Monday, November 27, 2017

Happy Holidays from Shrink Rap: Free Kindle Novel Promotion!

Happy Holidays!

At this time of year, I like to set up free downloads to two of my novels. You can get these books for free on your Kindle from Tuesday, November 28th through Saturday, December 2nd at no cost.

Double Billing is the story of a woman whose life changes when she discovers she has an identical twin. It's a quick read with a little  psychiatry sprinkled in.  One reviewer said:

 The book was a page-turner because of elegant structure and pacing.  I really cared about the author’s take on things –because she is a psychiatrist? because I’ve followed  her blog for a while?– which meant that I was interested in the protagonist’s thoughts, feelings and actions.  At times I ached for the mess her life was in, at others I wanted to shake her into action, and then she’d find her backbone again, just in the nick.  

Home Inspection is a story told through psychotherapy sessions in a format that is similar to the HBO series In Treatment. Dr. Julius Strand is a psychiatrist who plods along in his already-lived life until two of his patients inspire him through their own struggles to find meaning.  One reviewer wrote:

 I like to read all sorts of books, but books where there's something in it that reflects a part of me, a part of my life, a part of my experiences, are something I go out of my way to find. I have not found any fiction book that does nearly as much to show what psychotherapy is like.

There is is a single link to my Amazon page with all my books here.

If you don't own a Kindle reader, you can install a free Kindle app on your computer, tablet, or cell phone by going here and then you can read any Kindle book. You don't need to buy a Kindle to read on your computer, tablet, or smartphone.

 Both novels are also available as as paperbacks from Amazon, but not for free.  And our two non-fiction books can also be found on that page, but again, not for free.

I'm more than happy to have people download my novels at no cost
-- I'll be keeping the doctor day gig -- so please tell/tweet/blog/share the free promotions to anyone you think might be interested.

Finally, If you do read any of the books, please consider putting a review on Amazon.   


Monday, November 20, 2017

Laura's Law (outpatient commitment): The Answer to Preventing Mass Murder?

2017 has broken the record for the most mass murders in a single year -- not something to be proud of, my fellow Americans.

After the latest mass shooting in Tehama, California, John Snook, the executive director of the Treatment Advocacy Center had an op ed piece in the The Sacramento Bee titled
"Tehama Country had a tool to Get the Shooter Into Treatment.  It Just Didn't Use it and the System Failed."  The article notes that Laura's Law, where a judge orders a patient to get outpatient treatment, exists in many California counties, but not the one where the shooter lived.  If only, if only.

We know little about this shooter.  He was a violent man with a history of stabbing a woman (he was out on bail) and of shooting at neighbors.  His sister has stated that he had a long mental health and he was paranoid, and anti-government.  Prior to his shooting spree, he killed his wife and buried her in the floors.   The shooter worked as a marijuana farmer, we know nothing about his drug use or his treatment history.  He was known to the police, and clearly repeatedly dangerous, but the judicial system saw fit to let him remain out of jail on bail, which his mother in North Carolina posted, while he awaited trial. His guns were made by the shooter with pieces he had ordered and assembled, other guns were registered to someone else (?stolen).  He had a history of violence, and this crime does not sound to have been a surprise to the neighbors who feared him; one of the victims was the woman he had previously stabbed.

So would this mass shooting have been prevented if Laura's Law was implemented in his country?
First off, we don't know about the shooter's mental health history.  Oddly enough, while Tehama does not have outpatient commitment, the shooter could have been confined on an inpatient unit if a "5150" had been filed to detain him for an evaluation on an inpatient   Also, the shooter had multiple charges for violent crimes -- he could have been diverted to a mental health court and mandated into treatment through the legal system.  That also didn't happen-- or at least we haven't heard about any of those actions happening.  I suspect that the shooter fell through the mental health system  cracks, but it's clear he fell through the cracks in the legal system.  

So would Laura's Law have prevented THIS mass shooting?  Perhaps, if the following list of stimpulations were met:
~If the shooter's violence was a product of his mental illness.  People without mental illness are violent, and people with mental illness are violent for reasons unrelated to their psychiatric disorders.
~If the shooter's symptoms that caused him to kill people were eliminated by the use of psychiatric medications.  Not everyone has a good response to medications and so far, we haven't heard that he was so much better when he took medications.   Forcing people to take medications doesn't fix/prevent everything, and the average length of stay in a forensic facility for people who have committed violent crimes due to their mental disorders is YEARS.  Sick, violent people don't magically get better with a judge's order. 
~If the perpetrator was ordered to treatment and if he complied with the order to go to treatment and to take medications.  Not everyone does, and from what we know, this man broke laws, both with his violent behaviors, and with his planned and purposeful assembly of illegal weapons.
~If services were available for the perpetrator to receive them. In half the counties in this country, there are no mental health professionals.
~Does Assisted Outpatient Treatment prevent gun violence?  We don't know.  In New York, where AOT has been studied, one large study showed AOT, with partner services including case management and housing prioritization, AOT reduced hospitalizations and incarcerations, but people with a history of violence were  excluded from the AOT study.  We don't know that outpatient commitment reduces violence or gun violence.

Just a thought: other countries have mental illness illness.   Other countries don't have mass shootings.  What else they don't have?  One gun for every citizen. 

Tuesday, November 14, 2017

When Paranoia Meets Reality: Your Medicine Snitching On You

Medication non-compliance is a problem: patients don't take their pills.  We hear about it all the time in psychiatry: people don't take their medications and they relapse.  Sometimes they decide they don't need them when they do, sometimes they don't like the side effects or risks of the medications, but mostly, they just forget.  You may hear about this problem as if it belongs to psychiatry, but it doesn't.  Patients don't take their cardiac medications, either; in fact humans are only randomly compliant with all types of meds.

Swoop in technology, here to solve the problem.  Now sensors placed in tablets can notify the doctor and up to four other people to inform them if and when a patient has taken their pill!  And what pill was was the first to be approved for the use?  Abilify: an anti-psychotic medication used to treat schizophrenia and bipolar disorder, and also used to augment anti-depressants.  Was that the wisest choice?  To have a tattle-tale system in a medication used to treat paranoia?  I'm thinking there could be a better place to start.

So the patient swallows a medication and his stomach acid signals the sensor.  He also has to wear a skin patch on his abdomen, under his ribs.  A notice goes out to an App on his doctor's phone, and to anyone else he wants notified (presumably himself).  He has to consent to this, but questions have been raised about whether the courts will require patients to do this in terms of release from incarceration, for mental health courts, or if it will be priced in such a way to incentivize it's use.  Will people be coerced?  Will they like it?  Will they remember to check their App to see if their loved one took their medication?  Do doctors really want to be notified every time a patient takes their medications?  Will EMRs now have boxes to check to verify that the doctor has looked to see if the patient has swallowed his pill, as directed, daily, at the correct times? Will doctors be liable if they fail to check results and take action when patients aren't taking their medications and if there is a bad outcome? Will sensors work to improve medication adherence?  And then there is the Creepiness Factor.   You can tell I'm a bit skeptical of this, but that's not new.  ClinkShrink will happily tell you that I was wary of the Internet the first time I went surfing: too slow, it will never catch on.  I was wrong. 

Want to read more? Here's the New York Times article: First Digital Pill Approved to Worried About Biomedical Big Brother.

Your thoughts?