Report: Too little mental health care for seniors

WASHINGTON (AP) — Getting older does not just mean a risk for physical ailments like heart disease and creaky knees: A new report finds as many as 1 in 5 American seniors has a mental health or substance abuse problem.

And as the population rapidly ages over the next two decades, millions of baby boomers may have a hard time finding care and services for mental health problems such as depression — because the nation is woefully lacking in doctors, nurses and other health workers trained for their special needs, the Institute of Medicine said Tuesday.

Instead, the country is focused mostly on preparing for the physical health needs of what has been called the silver tsunami.

"The burden of mental illness and substance abuse disorders in older adults in the United States borders on a crisis," wrote Dr. Dan Blazer of Duke University, who chaired the Institute of Medicine panel that investigated the issue. "Yet this crisis is largely hidden from the public and many of those who develop policy and programs to care for older people."

Already, at least 5.6 million to 8 million Americans age 65 and older have a mental health condition or substance abuse disorder, the report found — calling that a conservative estimate that does not include a number of disorders. Depressive disorders and psychiatric symptoms related to dementia are the most common.

While the panel could not make precise projections, those numbers are sure to grow as the number of seniors nearly doubles by 2030, said report co-author Dr. Peter Rabins, a psychiatrist at Johns Hopkins University. How much substance abuse treatment for seniors will be needed is a particular question, as rates of illegal drug use are higher in people currently in their 50s than in previous generations.

Mental health experts welcomed the report.

"This is a wake-up call for many reasons," said Dr. Ken Duckworth of the National Alliance on Mental Illness. The coming need for geriatric mental health care "is quite profound for us as a nation, and something we need to attend to urgently," he said.

Merely getting older does not make mental health problems more likely to occur, Rabins said, noting that middle age is the most common time for onset of depression.

But when they do occur in older adults, the report found that they are too often overlooked and tend to be more complex. Among the reasons:

—People over 65 almost always have physical health problems at the same time that can mask or distract from the mental health needs. The physical illnesses, and medications used for them, also can complicate treatment. For example, up to a third of people who require long-term steroid treatment develop mood problems that may require someone knowledgeable about both the medical and mental health issues to determine whether it is best to cut back the steroids or add an antidepressant, Rabins said.

On the other side, older adults with untreated depression are less likely to have their diabetes, high blood pressure and other physical conditions under control — and consequently wind up costing a lot more to treat.

—Age alters how people's bodies metabolize alcohol and drugs, including prescription drugs. That can increase the risk of dangerous overdoses, and worsen or even trigger substance abuse problems.

—Grief is common in old age as spouses, other relatives and friends die. It may be difficult to distinguish between grief and major depression.

That also means a loss of the support systems that earlier in life could have helped people better recover from a mental health problem, said Dr. Paul D.S. Kirwin, president of the American Association for Geriatric Psychiatry. Adding stress may be loss of a professional identity with retirement, and the role reversal that happens when children start taking care of older parents.

"There'll never be enough geriatric psychiatrists or geriatric medicine specialists to take care of this huge wave of people that are aging," Kirwin said.

The Institute of Medicine report recognizes that. It says all health workers who see older patients — including primary care physicians, nurses, physicians' assistants and social workers — need some training to recognize the signs of geriatric mental health problems and provide at least basic care. To get there, it called for changes in how Medicare and Medicaid pay for mental health services, stricter licensing requirements for health workers, and for the government to fund appropriate training programs.

via Associated Press

Please sign on: Opposition to Nutrition Cuts in House Farm bill

With the announcement earlier today that the initial version of House Farm Bill includes $16 billion in cuts to SNAP/CalFresh, it’s important that we send a strong and unified message to our California Agriculture Committee Members in opposition to those cuts. The Senate has already passed a bill that includes $4.5 billion in cuts to SNAP. 

We are working with local food banks to get local organizations that are in the districts of California’s three Congressmen who serve on Agriculture Committee to sign a letter (letters attached) asking the Congressmen to oppose cuts to SNAP/CalFresh in the Farm Bill.  We are also asking statewide organizations to sign all three letters – they’re identical except who they’re addressed to.  The deadline to sign your organizations onto the letter(s) has been extended to Monday, July 9.  If you have local partners, members or affiliates in any of the three congressional districts who would be interested in signing the letter, I would very much appreciate you passing this along.  Below I’ve listed the three Congressmen and the counties that make up their congressional districts.  I’ve also outlined the steps that you can take to get signatures and provided a template for an email you can send to local partners.  Thanks in advance for your help!

1.       If you’re a statewide organization, sign onto all three letters by emailing me and letting me know you would like to sign.  Please provide me with the correct spelling of the name of your organization.

2.       Send a request to local organizations in each of the three congressional districts to sign the letter to their relevant Congressman.  Below is a list of the three California Congressmen who serve on the Agriculture Committee and all the counties they represent.  There is also a template for an email you can send to local partners.

California Congressmen on Agriculture Committee and the Counties they Represent (some partially)

Congressman Dennis Cardoza - Merced, Stanislaus, San Joaquin, Madera

Congressman Jim Costa - Fresno, Kings, Kern

Congressman Joe Baca - San Bernardino

Template Email to Local Organizations

Sign your Organization on to a Letter to Costa/Cardoza/Baca to Prevent SNAP/CalFresh Cuts

Sign your organization on to the attached letter to Congressman Costa/Cardoza/Baca  asking him to oppose cuts to SNAP/CalFresh or any other nutrition programs.  The Chairman of House Committee on Agriculture has just introduced a Farm Bill with devastating cuts to SNAP/CalFresh.  The bill includes $16 billion in cuts to SNAP over ten years.  The Congressman is a member of the Agriculture Committee and will be in a unique position to oppose those cuts.

Please take a moment to sign your organization on as a supporter of the attached letter.  The deadline to sign is this Monday, July 9.  To sign your organization onto the letter, just email Eric Manke at eric@cafoodbanks.org and let me know that your organization would like to be listed as a signer of the Costa/Cardoza/Baca Farm Bill letter.  Please provide Eric with your name and the correct spelling of the name of your organization.  

Download below:

(1) Costa Letter

(2) Cardoza Letter

(3) Baca Letter

Budget Impasse May Cost 300,000 U.S. Non-Defense Jobs

At least 300,000 jobs in industries including computer services, tourism, package delivery and meat processing may be lost if Congress fails to avert $1.2 trillion in automatic federal spending cuts starting next year. 

Across-the-board reductions in non-defense spending will have a ripple effect over the next two years on companies that aren’t government contractors, according to the Bipartisan Policy Center in Washington, which made the forecast. Hundreds of thousands more jobs are at risk from additional Defense Department reductions, amid an 8.2 percent jobless rate in May.

“You are going to see reductions, frankly, in every area of the American economy,” Dov Zakheim, a former Defense Department comptroller who worked with the policy center, said in an interview.

The cuts are part of $1.2 trillion in reductions to domestic and defense programs that will start in 2013 if Congress doesn’t act. They were required after talks failed last year on a bipartisan plan to curb the U.S. deficit. The Defense Department will bear half of the reductions and other government agencies will share the rest, starting with about $55 billion in 2013.

About $16.2 billion of that would come from mandatory programs such as Medicare and farm subsidies, according to the Center on Budget and Policy Priorities, a Washington group that advocates for programs that help lower-income and middle-class Americans.
“I don’t like across-the-board meat-ax cuts,” Senator Susan Collins, a Maine Republican, said in an interview. “We should be making decisions.”

‘Time Bomb’

The reductions are a “swiftly ticking time bomb,” Scott Lilly, a senior fellow at the Center for American Progress, wrote on the Washington group’s website that says it promotes “progressive ideas.”

The Federal Aviation Administration may close air traffic towers in smaller communities or reduce the number of air traffic controllers as the result of a potential $1.5 billion spending decline, Lilly said in a telephone interview. That may force package-delivery services, such as FedEx Corp. (FDX) (FDX) and United Parcel Service Inc. (UPS) (UPS), to reduce flights, he said.

“FAA cuts would have deleterious impacts on operations,” Danny Werfel, the controller at the Office of Management and Budget, told the House Budget Committee in April. He also said about 300 national parks would be fully or partially closed.

Cuts to the National Park Service budget may delay the start of the summer season at Yellowstone National Park in Wyoming for weeks, leaving hotels and restaurants without the business tourists would bring, Lilly said.

Keeping Quiet

While officials at Lockheed Martin Corp. (LMT) (LMT), the world’s largest defense contractor, say it and other companies will stop hiring and investing as the automatic changes loom, many non- defense companies are keeping quiet publicly.

“It would be premature to discuss specific impacts on our business from any change in federal spending, given that options are still being discussed by all sides,” Maury Donahue, manager of regulatory and public affairs communications at Memphis, Tennessee-based FedEx, said in an e-mailed statement. Kara Ross, spokeswoman for Atlanta-based UPS, said the company had no immediate comment.

Companies have so many questions about the automatic cuts “that the uncertainty is the only certainty right now for everybody,” Stan Soloway, president of the Professional Services Council, said in a telephone interview. The trade group, located outside Washington in Arlington, Virginia, represents the government professional and technical services industry.

1 Million Jobs

The spending reductions may lead to a loss of 1 million defense and non-defense jobs in 2013 and 2014 through fewer hirings, attrition and layoffs, said Steve Bell, senior director of the Bipartisan Policy Center’s economic policy project. Of that number, at least 300,000 are unrelated to defense, according to Bell and Zakheim. The group was created in 2007 by four Republican and Democratic former Senate majority leaders.

The White House Office of Management and Budget hasn’t issued guidance to federal agencies on how to put the automatic cuts in place. The Senate voted in June to seek reports from the OMB on the reductions’ effect, and from President Barack Obama on how the government would implement them. The House hasn’t adopted similar measures.

‘High Risk’

To the extent that government agencies can decide what to eliminate, “anything expendable will be at high risk,” said Daniel Gordon, associate dean for government procurement law at George Washington University Law School in Washington. “That would include, in particular, professional services and consultants, but also anything that involves investing in the future,” such as information-technology improvements.

Hewlett-Packard Co. (HPQ) (HPQ), with $3.1 billion in government contracts in 2011, and Dell Inc. (DELL) (DELL) with $1.4 billion, are among the government’s top 50 contractors, according to a ranking of 200 federal industry leaders by Bloomberg Government. Neither company responded to requests for comment.

via bloomberg

Mental health and obesity linked

According to researchers, addressing mental health when treating obesity is essential. It is argued that obesity shares many of the same physical causes and long-term effects as mental illness, causing the two conditions to dovetail and exacerbate each other over time.

Dr. Arya Sharma, scientific director of the Canadian Obesity Network, said that the relationship between the two is critical and is not often made clear to patients. "In assessing someone for obesity, you need to assess mental health as your number one priority before you even start thinking about what people eat and how much people move," he said. "Because right away you can assume that if there's a mental health problem going on, managing weight is going to be very difficult."

In Dr. Sharma's opinion, people struggling with obesity often contend with mental stresses, from body image issues to mood disorders, all of which affect efforts to lose weight since mood has a direct impact on metabolism. Thus, adding negative emotional turns can make it harder for the body to process certain foods. For individuals seeking treatment for mental illness, obesity could pose a very real threat. Many antipsychotic medications cause weight gain and food is often an attractive coping mechanism. Undoubtedly, treatments for weight loss should address both physical and psychological health, and physicians are encouraging this holistic approach more and more.

Via examiner.com

How a community clinic in a poor D.C. neighborhood reacted to the Supreme Court decision

Paula Stewart, 49, hasn’t heard much about Obamacare, and she greeted the news of the Supreme Court’s decision this morning with a shrug. But the HIV-positive D.C. resident credits one local beneficiary of the Affordable Care Act for saving her life.

“I’m 30-years positive. I’m an addict,” said Stewart, who just left the waiting room of the Family and Medical Counseling Service. She’s been receiving treatment there since she got out of jail, not only for HIV, but also asthma, diabetes, and bipolar disorder. “I’ve got the best health care ever seen in the world,” she asserted.

The community health clinic sits just across the river from the Capitol, in D.C.’s predominantly black Anacostia neighborhood. On the third floor of a big brick complex on Martin Luther King Jr. Boulevard, the clinic isn’t much bigger than a typical doctor’s office. The small white waiting room is plastered with educational posters on diabetes and Hepatitis C, chock full of pamphlets on HIV and a dozen blue chairs. The Family and Medical Counseling Service isn’t free, but it has a sliding fee scale, and patients who are uninsured and can’t afford to pay still receive care. And Obamacare is already helping the clinic expand its primary-care services thanks to an early grant it received under the law.

“The Supreme Court—hopefully they’re doing the right thing by making sure that insurance is available to all people, not just those can afford it,” Dr. Veronica Jenkins, the clinic’s medical director, said after she heard news of the ruling.

Benjamin Johnson, who was waiting outside a food bank in the lobby of the building, said he hoped that the decision wouldn’t have a negative impact on Medicaid. (Under the ruling, states are now permitted to opt out of the program’s expansion without losing all of their federal funding.) Before enrolling in Medicaid a little over a year ago, Johnson went to the ER instead and racked up $11,000 in medical bills. “My job doesn’t give me health care. I’m 49 years old, with high blood pressure, sciatica,” said Johnson, who earns $12,000 a year through his part-time job at a moving company. The difference now: “I pay a dollar for medication, and that’s a blessing,” Johnson said. “I work and pay taxes and still can’t afford health insurance [on my own].”

The District of Columbia is actually one of the few states that’s already moved ahead with the Medicaid expansion ahead of 2014. As such, Jenkins says she expects to her clinic to see more low-income patients with insurance. “That’s more revenue to help keep the clinic alive,” she explained. And having more insured patients means it will be easier to subsidize patients who are still uninsured and can’t pay, Jenkins says. “It will increase the number of people who come to us.”

But in the clinic’s waiting room, where a video about a single mother was playing in the background, there was still some lingering skepticism. “I have mixed emotions,” said Charles Griego, a sign-language interpreter who was accompanying a deaf patient. “It’s a great idea that could benefit a lot of people,” said Griego. But, he asked, “how is it going to be implemented?”

Lawsuit takes aim at California's legal protections for teachers

A Bay Area nonprofit backed partly by groups known for battling teachers unions has filed a lawsuit seeking to overturn five California laws that, they say, make it too difficult to dismiss ineffective teachers.

The suit, filed on behalf of eight students, takes aim at California laws that govern teacher tenure rules, seniority protections and the teacher dismissal process.


"A handful of outdated laws passed by the California Legislature are preventing school administrators from maintaining or improving the quality of our public educational system," according to the lawsuit, which was filed Monday in Los Angeles County Superior Court and announced Tuesday.


The group behind the legal action is the newly formed Students Matter. The founder is Silicon Valley entrepreneur David F. Welch and the group's funders include the foundation of L.A. philanthropist Eli Broad.

The suit contends that teachers can earn tenure protections too quickly — in two years — well before their fitness for long-term employment can be determined. The suit also seeks to invalidate the practice of first laying off less experienced teachers during a budget crisis, rather than keeping the best teachers. And it takes aim at a dismissal process that, it alleges, is too costly, too lengthy and typically results in ineffective teachers holding on to jobs.

The move to address teacher quality has become a national issue from the Obama administration on down. In California, officials supported by powerful teachers unions have been reluctant or opposed to changing teacher job protections. Advocates, instead, are turning to the courts.

Such efforts are misguided at best, especially at a time when sweeping budget cuts have decimated schools, said Joshua Pechthalt, president of the California Federation of Teachers.

"We should be fighting like crazy to make sure schools are not laying off any teachers, except those who shouldn't be in front of a classroom," he said. And, he said, those teachers can be dealt with under current laws if school systems have sufficient resources and use them properly.

This latest legal effort is the most sweeping of several underway — all of which affect the Los Angeles Unified School District. The first, Reed vs. L.A. Unified, resulted in a settlement that allows the nation's second-largest district to bypass some campuses when layoffs are necessary. The teachers union has appealed.

A coalition of allied groups called Monday for the teachers union to drop its appeal. Their event was held across from Liechty Middle School, a campus exempted from layoffs under the settlement.

Another ongoing case alleges that L.A. Unified is not following state laws that mandate regular teacher evaluations and that they need to include evidence of student achievement.

The defendants in the latest litigation include state elected officials, L.A. Unified and a San Jose school district.

L.A. schools Supt. John Deasy commended the intent of the advocates for trying to force needed changes. The lawsuit "is aggressively going after long-term issues which have thwarted the rights of students to a high-quality education," Deasy said.

The L.A. school board has supported speeding up teacher dismissals. Deasy also wants to extend the time needed to earn tenure. The lawsuit does not propose specific solutions to the laws it deems objectionable.

Within L.A. Unified, Deasy has moved ahead with developing and testing a new evaluation system that incorporates student test scores. He said such a system would provide a clear view of which teachers are effective — whether the purpose is to decide whom to lay off or whom to help.

The teachers union has challenged Deasy's decision to impose the new system before a state labor board.

The advisory committee of Students Matter includes Students First, a group headed by former District of Columbia schools Chancellor Michelle Rhee; Democrats for Education Reform, whose California branch is led by former state Sen. Gloria Romero; and Parent Revolution, which organizes parents to compel dramatic changes at local schools through so-called parent-trigger laws. All of these have faced off against teacher unions in the past.

The legal team includes Theodore B. Olson, a U.S. solicitor general in the George W. Bush administration, and Theodore J. Boutrous Jr., a partner at Gibson, Dunn & Crutcher. Both represented activists who successfully overturned California's ban on gay marriage.

L.A. school board member Steve Zimmer said he detected an underlying anti-union agenda.

"What matters to the folks who fund this is not students, it's eliminating public sector unions," he said.

http://www.latimes.com/news/local/la-me-0516-lausd-teachers-20120516,0,6292585.story

GlaxoSmithKline in $3 billion fraud settlement

NEW YORK (CNNMoney) -- GlaxoSmithKline was slapped with a $3 billion fine Monday by the U.S. Justice Department after failing to report safety data on some of the company's most popular drugs.

The payment -- with $1 billion going to settle criminal wrongdoing, and $2 billion to cover civil liabilities -- is the largest fraud settlement in U.S. history, and the largest payment ever by a drug company.

GlaxoSmithKline (GSK) will plead guilty to two counts of introducing misbranded drugs, Paxil and Wellbutrin, into interstate commerce.

Specifically, the government alleged that the drugs were marketed as a treatment for conditions for which they had not been approved. It said Paxil, which treats depressive and anxiety disorders in adults, was marketed to children and adolescents, and Wellbutrin, an antidepressant, was marketed as a weight-loss aid.

A third count involves a failure to report safety data about the drug Avandia, a diabetes drug, to the Food and Drug Administration between 2001and 2007.

In addition to the criminal and civil resolutions, GlaxoSmithKline has reached a 5-year compliance agreement with the Department of Health and Human Services. Under terms of the deal, according to department Inspector General Daniel R. Levinson, company executives could forfeit annual bonuses if they or their subordinates engage in significant misconduct, and sales agents are now being paid based on quality of service rather than sales targets.

GlaxoSmithKline said in a statement that the settlement will be funded through existing cash resources.

"On behalf of GSK, I want to express our regret and reiterate that we have learnt from the mistakes that were made," CEO Andrew Witty said in a statement, adding that the company has changed its procedures for compliance, marketing and selling since the incidents.

Shares of GlaxoSmithKline stock rose 1.3% in Monday trading.

--CNN's Terry Frieden and CNN's Medical Unit contributed to this report 

First Published: July 2, 2012: 11:24 AM ET