care and legislative leadership to craft bipartisan legislation to address this issue.”

Clinical social workers are one of the nation’s largest groups of providers of mental health services. Currently, there are more than 300,000 social workers in the United States working in health care, mental health and substance use disorder treatment, according to the Bureau of Labor Statistics.

The House and Senate versions of the “Improving Access to Mental Health Act” would increase access to mental health services for residents of skilled nursing facilities and provide access to the complete set of clinical services that help Medicare beneficiaries cope with medical conditions.

In addition, the bill would align Medicare payment for clinical social workers with that of other non-physician providers by increasing the reimbursement rate from 75 percent to 85 percent of the physician fee schedule.

There are already 14 co-sponsors for the House bill, which was released in March 2017. Sens. Stabenow and Barrasso introduced the Senate version of the bill on March 22.

“It is fitting that this legislation was introduced in March, which is Social Work Month,” McClain said. “There is no better way to recognize the contributions of the nation’s more than 650,000 social workers than to put forward a bill that would support the clients who social workers serve, improve our nation’s mental health delivery system, and give social workers the reimbursement they need to do their critically important work.”

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LGBTQ

Gay, Bisexual, Sexually Abused Male Inmates More Fearful of Prison Rape, More Open to Therapy

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There is nowhere to escape in what often is referred to as a “sexual jungle,” especially for the most vulnerable. However, “Zero tolerance” toward prison rape is now national policy thanks to the Prison Rape Elimination Act passed by the United States Congress in 2003. Although this law changed how Americans think about prison rape, few studies have examined how inmates perceive rape and if they feel safe in prison. Even less is known about how their perceptions influence whether or not they ask for mental health treatment while incarcerated.

The most recent National Inmate Survey of 2011-12 of 92,449 inmates age 18 or older shows that among non-heterosexual prison inmates, more than 12 percent reported sexual victimization by another inmate and almost 5.5 percent were victimized by a prison staff member within the past 12 months. In comparison, 1.2 percent of heterosexual prisoners were sexually victimized by an inmate and 2.1 percent were victimized by a prison staff member. These rates are even higher for those with mental illness. About one in 12 inmates with a mental disorder report at least one incident of sexual victimization by another inmate over a six-month period, compared to one in 33 male inmates without a mental disorder.

Using data from more than 400 male inmates housed in 23 maximum-security prisons across the U.S., researchers from Florida Atlantic University conducted a novel study to examine the factors related to fear of rape in prison and the likelihood of male inmates requesting mental health treatment while incarcerated. They focused specifically on prisoners at risk of being sexually victimized in prison: gay or bisexual inmates and those with a history of childhood sexual abuse.

A key finding from the study, published in the Journal of Interpersonal Violence, is that sexual orientation and a history of childhood sexual abuse are significant predictors of male inmates fearing rape as a big threat in prison and voluntarily requesting mental health treatment. Findings from the study reveal that nearly 38 percent of gay and bisexual inmates and 37 percent of inmates with childhood sexual abuse fear rape as a big threat.

Compared with straight inmates, gay and bisexual inmates are approximately two times more likely to perceive rape as a threat and three times more likely to voluntarily request mental health treatment in prison. Inmates with a history of childhood sexual abuse are more than twice as likely to perceive rape as a threat and almost four times more likely to request mental health treatment than inmates who did not report a history of childhood sexual abuse. Notably, this finding is inconsistent with previous research that has shown that there is no significant relationship between childhood sexual abuse and feelings of safety among male inmates.

“The consequences of perceiving rape to be a threat in prison are vast and could contribute to violence among inmates as well as negative mental health ramifications such as increased fear, psychological distress, chronic anxiety, depression and thoughts of suicide,” said Cassandra A. Atkin-Plunk, Ph.D., co-author and an assistant professor in the School of Criminology and Criminal Justice within FAU’s College for Design and Social Inquiry.

Inmates incarcerated for two to five years are nearly three times more likely to perceive that rape is a big threat compared with inmates incarcerated for less than two years. Inmates in prison longer than 18 years are nearly four times more likely to voluntarily request mental health treatment in prison. The researchers also found that Black inmates are twice as likely to seek mental health treatment in prison compared to White inmates.

“Knowing that gay and bisexual inmates and inmates with a history of childhood sexual abuse are more likely to fear rape and seek mental health treatment, prison staff can target outreach and treatment efforts for this vulnerable sub-population,” said Mina Ratkalkar, LCSW, MS, lead author and a licensed clinical social worker pursuing a Ph.D. who conducted the study while she was a graduate student at FAU. “Our study shows that these sub-groups of inmates are receptive to treatment, and our findings have implications for both practice and policy in the United States.”

The sample consisted of a nearly equal number of men in their 20s, 30s and 40s. Black inmates made up about half of the sample, with White inmates comprising about one-third of the sample. Nearly one-third of the sample had previously been in juvenile detention and about one-quarter were incarcerated for the first time in the adult criminal justice system at age 18 or younger.

About 16.4 percent of the sample identified as gay or bisexual. About one-fifth of the men (73) reported a history of childhood sexual abuse, and about one-third of the men reported having received mental health treatment outside of prison.

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Health

How to Recognize and Help an Addict

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It’s devastating to know a friend or a loved one suffers from an addiction. Before people get help, they often go down a long road of addiction prior to anyone, including themselves, noticing a problem. Consider the information and advice below if you know or suspect someone is an addict.

Your Gut

Addicts are excellent liars. It can seem disheartening to hear that you shouldn’t take them at face-value. However, listen to your gut. Your gut is telling you that something is wrong. Do not ignore this. They will tell you all the right things you’d like to hear. They will go into detail about where they were, why they did something and more. Everything will sound right to your mind. The very fact that you feel something isn’t right means more than likely something truly isn’t. Listen to what they say, and take notes because if they are addicts, they will slip up eventually. Don’t be the big-bad wolf that’s out to get them, but don’t be an enabler either. Enablers help them to stay stuck in their addiction by making excuses for them.

Denial

Addicts especially high-functioning addicts think that if they’re able to go to work, bring money home, do housework and other normal day-to-day life they do not have a problem with addiction. An addict is not just the junkie on the corner. Most addicts are high-functioning, which means they go under the radar for what passes as an addict to society. Because of this, and for reasons such as not wanting to face themselves, addicts will lie to themselves and the world. This is why most addicts are in denial. They might also reason that they don’t drink “enough” to be an addict. Make no mistake that alcoholism isn’t about the quantity of alcohol ingested. It’s about the mental obsession and physical craving of alcohol that makes someone an alcoholic. People who don’t drink for three of four months and suddenly “binge” can be alcoholics.

Things Don’t Add Up

It is often said that addicts lead double lives. This is true for anyone living in dysfunction. To the outside world, they have it together. Underneath that façade is a broken human being who uses alcohol, substances or anything else to get by. To make matters worse, this outward appearance can be further covered up, or justified, with a prescription medication. Abuse of a prescription medication is a serious concern. People often overdose on their pills or makeup excuses for why they need them even though they don’t have a legitimate need for them. This is why centers offer painkiller addiction treatment because it is a common phenomenon. It is also a growing phenomenon.

Real Help

To the addict, you’re “mean,” “unreasonable,” and a few choice words when you confront them. Expect this upfront. It’s not a reflection of who you are as a person despite their best attempts to assassinate your character. What they say about you has everything to do with their dysfunction. More often than not, they will choose their addiction over you. Real help and real love mean saying, “I’m going to tell you the truth,” “I need to love myself before I can love you,” or “I don’t accept your excuse. You’re responsible for your behavior, and I refuse to be a part of your life until you take responsibility for yourself.”

You can’t force someone to get help, but you can stop enabling them. Don’t make excuses for their behaviors or addiction. Addicts have to want to get help before they do. Once you know there is a problem, stand your ground. Speak truthfully to the addict. Above all, love yourself because this has been and will continue to be incredibly hard on you. Understand that they have to learn to love themselves too.

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Health

Veterans: Take This Survey!

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Learning about military-to-civilian reintegration requires asking the right questions of the right people. A novel, new study is seeking military veteran respondents to learn more about the way service impacts health, civic engagement, and socio-economic outcomes for military-connected men and women. The data collected through this survey are expected to help us answer questions such as:

• Do veterans feel welcome and interested in institutional service groups like the VA and informal groups like VSOs? Do those organizations serve their needs? How are prospective members welcomed and served?
• How does military service impact community involvement and political engagement?
• How does military service impact experiences on the job market (and is this effect conditioned by demographic factors?
• Does military service break the glass ceiling for service women?

The project was developed by an interdisciplinary research team with experience, training, and connections to the military community. Dr. Kyleanne Hunter is a Marine Corps Cobra pilot and political science researcher. Dr. Rebecca Best is an experienced security studies researcher with a focus on service women. Dr. Kate Hendricks Thomas is a public health researcher and Marine Corps veteran. Each has specific training in community-based, participatory research and is invested in filling current gaps in what we think we know about the transition from service member to civilian.

Access the survey online here: https://udenver.qualtrics.com/jfe/form/SV_572AiK5P3P75KQt

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