Mental health centers are changing to "behavioral" health centers

[heyjack70]

Have you been seeing this shift. XYZ Community Mental Health Center is changing it's name to XYZ Behavioral Health. But there is absolutely nothing different about the services being provided. I've seen this at several different clinics over the last 5 years. From what I can tell it's just branding. Maybe the name "mental health" center is stigmatizing. But I think "behavioral health" is extremely inaccurate.

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[OldPsychDoc]

Wait ten years, the pendulum will swing back...

 

[tishage]

"Behavioral health" is administrator speak for "mental health & substance use". It's supposed to be more encompassing than "mental health." But I have seen the same thing at the local & federal level, so imagine we'll see this more & more

 

[slappy]

"Behavioral health" is administrator speak for "mental health & substance use". It's supposed to be more encompassing than "mental health."

And also personality disorders which to the lay public is behavioral, not mental.

 

[Mapplicant]

Seems like the word "mental" is gaining in PR ugliness. This happened at exactly the hospital where I'm doing my residency at.

It used to be called a regional mental health center....now the name is changed to The Center for Behavioral Medicine.

This brings back memory of Thomas Insel's TED talk on mental illness and his staunch opinion that psychiatric disorder should NOT be viewed as "behavioral disease" but as "brain disease."

 

[splik]

This brings back memory of Thomas Insel's TED talk on mental illness and his staunch opinion that psychiatric disorder should NOT be viewed as "behavioral disease" but as "brain disease."

yuck. i don't know which is worse. both are reductionistic, but the latter is just plain dishonest. mental illnesses with the exception of the dementias, are not brain diseases, they are not diseases at all.

 

[slappy]

yuck. i don't know which is worse. both are reductionistic, but the latter is just plain dishonest. mental illnesses with the exception of the dementias, are not brain diseases, they are not diseases at all.

More and more studies show functional changes in the brain with a lot of mental illnesses. We are most likely limited only by our ability to "see" the structural changes. Regardless, even functional derangement of brain cells [that modulate the chemical transmitters] would qualify them as diseases since the scientific definition of the term is "a derangement in the structure or function of cells, tissues and organs".

 

[splik]

More and more studies show functional changes in the brain with a lot of mental illnesses. We are most likely limited only by our ability to "see" the structural changes. Regardless, even functional derangement of brain cells [that modulate the chemical transmitters] would qualify them as diseases since the scientific definition of the term is "a derangement in the structure or function of cells, tissues and organs".

Most functional neuroimaging studies have very small sample sizes, and don't have the power for us to pay much heed to an association, let alone make causal inferences, most findings are not consistently replicated, no findings are diagnosis specific, and the methodologies for both structural and functional neuroimaging studies are rather arbitrary and try and make something out of small differences the significance of which is unknown. In psychiatric genetic studies, the associations tend to be transdiagnostic and thus do not support the existence of our current mental disorders as diseases, and with exception of the older candidate gene studies and some of the GWAS studies, most studies fail to explore functionality of particularly SNPs or CNVs associated with psychopathology again making it hard to make sense of the biological plausibility of these associations.

Although the NIMH is moving away from DSM-based diagnoses to RDoC, it is laughable that for long people have assumed that diagnoses like 'schizophrenia', 'bipolar disorder' and 'depression' represent 'diseases' that are natural kinds and for which biomarkers can be found for. Psychiatric diagnoses require functional impairment or significant distress and thus are socially constructed and determined more by social and psychological factors that have nothing to do with underlying biology of the phenomena. Whether someone is significantly impaired or distressed by, say auditory hallucinations, which is what we require in order to say this is part of an illness, has little to do with neurobiology of auditory hallucinations themselves.

I am not disputing that psychiatry will not at some point progress to a phase where there are identifiable 'diseases' (though I am not sure how necessary or desirable this actually is), but I am disputing that our current concepts of mental disorder equate in any way, shape or form, to 'diseases' - of the brain or otherwise.

 

[SteinUmStein]

Your statement was originally "mental illnesses with the exception of the dementias, are not brain diseases, they are not diseases at all." It was not "our current diagnostic framework as codified in the DSM does not represent discrete, identifiable, biomarkable diseases." Those are very very different statements. The other poster was responding to the first statement, not the second.

 

[jettavr6]

Mental Health, behavioral health, behavioral neurological health --- There is such a strong stigma attached to our field. Unfortunately, there are so many people in need of our services who just will not step in to a clinic when the words "mental health" are on the front door. Most of us would agree, myself included, that mental health center is perfectly acceptable - but that doesn't go far if patients and their families think differently. Personally, I don't like the term "behavioral health" but I don't have a better suggestion... would love to hear others thoughts.

 

[whopper]

I've seen institutions change names in a relatively innocent attempt to merely create a new paradigm within it's workforce or customer base. Kind of like how a company changes their slogan every few years. This might simply be a case of that.

 

[tishage]

Mental Health, behavioral health, behavioral neurological health --- There is such a strong stigma attached to our field. Unfortunately, there are so many people in need of our services who just will not step in to a clinic when the words "mental health" are on the front door. Most of us would agree, myself included, that mental health center is perfectly acceptable - but that doesn't go far if patients and their families think differently. Personally, I don't like the term "behavioral health" but I don't have a better suggestion... would love to hear others thoughts.

I think that some ppl do not seek treatment bc of stigma, but that a significant amt of ppl with more serious mental illness don't seek treatment bc of anosognosia, which is a whole other issue. Regardless, changing terms for what are ultimately the same services will do little to address stigma & get someone to come in the door, & seems like a superficial approach to what is a much more complex issue. The fact that the clinic 2 blocks from someone's house is now called a BH clinic as opposed to a MH clinic will not cause that person who's concerned about stigma to now go to that clinic, IMO. What will truly address stigma is ppl openly talking about their struggles & successes with mental illness, installing a nuanced rather than black & white view of mental illness, & engaging with media & other avenues of popular culture (ie: film, etc) so that it's engrained in everyday life the same way that cancer & other previously stigmatized conditions now are

 

[slappy]

Most functional neuroimaging studies have very small sample sizes, and don't have the power for us to pay much heed to an association, let alone make causal inferences, most findings are not consistently replicated, no findings are diagnosis specific, and the methodologies for both structural and functional neuroimaging studies are rather arbitrary and try and make something out of small differences the significance of which is unknown. In psychiatric genetic studies, the associations tend to be transdiagnostic and thus do not support the existence of our current mental disorders as diseases, and with exception of the older candidate gene studies and some of the GWAS studies, most studies fail to explore functionality of particularly SNPs or CNVs associated with psychopathology again making it hard to make sense of the biological plausibility of these associations.

Although the NIMH is moving away from DSM-based diagnoses to RDoC, it is laughable that for long people have assumed that diagnoses like 'schizophrenia', 'bipolar disorder' and 'depression' represent 'diseases' that are natural kinds and for which biomarkers can be found for. Psychiatric diagnoses require functional impairment or significant distress and thus are socially constructed and determined more by social and psychological factors that have nothing to do with underlying biology of the phenomena. Whether someone is significantly impaired or distressed by, say auditory hallucinations, which is what we require in order to say this is part of an illness, has little to do with neurobiology of auditory hallucinations themselves.

I am not disputing that psychiatry will not at some point progress to a phase where there are identifiable 'diseases' (though I am not sure how necessary or desirable this actually is), but I am disputing that our current concepts of mental disorder equate in any way, shape or form, to 'diseases' - of the brain or otherwise.

I agree that the functional neuroimaging studies usually have small sample sizes. But that is why we have meta analyses to improve the power. Here's one that does this in a somewhat indirect way: Messina I, Sambin M, Palmieri A, Viviani R (2013) Neural Correlates of Psychotherapy in Anxiety and Depression: A Meta-Analysis. PLoS ONE 8(9): e74657. doi:10.1371/journal.pone.0074657. There are others as well, and we are certainly not at a stage where we can make causal inferences, but the very existence of the functional changes in disease states prove that they are, in fact, diseases. I'm with you on the genetic studies though - I'm yet to be impressed.

 

[michaelrack]

Mental Health, behavioral health, behavioral neurological health --- There is such a strong stigma attached to our field. Unfortunately, there are so many people in need of our services who just will not step in to a clinic when the words "mental health" are on the front door. Most of us would agree, myself included, that mental health center is perfectly acceptable - but that doesn't go far if patients and their families think differently. Personally, I don't like the term "behavioral health" but I don't have a better suggestion... would love to hear others thoughts.

I was a resident at a "Dept of Psychiatry and Behavioral Medicine"; some members of the public felt that this title meant that we used medicine to control behavior.

 

[OldPsychDoc]

I was a resident at a "Dept of Psychiatry and Behavioral Medicine"; some members of the public felt that this title meant that we used medicine to control behavior.

And we don't?

 

[DermViser]

Have you been seeing this shift. XYZ Community Mental Health Center is changing it's name to XYZ Behavioral Health. But there is absolutely nothing different about the services being provided. I've seen this at several different clinics over the last 5 years. From what I can tell it's just branding. Maybe the name "mental health" center is stigmatizing. But I think "behavioral health" is extremely inaccurate.

Anything that lessens the stigma is a GOOD thing.

 

[johnhoedack]

I agree that the functional neuroimaging studies usually have small sample sizes. But that is why we have meta analyses to improve the power. Here's one that does this in a somewhat indirect way: Messina I, Sambin M, Palmieri A, Viviani R (2013) Neural Correlates of Psychotherapy in Anxiety and Depression: A Meta-Analysis. PLoS ONE 8(9): e74657. doi:10.1371/journal.pone.0074657. There are others as well, and we are certainly not at a stage where we can make causal inferences, but the very existence of the functional changes in disease states prove that they are, in fact, diseases. I'm with you on the genetic studies though - I'm yet to be impressed.

Most meta-analyses are garbage from the start. This is especially true when trying to establish a correlation like brain size to mental illness. The reason it is garbage is that studies that do show some sort of correlation get published and those that don't never see the light of day. Then when you go and collect all the papers that discuss it you have a profound ignorance of the studies that show no correlation and thus your positive meta analysis is junk.

 

[slappy]

Most meta-analyses are garbage from the start. This is especially true when trying to establish a correlation like brain size to mental illness. The reason it is garbage is that studies that do show some sort of correlation get published and those that don't never see the light of day. Then when you go and collect all the papers that discuss it you have a profound ignorance of the studies that show no correlation and thus your positive meta analysis is junk.

Of course publication bias exists in all scientific fields. There is nothing we can do about it apart from getting more and more grant agencies to stipulate publication no matter the result. And if we think publication bias makes collation of mostly positive studies "garbage", then we would literally have nothing to go by. Most of these studies also use funnel plots to quantify such biases. There is a reason why systematic reviews and meta analyses are considered the highest forms of evidence.

 

[nancysinatra]

It's not just stigma that keeps people from seeking help for their problems. There's often denial as well. It isn't unique to mental health either - people exhibit denial regarding all kinds of medical problems.

Americans are very PC. Terms change every day if some bureaucrat thinks they sound "nicer."

 

[Jorje286]

Psychiatric diagnoses require functional impairment or significant distress and thus are socially constructed and determined more by social and psychological factors that have nothing to do with underlying biology of the phenomena.

That's a definitely a "limitation" in psychiatry in that diagnoses are still largely built on the chief complaint and presenting signs and symptoms rather than underlying etiology. However, not long ago that used to be the case in many other medical fields, and it was precisely basic science that enabled us to define diseases in terms such as, say appendicitis rather than right lower quadrant pain, or MI rather than chest pain. And it's probably going to be basic science that will enable us to define mental illness in terms of etiology, but the brain is the hardest organ to crack and psychiatry was basically defined as the brain-related field that doesn't deal with readily seen changes in structure. fMRI and other brain sciences are certainly a step in the right direction. It's all in the brain ultimately, and that doesn't negate the influence of environment and psychological dynamics, cause they will leave their imprint on the brain.

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Anyways, I do think "mental" carries unnecessary stigma and has zero scientific validity. Personally I look at psychiatrists as experts in thought and behavioral disorders; that's probably the best approximation but too long.

 

[erg923]

some members of the public felt that this title meant that we used medicine to control behavior.

is that not correct?

 

[MacDonaldTriad]

yuck. i don't know which is worse. both are reductionistic, but the latter is just plain dishonest. mental illnesses with the exception of the dementias, are not brain diseases, they are not diseases at all.

20 years ago, during the new DSM-IV launch, we were told that the term “organic” in DSM-III-R was being replaced by “due to…” because all mental illness had an organic basis in origin” even if we were not smart enough yet to know what that was. “Even personality disorders are beginning to find physiological etiology.”

Of course 20 years later I haven’t seen any personality disorders become any less symptomatically defined. There was a fear that if we have “organic mood disorders”, or “organic psychotic disorders”, this would infer that other mood and psychotic disorders where “functional”.

I think we can all have our own beliefs about how “organic” mental illnesses are, but if we are too extreme on the anti-organic band wagon, then psychiatry is just a bunch of poorly trained want to be psychologists. Our patients would be much better off seeing psychologists if you believe this.

 

[erg923]

20 years ago, during the new DSM-IV launch, we were told that the term “organic” in DSM-III-R was being replaced by “due to…” because all mental illness had an organic basis in origin” even if we were not smart enough yet to know what that was. “Even personality disorders are beginning to find physiological etiology.”

Of course 20 years later I haven’t seen any personality disorders become any less symptomatically defined. There was a fear that if we have “organic mood disorders”, or “organic psychotic disorders”, this would infer that other mood and psychotic disorders where “functional”.

I think we can all have our own beliefs about how “organic” mental illnesses are, but if we are too extreme on the anti-organic band wagon, then psychiatry is just a bunch of poorly trained want to be psychologists. Our patients would be much better off seeing psychologists if you believe this.

What about being psychologist=dimissing role of the brain in producing behavior. This makes no sense.

 

[MacDonaldTriad]

I don’t mean to imply that psychologists don’t recognize the organic basis of behavior. Their cognitive, behavioral, and insight oriented interventions have been shown to have caused physiologically measurable changes in the brain. I’m simply saying that if we abandon the disease model, our interventions wouldn’t be any different than those of our psychology counterparts.

Of course, the truth is that our medications can do things no other treatments can do, and meds fail to do so much, both camps will always be needed.

 

[Jorje286]

I think we can all have our own beliefs about how “organic” mental illnesses are, but if we are too extreme on the anti-organic band wagon, then psychiatry is just a bunch of poorly trained want to be psychologists. Our patients would be much better off seeing psychologists if you believe this.

I think the dichotomy is harmful to the discipline and of course under it lies an acceptance of dualism. Just because one can believe in an "organic" basis of mental illness does not mean they will treat their patients with any less empathy or psychological understanding. The therapeutic effect of empathy as well as psychodynamic theories have their own "organic" bases. These two formulations are NOT mutually exclusive and it's this sort of misunderstanding that dualists have. And just because there are plenty of holes in the "organic" formulation of the mind does not mean it's defunct; it's like creationists arguing that evolution is wrong because we haven't figured out every step in the evolutionary process. Of course opinions run strong on this subject for very good reasons, and that's one of the reasons why psychiatry is such an exciting field.

 

[smalltownpsych]

The changing of the names also relates to a phenomenon I have seen described as a euphemism treadmill. A great example is seen in terms to describe individuals with global deficits in cognitive functioning. Terms such as idiot, imbecile, and *****, became mental ******ation, then developmental disability, then intellectual disability. The word starts off as neutral, but the construct underlying it is negative and then the term evolves into a pejorative. Changing terms will not change stigma and it is a complicated issue. I have patients that make other patients in the waiting room very uncomfortable because of odd behavior, poor hygiene and self-care, or even just significant socio-economic differentials. If my practice was in a bigger city, we could keep them more separate, I guess. Not thinking that would be much better.

 

[heyjack70]

is that not correct?

I don't think so. We may influence thoughts or emotions, but we don't directly cause behavior. Ultimately it's the patient deciding to do whatever they're going to do.

 

[erg923]

I don't think so. We may influence thoughts or emotions, but we don't directly cause behavior. Ultimately it's the patient deciding to do whatever they're going to do.

Uh, right. im not buyin it...

 

[nancysinatra]

I don't think so. We may influence thoughts or emotions, but we don't directly cause behavior. Ultimately it's the patient deciding to do whatever they're going to do.

Including involuntary admission?

 

[heyjack70]

Uh, right. im not buyin it...

...well, if you're not buying it that's good enough for me


...

 

[heyjack70]

Including involuntary admission?

Involuntary admission is a very narrow instance of when mental health treatment restricts freedom. I'd argue this is not controlling behavior. You might say behavior is controlled with involuntary medications used to emergently tranquilize someone, but I hope we all agree is not the thrust of community mental health treatment.

 

[erg923]

...well, if you're not buying it that's good enough for me


...

Wait, I think I'm confused, are you saying using psychotropics as an agent of/for behavior change is a bad thing? It seems like your are trying real hard to distance yourself from this notion, although Im not sure why.

Short-term psychotherapy is essentially, behavior modification via (or in addition to) processing of emotional/psychological problems, no? Behavior (and behavioral change) is part of the very definition of my field. I am in no way afraid to admit that behavior change is exactly what I strive do. I would hope our goals are the same, even though we use different agents to do so. What's with the your reluctance to admit the obvious?

When you Rx medication for your bipolar patient, what exactly do you think you are trying to modify, ultimately? Suboxone? Naltrexone/Antabuse? Stat orders of Haldol and Ativan? I could go on...

 

[smalltownpsych]

I'm thinking the confusion has to do with the word "control". As often is the case, arguing about two different constructs. Control is an absolute term so relatively easy to dispute.

 

[Therapist4Chnge]

I feel like I'm back in undergrad Philosophy 101….

 

[erg923]

con·trol

verb (used with object), con·trolled, con·trol·ling.
1. to exercise restraint or direction over; dominate; command.
2. to hold in check; curb: to control a horse; to control one's emotions

 

[heyjack70]

Wait, I think I'm confused, are you saying using psychotropics as an agent of/for behavior change is a bad thing? It seems like your are trying real hard to distance yourself from this notion, although Im not sure why.

Short-term psychotherapy is essentially, behavior modification via (or in addition to) processing of emotional/psychological problems, no? Behavior (and behavioral change) is part of the very definition of my field. I am in no way afraid to admit that behavior change is exactly what I strive do. I would hope our goals are the same, even though we use different agents to do so. What's with the your reluctance to admit the obvious?

When you Rx medication for your bipolar patient, what exactly do you think you are trying to modify, ultimately? Suboxone? Naltrexone/Antabuse? Stat orders of Haldol and Ativan? I could go on...

My problem with the behavioral health naming is that people don't have "behavioral" illness. They most definitely have mental illness that can affect their behavior. I'm working on the mental. Even in behavioral therapy we're working on the person's mind/brain to implement behavioral change strategies with the ultimate goal of affecting the mental (depression, anxiety, etc). The person's mind/brain drives their behavior, not me. "Behavioral health" makes me think of controlling people's actions, which is absolutely not correct.

Stepping back, we could argue that all doctors' affect behavior ultimately. For example, a cardiologist is a heart doctor. When he puts in a stent he is allowing someone to run a marathon...boom...behavioral health. An internist pulls fluid off a heart failure patient, now their feet aren't edematous to the point of immobility--> the person can now walk...a behavior. A psychiatrist/psychologist treats a person's depression, now the person has the energy to go to work-->behavior. A psychiatrist prescribes an antipsychotic and the patient's delusions of persecution and hallucinations improve, they stop yelling at people on the subway-->behavior. A surgeon removes through cancer and the patient stops coughing-->behavior.

So calling mental health 'behavioral health' is either extremely vague to the point of being meaningless, or it's implying that we are able to actually control a person's behavior.

 

[erg923]

Ok, but none of this really had anything to do with "Behavioral Health Centers issue (I dont really care what you call it).... it was whether we are controling human behavior with psychotropic medications. The answer is a big fat YES, and I'm not sure anyone needs to feel too bad about admitting it.

Look, all of what you said is fine and dandy (little idealistic for inpatient work, but whatev...) so long as one isn't deluding themselves into thinking that they aren't prescribing to modify behaviors as well. Sometime its emotions, but, yes, sometimes its just behavior(s). Look at thee criteria for Bipolar Disorder and tell me how many of those criteria you are trying to control (read as modify/restrain/reduce)? Now, how many of those are behaviors (as opposed to internal "feelings"), or at least behaviorally defined? About half of them.

 

[nancysinatra]

Involuntary admission is a very narrow instance of when mental health treatment restricts freedom. I'd argue this is not controlling behavior. You might say behavior is controlled with involuntary medications used to emergently tranquilize someone, but I hope we all agree is not the thrust of community mental health treatment.

Restraints? Seclusion?

I guess I am jaded - I think a lot of what goes on with psychotropics and other mental health treatments often amounts to glorified sedation. I did my residency at a place with a lot of malingerers with antisocial traits, not to mention drug seekers, and those people got "emergency tranquilized" just as often as anyone else. The following scenario you describe seems to me to be an idealized rarity:

A psychiatrist prescribes an antipsychotic and the patient's delusions of persecution and hallucinations improve, they stop yelling at people on the subway-->behavior..

 

[heyjack70]

I think all that is fine so long as one isn't deluding themselves into thinking that they aren't prescribing to modify behaviors as well. Sometime its emotions, but, yes, sometimes its just behavior(s). Look at thee criteria for Bipolar Disorder and tell me how many of those criteria you are trying to control (read as modify/restrain/reduce)? Now, how many of those are behaviors (as opposed to internal "feelings"), or at least behaviorally defined? About half of them.

I agree the symptom criteria you mention are outward manifestations of what is happening in the person's brain.

 

[erg923]

I agree the symptom criteria you mention are outward manifestations of what is happening in the person's brain.

So, basically, "behaviors." lol Behaviors we hope dont happen as much if they take that little pill, perhaps?

 

[heyjack70]

Restraints? Seclusion?

I guess I am jaded - I think a lot of what goes on with psychotropics and other mental health treatments often amounts to glorified sedation. I did my residency at a place with a lot of malingerers with antisocial traits, not to mention drug seekers, and those people got "emergency tranquilized" just as often as anyone else. The following scenario you describe seems to me to be an idealized rarity:

Working in a forensic competency restoration unit I've seen many more examples of clear schizophrenia than I ever saw in a psych ED or acute inpatient. By the time they get sent for restoration they've usually been incarcerated for at least a couple of months, which means whatever drugs they were using have washed out. You also have nurse's eyes on people every day for weeks or months, so the malingerers get spotted. You certainly also have a lot of antisocial patient's coming through, and many patients have both schizophrenia and antisocial, but you also get to watch as the medications work on delusions and hallucinations often over the course of several months, as opposed to a 10 days acute psych admission.

 

[heyjack70]

So, basically, "behaviors." lol Behaviors we hope dont happen as much if they take that little pill, perhaps?

Yes, the brain causes behavior. And we treat people with medications that work on their brain. Calling it behavioral health excludes the brain (emotions and thoughts), which I think is the most important part. Mental Health, including emotions and thoughts, which ultimately drive behavior, is the better descriptor IMO.

 

[bashir]

The ascendance of the term "behavioral health" has never bothered me much, as I saw it is as part of the inevitable "euphemism treadmill" referenced by smalltownpsych, without considering what the term implies. However, this exchange between heyjack and erg has put me firmly into the anti-"behavioral health" camp.

Ultimately the successful treatment of mental illness will have huge effects on patients' behavior, but as erg points out, that is not the direct target of the interventions of psychiatrists OR psychologists. One could argue that this is a distinction without a difference but I have to disagree. Indefinitely institutionalizing someone with paranoid delusions so that they are unable to act on them is treating their behaviors, but thankfully that is no longer a mainstay of mental health treatment, but rather a last resort for when modern psychiatry fails a patient. Medications and therapy both work at the level of the thoughts and emotions that drive behavior, with infinitely better results for patients than controlling behavior directly (like the bad old days).

 

[smalltownpsych]

Another perspective is that the behaviors impact the mental state. Engagement in pleasurable activity has been demonstrated to affect mood as much as medication treatments for depression, and this can lead to long-term behavioral change. That is to say they might continue the activity because they do enjoy it and this leads to better long-term outcomes.

Another way to look at it is. If I don't see a change in behavior, in other words, a measurable outcome, then have I really helped the patient? There may be exceptions to this, but my experience has shown that change in behavior = good outcome.

 

[erg923]

Medications and therapy both work at the level of the thoughts and emotions that drive behavior, with infinitely better results for patients than controlling behavior directly (like the bad old days).

Thats really not universally true at all. Example, behavioral activation for depression and the explanatory model underlying it. What does it tell us?

 

[nancysinatra]

The ascendance of the term "behavioral health" has never bothered me much, as I saw it is as part of the inevitable "euphemism treadmill" referenced by smalltownpsych, without considering what the term implies. However, this exchange between heyjack and erg has put me firmly into the anti-"behavioral health" camp.

Ultimately the successful treatment of mental illness will have huge effects on patients' behavior, but as erg points out, that is not the direct target of the interventions of psychiatrists OR psychologists. One could argue that this is a distinction without a difference but I have to disagree. Indefinitely institutionalizing someone with paranoid delusions so that they are unable to act on them is treating their behaviors, but thankfully that is no longer a mainstay of mental health treatment, but rather a last resort for when modern psychiatry fails a patient. Medications and therapy both work at the level of the thoughts and emotions that drive behavior, with infinitely better results for patients than controlling behavior directly (like the bad old days).

I thought the jails were our last resort for the mentally ill. That's what I read in the newspapers.

 

[erg923]

Yes, the brain causes behavior. And we treat people with medications that work on their brain. Calling it behavioral health excludes the brain (emotions and thoughts), which I think is the most important part. Mental Health, including emotions and thoughts, which ultimately drive behavior, is the better descriptor IMO.

I would venture to say that there is much more operant behavior going on within psychiatric disturbances than you are admitting to here. That is, not everything we treat (ie., symptoms) is due to, or a part of, the mental illness. Some of it is, purely, operant. Thus, "behavioral health." But yes, of course that behavior orginated from the brain. No one is obviously going to dispute that.

 

[bashir]

I thought the jails were our last resort for the mentally ill. That's what I read in the newspapers.

Well yes, incarceration has become a shamefully common method of institutionalizing people with mental illness in this country since the closing of state mental hospitals, but that's another discussion.

 

[nancysinatra]

Working in a forensic competency restoration unit I've seen many more examples of clear schizophrenia than I ever saw in a psych ED or acute inpatient. By the time they get sent for restoration they've usually been incarcerated for at least a couple of months, which means whatever drugs they were using have washed out. You also have nurse's eyes on people every day for weeks or months, so the malingerers get spotted. You certainly also have a lot of antisocial patient's coming through, and many patients have both schizophrenia and antisocial, but you also get to watch as the medications work on delusions and hallucinations often over the course of several months, as opposed to a 10 days acute psych admission.

Just an aside - how often are you able to correctly diagnose ASPD and schizophrenia in the same patient? The criteria for ASPD state "the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode." I would think if you succesfully treat the psychosis, then the patient will have been "restored to competence" (i.e. they can reason about their legal case in a non-psychotic fashion). Then it is time for them to face their charge, correct? Do you evaluate them for ASPD then? It seems to me it might be hard to do an unbiased ASPD evaluation for someone who has a pending legal charge. A lot depends on their plea, and the outcome of the case. (I.e. if someone's charged with murder, but pleads innocent, you shouldn't just slap on an ASPD diagnosis no matter how unremorseful, etc, they seem, until at least a jury has weighed in on it.) And it might be hard to evaluate past symptoms and behavior because you can't be sure if they were psychotic at times in the past where they engaged in antisocial-seeming behavior.

In any case a competency restoration unit is a quite specialized setting. Must be very interesting to work there.

 

[nancysinatra]

Well yes, incarceration has become a shamefully common method of institutionalizing people with mental illness in this country since the closing of state mental hospitals, but that's another discussion.

Well, you mentioned the "bad old days" above, so I wondered what about the current days is "better." Most mental illness is "treated" in jails now, isn't it? It's not "shameful" because society doesn't seem very ashamed, and it's not just "common" - it's actually the norm now, at least in some places.