Psychiatric Times Vol 15 No 2

There is and has been much debate about the issue of assisted suicide as physicians, lawyers and lay people argue the pros and cons of assisting in someone's death. The physician who agrees to participate in this endeavor points out that his or her concern is to alleviate suffering. Notwithstanding that, painkillers are notoriously prescribed in inadequate, understrength doses; people with serious illness who are depressed are considered unlikely candidates for treatment of their depression because, sayeth the physician: "It is only natural, understandable, to be depressed with that kind of terrible illness."

On the surface, mental health parity does not appear to be controversial. Why should insurance companies and government insurance discriminate against patients with psychiatric problems? Making an artificial separation between psychiatric and medical illness makes little clinical sense. It is also clear that the treatment of psychiatric disorders often decreases physical symptoms, resulting in fewer visits to nonpsychiatric physicians. Cost estimates for mandating parity, although widely divergent, have generally been thought to be low. However, many seemingly benign regulations can often result in unforeseen costs and negative effects.

For elders confronted with the necessity of living in a nursing home, the choice of facility is a decision with profound consequences-for their health, their quality of life and their family finances. Nursing home care may cost $50,000 a year or even more, and more than half of all elders begin their nursing home stays by paying the costs out of pocket. That imposing sum can purchase excellent care, or can pay the rent for a place that is literally "worse than death" for the unfortunates who live there.

A lawsuit brought on behalf of the 600,000-member United Seniors Association (USA) and four individual Medicare recipients last December may turn the Washington, D.C., federal court where it was filed into the latest health care battleground. The issue: Does a patient's right to choose a physician outweigh the federal government's efforts to regulate health care provided to the elderly?

The ERISA shield has become a favorite of employers and benefits providers, because its overwhelming effect is to reduce the situations in which they can be held legally responsible for misdeeds. Even in cases where a violation can be established, the statutory penalties are insufficient to make bringing cases to court worthwhile, or are inadequate to deter future improper conduct. Efforts over the years to enact an amendment to ERISA have failed because of powerful lobbying by business and health care interests. re reluctant to utilize, inform or confront their care providers, impairing collaboration in treatment.

This year at the 10th Annual U.S. Psychiatric & Mental Congress, CME LLC honored deserving recipients with the prestigious "Lifetime Achievement Award." The award winners for 1997 were recognized during a presentation ceremony in Orlando, Fla., in November.

Every evening, just when quiet comes, she awakens on the prowl.

It is estimated that 60% to 70% of American people who have health insurance have a plan which falls under the provisions of the Employee Retirement Insurance Security Act of 1974 (ERISA). ERISA was designed to protect and enhance pensions and benefits for employees of nationwide companies, and was heavily lobbied for by business as more and more employers established facilities in multiple states.

Depression, subcortical dementia and normal aging: all three may have similar neurobehavioral manifestations. So how does a clinician make a differential diagnosis?

Recent headlines in national newspapers declaring that mentally ill patients are often denied care by psychiatric hospitals merely confirmed what most psychiatrists have known for years. A study published last December, however, created a stir when the authors released what they called "the first national analysis of the factors that promote or constrain economically motivated transfers of patients in relation to competitive pressures, hospital ownership, and managed care practices."