Socialist nightmare - "Thousands of suicidal children turned away by over-stretched NHS clinics"

[cbrons]

http://www.independent.co.uk/news/u...e-report-childrens-commissioner-a7053576.html

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[splik]

I presume your title was somehow meant to be derogatory. Britain does not have a socialist government - this is the result of a conservative government that believes in the 3 tenets of neoliberalism (austerity, deregulation, privatization) and hates the fact there was a national health service and is doing their best to destroy it. even so, children with mental illness are much better off in the UK than they are in the US - you must know how limited child psych services are in the US - chidren sometimes board for weeks or even months in emergency rooms. Also the state of child psychiatry in this country has been a disgrace to the profession with fads such as pediatric bipolar disorder and the liberal use of polypharmacy and antipsychotics in very young children. I haven't heard of 2 years old being diagnosed with bipolar disorder outside the US.

 

[Seattle Mariners Fan]

I presume your title was somehow meant to be derogatory. Britain does not have a socialist government - this is the result of a conservative government that believes in the 3 tenets of neoliberalism (austerity, deregulation, privatization) and hates the fact there was a national health service and is doing their best to destroy it. even so, children with mental illness are much better off in the UK than they are in the US - you must know how limited child psych services are in the US - chidren sometimes board for weeks or even months in emergency rooms. Also the state of child psychiatry in this country has been a disgrace to the profession with fads such as pediatric bipolar disorder and the liberal use of polypharmacy and antipsychotics in very young children. I haven't heard of 2 years old being diagnosed with bipolar disorder outside the US.

Well that 3 year old did throw two temper tantrums and was then laughing and talking about how he's king of sandbox two hours later. Sounds like it time for some meds to me

Bottom line is that both US and European systems are radically underproducing qualified health care professionals, and have been so for decades. Regardless of whether you have a market system, a mixed system, or a controlled system, that's going to generate problems. Meanwhile we have the obesity epidemic and a rising median age of population, along with declining family and social cohesion leading to spikes in psychiatric illnesses.

Shortages in Europe are being managed with lines and underperforming services, and in the USA we are managing shortages by making access to health care cost-prohibitive for normal people. I'm not sure which is worse.

 

[cbrons]

I presume your title was somehow meant to be derogatory. Britain does not have a socialist government - this is the result of a conservative government that believes in the 3 tenets of neoliberalism (austerity, deregulation, privatization) and hates the fact there was a national health service and is doing their best to destroy it. even so, children with mental illness are much better off in the UK than they are in the US - you must know how limited child psych services are in the US - chidren sometimes board for weeks or even months in emergency rooms. Also the state of child psychiatry in this country has been a disgrace to the profession with fads such as pediatric bipolar disorder and the liberal use of polypharmacy and antipsychotics in very young children. I haven't heard of 2 years old being diagnosed with bipolar disorder outside the US.

Well yes the title was meant to be derogatory and hyperbole.

But I mean come on, you've really seen a 2 year old diagnosed with bipolar disorder? Surely you are exaggerating

 

[splik]

look up the case of Rebecca Riley which sadly was not exceptional. the pedi bp fad is mostly over now but you see DMDD and such diagnoses and in my 6 months doing child psych as a resident I saw kids on 8 or 9 psychotropic drugs including multiple antipsychotics and they had often been on psychoactive drugs from 2 or 3. (these we're very disturbed children who had all been violent/homicidal/fire setting etc)

 

[notdeadyet]

The article said that 28% of children in the UK referred to psychiatric services were unable to get it..

I wish I could successfully refer 72% of children with psychopathology into treatment here in the US. That would be awesome!

 

[lymphocyte]

I presume your title was somehow meant to be derogatory. Britain does not have a socialist government - this is the result of a conservative government that believes in the 3 tenets of neoliberalism (austerity, deregulation, privatization) and hates the fact there was a national health service and is doing their best to destroy it. even so, children with mental illness are much better off in the UK than they are in the US - you must know how limited child psych services are in the US - chidren sometimes board for weeks or even months in emergency rooms. Also the state of child psychiatry in this country has been a disgrace to the profession with fads such as pediatric bipolar disorder and the liberal use of polypharmacy and antipsychotics in very young children. I haven't heard of 2 years old being diagnosed with bipolar disorder outside the US.

So much yes.

Just consider the use of psychotropic medication as de facto behavioural control in foster children as young as 2 or 3. The Inspector General report is damning, and I strongly suspect this practice isn't limited to California.

http://www.npr.org/sections/health-...top-misuse-of-psychiatric-meds-in-foster-care

And then there are the social and physical determinents of mental health (early and chronic stressors, social exclusion, medical comorbidities). These are much better looked after in the integrated, socially-minded, and cost-conscious NHS (which, by the way, is wildly popular in the UK, contrary to what some would have you believe).

I'd much rather be a poor kid with psychopathology in the UK than the US. And, by the way, if you ain't poor, you can just jump the queue and see a private doctor. So, we're talking about 28% of mostly poor children getting referrals turned away. How many poor children get referrals turned away in the US?

Sure there's room for improvement, but it's not news if things are going generally okay.

 

[SmallBird]

look up the case of Rebecca Riley which sadly was not exceptional. the pedi bp fad is mostly over now but you see DMDD and such diagnoses and in my 6 months doing child psych as a resident I saw kids on 8 or 9 psychotropic drugs including multiple antipsychotics and they had often been on psychoactive drugs from 2 or 3. (these we're very disturbed children who had all been violent/homicidal/fire setting etc)

I hope you are correct about the pedi BP fad but sadly this is still something we see a ton of... people continue to be able to get these insane evals up in Boston and arrive on our unit with four different diagnosis and at least as many medications. It is really very disturbing and I am not sure how the practice is being sustained.

 

[Dr. Mr. T]

Clearly needs to be medicated under our current system.

 

[Ceke2002]

So much yes.

Just consider the use of psychotropic medication as de facto behavioural control in foster children as young as 2 or 3. The Inspector General report is damning, and I strongly suspect this practice isn't limited to California.

http://www.npr.org/sections/health-...top-misuse-of-psychiatric-meds-in-foster-care

And then there are the social and physical determinents of mental health (early and chronic stressors, social exclusion, medical comorbidities). These are much better looked after in the integrated, socially-minded, and cost-conscious NHS (which, by the way, is wildly popular in the UK, contrary to what some would have you believe).

I'd much rather be a poor kid with psychopathology in the UK than the US. And, by the way, if you ain't poor, you can just jump the queue and see a private doctor. So, we're talking about 28% of mostly poor children getting referrals turned away. How many poor children get referrals turned away in the US?

Sure there's room for improvement, but it's not news if things are going generally okay.

In Australia our two party system consists of the Liberal National Party (usually just referred to as 'the Liberals') and the Labor Party - the Liberals are conservative, right wing (and determined to dismantle Australia's universal healthcare system nearly every damn time they get into office), the Labor Party are centre left, and whilst they have moved away from their democratic socialist roots over the years do still identify as a democratic socialist party in their party's charter or constitution (they are also the party that implemented universal healthcare in Australia in the first place).

Our mental health care system has never been fantastic, but it always gets worse under a Liberal government. The Liberals talk a good game, you don't really hear words like 'funding cuts' from them when it comes to mental health, instead it's always talk of 'efficiency', and 'streamlining services' and 'patient outcomes', which in the real world translates to something like "we're still not actually cutting funding, but a patient has a limited amount of time to be declared better or else we'll send in a bunch of government suits to audit community psychiatry records, and then they'll tell the psychiatrists who they can still treat and who they can't, not that it's about funding cuts of course, you understand (efficiency, streamlining, yay!)." I've been luckier than many needing mental healthcare under a Liberal government in that my Psychiatrist chose to bend the rules in order for me to even be treated at the community level in the first place (my other option was to wait an inordinate amount of time trying to find a private sector psychiatrist willing to bulk-bill under medicare, or pay a gap fee of around $60 a visit which I was completely unable to afford at the time), and then went into bat for me when his patient files were audited and they who hold the purse strings were trying to insist that myself, and several other patients still needing treatment, be discharged from the service immediately (he ended up transferring some of us to another clinic so he could continue working with us without a bunch of suits breathing down his neck). Had I not had a Doctor willing to do all that, I would be right royally screwed right now.

I also find it amusing as well how many people also seem to think that those of us who live under a universal healthcare system are either being subjected to this vision of third world conditions when it comes to healthcare, or that the Doctors who work within a universal healthcare system are somehow being held to ransom and if they had the choice they'd all flee the system en masse (neither of which are even remotely true).

Here, this is the average response of an Australian GP when medicare is threatened (this campaign is also being supported by the AMA).

RACGP President announcing a campaign against the Government's current attack on medicare.*



GP funded advert campaign to raise awareness of the current attack on medicare.





On top of that some GPs are also printing pro medicare messages onto patient's scripts, and both the Australian Medical Association and the RACGP have downloadable 'protest packs' available for Doctors to use. None of this exactly looks like Australian Doctors are desperate to be set free from the burden of a universal healthcare system.

(*We are currently in the midst of an election campaign after a double dissolution of Parliament, so we can expect to see protests in support of medicare increasing up until the actual election takes place).

 

[birchswing]

In Australia our two party system consists of the Liberal National Party (usually just referred to as 'the Liberals') and the Labor Party - the Liberals are conservative, right wing (and determined to dismantle Australia's universal healthcare system nearly every damn time they get into office), the Labor Party are centre left, and whilst they have moved away from their democratic socialist roots over the years do still identify as a democratic socialist party in their party's charter or constitution (they are also the party that implemented universal healthcare in Australia in the first place).

Our mental health care system has never been fantastic, but it always gets worse under a Liberal government. The Liberals talk a good game, you don't really hear words like 'funding cuts' from them when it comes to mental health, instead it's always talk of 'efficiency', and 'streamlining services' and 'patient outcomes', which in the real world translates to something like "we're still not actually cutting funding, but a patient has a limited amount of time to be declared better or else we'll send in a bunch of government suits to audit community psychiatry records, and then they'll tell the psychiatrists who they can still treat and who they can't, not that it's about funding cuts of course, you understand (efficiency, streamlining, yay!)." I've been luckier than many needing mental healthcare under a Liberal government in that my Psychiatrist chose to bend the rules in order for me to even be treated at the community level in the first place (my other option was to wait an inordinate amount of time trying to find a private sector psychiatrist willing to bulk-bill under medicare, or pay a gap fee of around $60 a visit which I was completely unable to afford at the time), and then went into bat for me when his patient files were audited and they who hold the purse strings were trying to insist that myself, and several other patients still needing treatment, be discharged from the service immediately (he ended up transferring some of us to another clinic so he could continue working with us without a bunch of suits breathing down his neck). Had I not had a Doctor willing to do all that, I would be right royally screwed right now.

I also find it amusing as well how many people also seem to think that those of us who live under a universal healthcare system are either being subjected to this vision of third world conditions when it comes to healthcare, or that the Doctors who work within a universal healthcare system are somehow being held to ransom and if they had the choice they'd all flee the system en masse (neither of which are even remotely true).

Here, this is the average response of an Australian GP when medicare is threatened (this campaign is also being supported by the AMA).

RACGP President announcing a campaign against the Government's current attack on medicare.*



GP funded advert campaign to raise awareness of the current attack on medicare.





On top of that some GPs are also printing pro medicare messages onto patient's scripts, and both the Australian Medical Association and the RACGP have downloadable 'protest packs' available for Doctors to use. None of this exactly looks like Australian Doctors are desperate to be set free from the burden of a universal healthcare system.

(*We are currently in the midst of an election campaign after a double dissolution of Parliament, so we can expect to see protests in support of medicare increasing up until the actual election takes place).

At least your country has a coherent enough political system to know who is on what side of what issue. Under Obama (Democrat) we finally got healthcare reform, which is pretty much a plan that was originally proposed by Republican President Nixon in the 1970s and was implemented by 2012 Republican presidential candidate Mitt Romney in Massachusetts—and yet was opposed by every Republican representative (and which they've held ceremonial votes to dismantle constantly since it passed). The (originally Republican) plan Obama passed came to fruition by cooperating with private insurance companies because a public option (actual universal healthcare) was a non-starter. Now, the current Republican presidential candidate is steadfastly against ObamaCare and wants universal healthcare—but will occasionally say he never said that, but then will later say "we've got to take care of everyone" (universal healthcare?). Hillary Clinton (the Democratic candidate) supports ObamaCare. And her primary opponent, Bernie Sanders (an Independent senator who caucuses with Democrats), supports universal healthcare.

If we had a parliamentary system, we'd at least have someone like Paul Ryan as the next potential Republican executive head. I wouldn't agree with him, but he's smart and coherent.

I have no idea what Donald Trump or the Republican party even are. At first I thought he was pretending to be a racist to get elected. Now I'm sure he's an actual racist. And I still have no idea what he thinks about healthcare.

 

[Blitz2006]

I just came back from a 2 week vacation in Australia. Sydney, Melbourne. My best friend is Internal Medicine resident in Melbourne ("RMO").

Let me tell you, The Aussies have it figured out. 2 tiered health system (Public and Private), its the best of both worlds (USA + Canada). And doctors are not poor (Cardiologists make on average 300-400k my friend told me). So they may not be able to bill 18 million dollars like here -> http://www.nytimes.com/2015/01/30/b...s-to-unblock-blood-vessels-in-limbs.html?_r=0

But the average cardiologist in Oz is almost on par with the average cardiologist in the US. I used to think Canada had the best healthcare system in the world, but now I think Australia takes the cake. Oh, and nobody sues in Australia.

I worked in the NHS for 2 years as a junior doctor/resident, before coming here. Yes, Cameron and his crew are trying to disintegrate NHS, but overall if I was a 'poor patient', I still would prefer to be treated in the UK vs. US. Doctors, ranging from Psychiatrists to Surgeons, actually clinically examine the patients, and their top priority isn't billing/coding/reimbursing + they are not swamped with paperwork/begging insurance companies for authorization, etc.

 

[lymphocyte]

I just came back from a 2 week vacation in Australia. Sydney, Melbourne. My best friend is Internal Medicine resident in Melbourne ("RMO").

Let me tell you, The Aussies have it figured out. 2 tiered health system (Public and Private), its the best of both worlds (USA + Canada). And doctors are not poor (Cardiologists make on average 300-400k my friend told me). So they may not be able to bill 18 million dollars like here -> http://www.nytimes.com/2015/01/30/b...s-to-unblock-blood-vessels-in-limbs.html?_r=0

But the average cardiologist in Oz is almost on par with the average cardiologist in the US. I used to think Canada had the best healthcare system in the world, but now I think Australia takes the cake. Oh, and nobody sues in Australia.

I worked in the NHS for 2 years as a junior doctor/resident, before coming here. Yes, Cameron and his crew are trying to disintegrate NHS, but overall if I was a 'poor patient', I still would prefer to be treated in the UK vs. US. Doctors, ranging from Psychiatrists to Surgeons, actually clinically examine the patients, and their top priority isn't billing/coding/reimbursing + they are not swamped with paperwork/begging insurance companies for authorization, etc.

But one problem (from a JMO point of view) is how long it takes to get into specialty training... almost 8 years for some (that's to get into training). Median total time for psychiatry specialisation is 7, with 5 being the minimum.

GME is simply not a priority in Australia and, from what I've heard, the UK. (It's just not a money-maker in the public system--they want cheap SRMO drones or for everybody to be a GP.)

Also, Australia is actually the second most litigious country in the world per capita for mad mal... but it's a distant second.

 

[Blitz2006]

I don't know about that. My friend in Oz said that to be a cardiologist it takes 7 years. That's only 1 more year than the U.S. but I don't know much about Oz training.

The UK I am very familiar with. To be a psychiatrist in England is 8 years, 2 years of foundation and then 6 of core training. That's why I decided to come to the states.

And for residency I think U.S is the best place in the world for training, with regards to resources, etc.


Sent from my SM-N910V using Tapatalk

 

[lymphocyte]

I don't know about that. My friend in Oz said that to be a cardiologist it takes 7 years. That's only 1 more year than the U.S. but I don't know much about Oz training.

The UK I am very familiar with. To be a psychiatrist in England is 8 years, 2 years of foundation and then 6 of core training. That's why I decided to come to the states.

And for residency I think U.S is the best place in the world for training, with regards to resources, etc.

Sent from my SM-N910V using Tapatalk

That's... odd. 9 years minimum according to the Royal Australasian College of Physicians (and my BPT roommate): 1 year JMO, 2 years residency (essentially transitional years) - > 3 years BPT (essentially IM residency) -> 3 years cardiology. And that doesn't include the wasteland of "unaccredited SRMO" filled with people who do to get onto BPT right away, the 30% of people that fail their final BPT fellowship exams, and the substantial research/PhD you need to get onto Cardiology training. It's not pretty. This paper thoughtfully compares the US, Canadian, UK, and Australian training schemes: https://www.mja.com.au/journal/2012/196/8/does-it-take-too-long-become-doctor

Training in the US is unreal. I was shocked at the autonomy, resources, research, and commitment to teaching when I did my rotations there... And though the programme was well-regarded, it certainly wasn't considered "top-tier" (I'm assuming those are stratostrophic with educational/career development potential). And you manage to do it in 4 years! And it's also the least xenophobic country in terms of training. You seem to get a decently fair go if you have the merit.

Anyway, I apologise for hijacking the original thread.

 

[smalltownpsych]

We have a three tier system in the US. Some poor kids can get substandard inpatient treatment and some very wealthy kids can pay cash for much better inpatient treatment and the kids in the middle get a week or two at best. I am intentionally conflating inpatient and residential since much ofh the time a brief hospital stay is not really what's indicated with an inpatient referral for a kid. The brief stay is just to try a new medication and send the kid back to same exact environment. Just feeding into the "magic pill" hope that our society seems to believe in regarding mental health.

 

[WingedOx]

Just feeding into the "magic pill" hope that our society seems to believe in regarding mental health.

yup. It ain't just the kids/parents either.

"but what am I supposed to do when I feel bad?" says 55 y/o the woman abusing xanax...

 

[smalltownpsych]

yup. It ain't just the kids/parents either.

"but what am I supposed to do when I feel bad?" says 55 y/o the woman abusing xanax...

The addiction component is one aspect of it, but I'm talking more about the mistaken and often well-intentioned belief that there is a quick fix to help people who are really struggling. It is throughout our system and built right into it. Schools, hospitals, CMHs, public policy, etc. Even sending kids to me for once a week psychotherapy outside of their environment is an example of that because it is of extremely limited usefulness. Many of them need more, but there is very little to offer until they are so severe that we put them in short-term hospital stay as an aversive treatment.

 

[WingedOx]

The addiction component is one aspect of it, but I'm talking more about the mistaken and often well-intentioned belief that there is a quick fix to help people who are really struggling. It is throughout our system and built right into it. Schools, hospitals, CMHs, public policy, etc. Even sending kids to me for once a week psychotherapy outside of their environment is an example of that because it is of extremely limited usefulness. Many of them need more, but there is very little to offer until they are so severe that we put them in short-term hospital stay as an aversive treatment.

I live in Illinois. You don't gotta tell that to me twice. We've been hit HARD. I don't even do child and I've seen more than my share of "psychiatric lock outs". For kids, the long-term or residential services just flat out don't exist.

The expectations though that we as MH providers have a quick fix is excrutiating both on the policy and clinical sides. I get these post OEF-IEF kids coming into my office basically believing that I'm going to suddenly make everything all better in the first session. Not a huge surprise coming form rural kids who are coming from areas where MH services either aren't available or aren't talked about. So much of what I do is resetting expectations.

 

[vistaril]

The addiction component is one aspect of it, but I'm talking more about the mistaken and often well-intentioned belief that there is a quick fix to help people who are really struggling.

our system(at least from our end of things as psychiatrists and to some degree psychologists and lcsws as well with your codes) is built on that though. The model for care is ALWAYS going to fit a workable billing units system rather than quality of care and not the other way around. That working billing system has to be based on codes which are only workable based on volume, and because of that you get the current psychiatric care model(especially outpatient model).

I'm not saying this is right or wrong....I'm just saying it is what it is.

 

[calvnandhobbs68]

I presume your title was somehow meant to be derogatory. Britain does not have a socialist government - this is the result of a conservative government that believes in the 3 tenets of neoliberalism (austerity, deregulation, privatization) and hates the fact there was a national health service and is doing their best to destroy it. even so, children with mental illness are much better off in the UK than they are in the US - you must know how limited child psych services are in the US - chidren sometimes board for weeks or even months in emergency rooms. Also the state of child psychiatry in this country has been a disgrace to the profession with fads such as pediatric bipolar disorder and the liberal use of polypharmacy and antipsychotics in very young children. I haven't heard of 2 years old being diagnosed with bipolar disorder outside the US.

Absolutely. The state of child psychiatry in this awesome "private" medical system isn't something to hold your head up about. We've had kids sit on the floor for (not exaggerating) months while they wait for an inpatient psych unit bed.

 

[Shikima]

C&A psychiatry - Teaching parents how to be parents.

 

[WingedOx]

C&A psychiatry - Teaching parents how to be parents.

I've always described it as "the art of fixing broken families with Ritalin"

 

[Shikima]

I've always described it as "the art of fixing broken families with Ritalin"

le sigh.

 

[smalltownpsych]

our system(at least from our end of things as psychiatrists and to some degree psychologists and lcsws as well with your codes) is built on that though. The model for care is ALWAYS going to fit a workable billing units system rather than quality of care and not the other way around. That working billing system has to be based on codes which are only workable based on volume, and because of that you get the current psychiatric care model(especially outpatient model).

I'm not saying this is right or wrong....I'm just saying it is what it is.

Yep. That is why the wealthy would send their kids to our therapeutic boarding school and pay 7k a month after they had spent 25k for a 30 day therapuetic wilderness program. These families had spent years dealing with medication management and 45 minute outpatient therapy sessions to no avail. We achieved amazing results, but the level of service and the sophistication with which it was provided is far beyond the scope of what is typically available. The research is clear that to be effective you have to coordinate and integrate all aspects of at-risk kids' lives including environment, family, peers, academics, arts, physical and that was what we did.

 

[vistaril]

Yep. That is why the wealthy would send their kids to our therapeutic boarding school and pay 7k a month after they had spent 25k for a 30 day therapuetic wilderness program. These families had spent years dealing with medication management and 45 minute outpatient therapy sessions to no avail. We achieved amazing results, but the level of service and the sophistication with which it was provided is far beyond the scope of what is typically available. The research is clear that to be effective you have to coordinate and integrate all aspects of at-risk kids' lives including environment, family, peers, academics, arts, physical and that was what we did.

Yes, but I'd also like to point out that that level of service and sophistication and overall treatment SHOULD be beyond the scope of what is typically available for the non-wealthy who can't self pay at those rates.

 

[Blitz2006]

That's... odd. 9 years minimum according to the Royal Australasian College of Physicians (and my BPT roommate): 1 year JMO, 2 years residency (essentially transitional years) - > 3 years BPT (essentially IM residency) -> 3 years cardiology. And that doesn't include the wasteland of "unaccredited SRMO" filled with people who do to get onto BPT right away, the 30% of people that fail their final BPT fellowship exams, and the substantial research/PhD you need to get onto Cardiology training. It's not pretty. This paper thoughtfully compares the US, Canadian, UK, and Australian training schemes: https://www.mja.com.au/journal/2012/196/8/does-it-take-too-long-become-doctor

Training in the US is unreal. I was shocked at the autonomy, resources, research, and commitment to teaching when I did my rotations there... And though the programme was well-regarded, it certainly wasn't considered "top-tier" (I'm assuming those are stratostrophic with educational/career development potential). And you manage to do it in 4 years! And it's also the least xenophobic country in terms of training. You seem to get a decently fair go if you have the merit.

Anyway, I apologise for hijacking the original thread.

Maybe he is wrong about the 7 years, I dunno. That training system sounds a lot like the NHS/UK. Bottleneck and horrible.

But yeah, training in the U.S is great.

Plus the ability to sub-specialize in fields like Sleep, Pain, Neuropsych, etc. is pretty much only available in the U.S.

Another reason why I came to the States: to sub-specialize and become an expert in a field.

 

[SmallBird]

Maybe he is wrong about the 7 years, I dunno. That training system sounds a lot like the NHS/UK. Bottleneck and horrible.

But yeah, training in the U.S is great.

Plus the ability to sub-specialize in fields like Sleep, Pain, Neuropsych, etc. is pretty much only available in the U.S.

Another reason why I came to the States: to sub-specialize and become an expert in a field.

It might be cool to have a sub thread collating some of this- part of the appeal of coming to the US for residency was the expedited training - I'll be done with Child Fellowship at 29, and if I'd stayed in South Africa I would have been a first year resident at this point, in a 5 year residency that's followed by a 3 year fellowship. And I feel pretty confident I could do a good job there or here - although I'm not moving back, as I found a great job here

 

[smalltownpsych]

Yes, but I'd also like to point out that that level of service and sophistication and overall treatment SHOULD be beyond the scope of what is typically available for the non-wealthy who can't self pay at those rates.

It is a good philosophical and ethical question. Many in our society seem to think that all people should have access to all treatments regardless of expense. I am definitely not a socialist by any means, but I still find it difficult to say to an individual family that they can't afford what their kid really needs. These are usually the middle class type people I am talking about. The impoversished kids get caught up in the public system which is also pretty questionable.

 

[whopper]

People might get mad at me for saying this but I'm going to say it cause I believe it to be true.

A major source to the child mental health problems are the parents (or lack thereof). We psychiatrists don't have medications that fix children being born in a literal warzone, the child of several by a mother with all of her children by different fathers, and none of those fathers are helping in any way shape or form to raise the children. The mother herself is loaded with problems (drug abuse, borderline PD, anti-social PD), and what do you expect of these children?

One could argue these parents shouldn't have had a kid in the first place and while I agree it's already done. Then add to the problem that if you try to introduce birth control into these areas the Right hails you as a villian for being pro-death, and so will the Left calling you genocidal and racist or elitist.

Now of course this is not all children. Some children really do have bipolar disorder, some even have schizophrenia (though it is exceedingly rare in children). Those are the children where meds should be considered.

Of course the kids I mentioned in the "warzone" need help, but this is help that social services cannot in pretty much every circumstance give a solution that effectively replaces being raised by a caring family in a good environment or even comes close. The vast majority of people don't adopt children.

Now flip this problem from the "warzone" to the 1%. Rotten spoiled brat children whose parents didn't really raise them either. The kids never starved, wear designer clothes, have sports cars but also have parents that never were there for them either and a similar problem happens. These kids are going to become monsters and their parents expect us to fix it with a pill.

As for the NHS system vs the US both systems are good or terrible in different things.

 

[lymphocyte]

People might get mad at me for saying this but I'm going to say it cause I believe it to be true.

A major source to the child mental health problems are the parents (or lack thereof). We psychiatrists don't have medications that fix children being born in a literal warzone, the child of several by a mother with all of her children by different fathers, and none of those fathers are helping in any way shape or form to raise the children. The mother herself is loaded with problems (drug abuse, borderline PD, anti-social PD), and what do you expect of these children?

How is this controversial? My C&A Australian attending, in customary Australian fashion, called it "****ty Life Syndrome." Yeah, sometimes life really is ****, and no, medications really aren't going to help. That can be true at any age...

 

[lymphocyte]

It is a good philosophical and ethical question. Many in our society seem to think that all people should have access to all treatments regardless of expense. I am definitely not a socialist by any means, but I still find it difficult to say to an individual family that they can't afford what their kid really needs. These are usually the middle class type people I am talking about. The impoversished kids get caught up in the public system which is also pretty questionable.

Do more for the least off. Let the better off do more for themselves. Redistribute opportunity not mere wealth. That way, everybody gets a fair go (or as close as possible), regardless of where they start in life. Behind the "veil of ignorance," who wouldn't agree to those terms?

And no public patients in the NHS or the Australian system are clamouring for "all treatments regardless of expense." They generally listen to what doctors tell them, because doctors aren't incentivised to needlessly intervene and people know that. The baseline trust seems much higher anecdotally.

 

[Shikima]

It is a good philosophical and ethical question. Many in our society seem to think that all people should have access to all treatments regardless of expense. I am definitely not a socialist by any means, but I still find it difficult to say to an individual family that they can't afford what their kid really needs. These are usually the middle class type people I am talking about. The impoversished kids get caught up in the public system which is also pretty questionable.

Ultimately it comes down to money. No one wants to spend it - out of pocket, insurance companies nor government entities. Yet idealization with results is expected at all levels.

 

[FlowRate]

which, by the way, is wildly popular in the UK, contrary to what some would have you believe

None of the people I know who have personally experienced the NHS for an extended period of time would call it "wildly popular."

 

[splik]

None of the people I know who have personally experienced the NHS for an extended period of time would call it "wildly popular."

He's right - the NHS is very popular in the UK, especially amongst those who have "experienced it for an extended period of time". In reality the NHS doesn't actually exist as it used to (in England at least) where much of it has been privatized, and the secretary of state for health is no longer responsible for health services etc. It was actually quite financially solvent a few years ago but now it has been heavily underfunded. Regardless, what remains of the NHS provides healthcare free at the point of use including some of the best care in the world. You don't see the level of iatrogenesis, overinvestigation, overpriced poor quality care you see in the US. In the US, hospitals make more money the more iatrogenic complications they induce in their patients. There is no benzo or prescription opioid epidemic, in fact the first benzo withdrawal clinic in the world was in the NHS. Prescription drugs are much cheaper. Many innovations have come from people working in the NHS, which shows that it isn't just the private sector that creates this sort of thing.

The NHS doesn't cover everything (and nor should it, but neither does private health insurance), and you might have to wait longer than you like for non-emergent/urgent procedures but it comes out quite well. It was also the most efficient health service in the world because there is no insurance which adds a layer of bureaucracy. If you want to be seen more quickly or a specific service you can always buy private insurance or pay out of pocket if you can afford to do so.

The mental health services in the UK leave alot to be desired. Bed occupancy is high in inpatient units, and community services could be better. But they are a helluva lot better than what is available in the US in the public sector. In the UK there is actually such a thing as community psychiatry - psychiatrists will visit patients in their homes. Home treatment teams include nurses who will sit with suicidal patients in their own home so they don't need to be admitted, and bring them their medications. The UK led the way in developing services for first episode psychosis and the at-risk mental state. Specialized services are available on the NHS (for example there is a depersonalization disorder clinic! No such clinic exists anywhere in the US that I know of.) There are specialist services for conversion disorder, chronic fatigue syndrome, an inpatient unit where patients can cut as much as they want, a psychoanalytically-based inpatient unit... mentalization-based treatment, cognitive analytic therapy, dynamic interpersonal therapy, CBT for psychosis, the maudsley family based treatment for eating disorders, mindfulness based cognitive therapy were all developed in the NHS.

When my dad had advanced colorectal cancer a few years ago we were lucky that the hospital down the road was a specialist GI hospital (one of the only GI hospitals in the world) and his surgeon had developed a number of surgical procedures. He got his chemotherapy and radiotherapy at a specialist cancer hospital and was seen very quickly. when he had a liver met he was treated in another hospital not too far off that had expertise in hepatobilliary surgery. cancer nurses would come to his house if he needed them to do so. He is still alive today and cancer and didn't have to pay a penny for his care or worry going bankrupt from these expenses. Some of the buildings were a bit run down, you wont get your own room unless you have an HAI, and the NHS certainly has its own problems but for most people it is going to beat the US hands down. it's wildly popular with my dad at least

 

[vistaril]

It is a good philosophical and ethical question. Many in our society seem to think that all people should have access to all treatments regardless of expense.

Yes, and these people are called I-M-B-E-C-I-L-E-S. A 'good philosophical and ethical question' is whether all of us have some right to a minimum standard of basic health care. I would say no, but that's just my opinion. Anyone who thinks all people should have access to 'all treatments regardless of expense' is likely selfish and tends to rationalize theft/stealing at their core.

 

[FlowRate]

He's right - the NHS is very popular in the UK, especially amongst those who have "experienced it for an extended period of time". In reality the NHS doesn't actually exist as it used to (in England at least) where much of it has been privatized, and the secretary of state for health is no longer responsible for health services etc. It was actually quite financially solvent a few years ago but now it has been heavily underfunded. Regardless, what remains of the NHS provides healthcare free at the point of use including some of the best care in the world. You don't see the level of iatrogenesis, overinvestigation, overpriced poor quality care you see in the US. In the US, hospitals make more money the more iatrogenic complications they induce in their patients. There is no benzo or prescription opioid epidemic, in fact the first benzo withdrawal clinic in the world was in the NHS. Prescription drugs are much cheaper. Many innovations have come from people working in the NHS, which shows that it isn't just the private sector that creates this sort of thing.

The NHS doesn't cover everything (and nor should it, but neither does private health insurance), and you might have to wait longer than you like for non-emergent/urgent procedures but it comes out quite well. It was also the most efficient health service in the world because there is no insurance which adds a layer of bureaucracy. If you want to be seen more quickly or a specific service you can always buy private insurance or pay out of pocket if you can afford to do so.

The mental health services in the UK leave alot to be desired. Bed occupancy is high in inpatient units, and community services could be better. But they are a helluva lot better than what is available in the US in the public sector. In the UK there is actually such a thing as community psychiatry - psychiatrists will visit patients in their homes. Home treatment teams include nurses who will sit with suicidal patients in their own home so they don't need to be admitted, and bring them their medications. The UK led the way in developing services for first episode psychosis and the at-risk mental state. Specialized services are available on the NHS (for example there is a depersonalization disorder clinic! No such clinic exists anywhere in the US that I know of.) There are specialist services for conversion disorder, chronic fatigue syndrome, an inpatient unit where patients can cut as much as they want, a psychoanalytically-based inpatient unit... mentalization-based treatment, cognitive analytic therapy, dynamic interpersonal therapy, CBT for psychosis, the maudsley family based treatment for eating disorders, mindfulness based cognitive therapy were all developed in the NHS.

When my dad had advanced colorectal cancer a few years ago we were lucky that the hospital down the road was a specialist GI hospital (one of the only GI hospitals in the world) and his surgeon had developed a number of surgical procedures. He got his chemotherapy and radiotherapy at a specialist cancer hospital and was seen very quickly. when he had a liver met he was treated in another hospital not too far off that had expertise in hepatobilliary surgery. cancer nurses would come to his house if he needed them to do so. He is still alive today and cancer and didn't have to pay a penny for his care or worry going bankrupt from these expenses. Some of the buildings were a bit run down, you wont get your own room unless you have an HAI, and the NHS certainly has its own problems but for most people it is going to beat the US hands down. it's wildly popular with my dad at least

I'm not trying to imply that NHS doesn't do good things, simply that I hadn't heard rave reviews about it from anyone IRL. It's tough on the internet because this usually comes up in the context of arguments in favor of socialized healthcare, so of course someone isn't going to point to the popular exemplar of socialized care and say "but ehh, it's not that great." The people IRL I know are also in favor of socialized healthcare, so it's not like they were trying to prove something with their criticism, which had to do with wait times and feeling like they clinical staff they interacted with were "clocked out." (Similar to criticisms you hear about the nursing staff at some VA's.)


----

Since the rights thing came up, I have to say I'm not swayed by the concept of "positive rights" because it's basically a redefinition of the essential meaning of "right" in a philosophic context. Might as well call them what they are: government entitlements that seem like a good idea to at least some people. Calling an entitlement a "right" gives people a flawed but logical shortcut--I don't need to argue for why this is a good thing, it's simply my right, QED.

 

[smalltownpsych]

Yes, and these people are called I-M-B-E-C-I-L-E-S. A 'good philosophical and ethical question' is whether all of us have some right to a minimum standard of basic health care. I would say no, but that's just my opinion. Anyone who thinks all people should have access to 'all treatments regardless of expense' is likely selfish and tends to rationalize theft/stealing at their core.

 

[deleted736562]

The government is responsible for everything from roads, to education, to funding science and spending on weapons more than all other countries combined (or something like this). But when it needs to stick up to the average person suffering from health conditions, all cry "theft" and "socialism".

 

[vistaril]

The government is responsible for everything from roads, to education, to funding science and spending on weapons more than all other countries combined (or something like this). But when it needs to stick up to the average person suffering from health conditions, all cry "theft" and "socialism".

ummm no. This is the argument of an idiot. First off to make a blanket statement like the govt is 'responsible' for all of these things is a matter of opinion. But more importantly, how you get a bull**** phrase like 'the average person suffering from health conditions' to equate to what we were talking about above is absurd.

The reality is that if superduper expensive high quality care(and yes I know cost and quality aren't always 1:1) is given to someone who doesn't have a pot to piss in, that care is only given by reaching into the wallets of others and taking their resources to pay for it. That is wrong. That is immoral. That is theft. Period.

 

[splik]

The reality is that if superduper expensive high quality care(and yes I know cost and quality aren't always 1:1)

there is no correlation, possibly inverse if anything

 

[smalltownpsych]

there is no correlation, possibly inverse if anything

Then maybe we should spend less money on health care so we could have better outcomes? It is also the same logic that since higher levels of education and training don't predict better outcomes why bother with paying for doctors when psychiatric nurse practitioners and online-degree MA therapists can do just as well.

 

[splik]

Then maybe we should spend less money on health care so we could have better outcomes?

well that is the aim of healthcare reform - greater access, better outcomes, lower costs. And anywhere else in the world you couldn't do it, but healthcare is so overpriced in this country, access so limited, and outcomes so poor that the "triple aim" is pretty achievable.

And that is not a bad logic - If indeed nurse practitioners and online-degree MA therapists can do just as well as psychiatrists and psychologists (im not quite sure this is true - especially for therapists) then we shouldn't pay for more expensive people. NPs definitely aren't cost effective and they keep asking to be paid the same as physicians to boot

 

[lymphocyte]

The reality is that if superduper expensive high quality care(and yes I know cost and quality aren't always 1:1) is given to someone who doesn't have a pot to piss in, that care is only given by reaching into the wallets of others and taking their resources to pay for it. That is wrong. That is immoral. That is theft. Period.

Hey @vistaril, what should we do with poor babies who are born with TOF? Is correcting their heart defect "wrong, immoral, theft... period"? Really? No grey? What about a poor 6 year old with renal failure? A poor 3 year old with blunt abdominal trauma that's bleeding out? Is it immoral theft to treat until the check clears? Does that change when it comes to mental illness? Suicidaility? Why?

 

[vistaril]

there is no correlation, possibly inverse if anything

well it obviously depends on what aspect within a system you are looking at.

 

[Shikima]

The problem everyone is skirting around is that there isn't a system which places accountability upon a person for their health care outcome, rather we're reduced to badgering a person to adopt "healthy lifestyles".

How is a person incentivized into adopting changes towards self improvement - weight loss, no substance abuse, management of emotional dysregulation, tight glycemic control, etc.

 

[smalltownpsych]

well that is the aim of healthcare reform - greater access, better outcomes, lower costs. And anywhere else in the world you couldn't do it, but healthcare is so overpriced in this country, access so limited, and outcomes so poor that the "triple aim" is pretty achievable.

And that is not a bad logic - If indeed nurse practitioners and online-degree MA therapists can do just as well as psychiatrists and psychologists (im not quite sure this is true - especially for therapists) then we shouldn't pay for more expensive people. NPs definitely aren't cost effective and they keep asking to be paid the same as physicians to boot

The hard part is how to demonstrate that level of training predicts outcomes. There are a few oft-cited studies that show no difference regardless of therapist training or experience. Kind of like project MATCH with addiction where they found no predictors. Doesn't mean they don't exist, just that our research methodology isn't catching it.

 

[vistaril]

Hey @vistaril, what should we do with poor babies who are born with TOF? Is correcting their heart defect "wrong, immoral, theft... period"? Really? No grey? What about a poor 6 year old with renal failure? A poor 3 year old with blunt abdominal trauma that's bleeding out? Is it immoral theft to treat until the check clears? Does that change when it comes to mental illness? Suicidaility? Why?

depends on the scenario(so yes there is grey).....if it's one of those babies with a 3 month survival max, then spending 3 million dollars to give them another month or two is wrong. If it's a scenario where there is evidence for an intervention with a very strong evidence base and clear outcome measures that are likely to result in a very marked difference in quality of life(decades and decades of potential high quality living), then sure...that's a different case. And that's why they are done.

In the specific case I responded to(30k wilderness camps for disturbed teens)....that's not even close to the same thing as a baby being born with TOF(in most TOF cases). The evidence base isn't the same. The outcome measures aren't the same. It's not even close.

 

[smalltownpsych]

The problem everyone is skirting around is that there isn't a system which places accountability upon a person for their health care outcome, rather we're reduced to badgering a person to adopt "healthy lifestyles".

How is a person incentivized into adopting changes towards self improvement - weight loss, no substance abuse, management of emotional dysregulation, tight glycemic control, etc.

I am incentified by how good I look and how well I perform when I take care of myself. I do try to help my patients see that too. It does help when I provide them with some social reinforcement to help counterbalance the immediate limbic system reinforcers.

 

[splik]

well it obviously depends on what aspect within a system you are looking at.

not really. have a read of the cost conundrum, atul gawande's most influential new yorker article