August 17

August 17, 2006

The Fisher Rx
Good for What Ails Us!

In This Patient File

"The Exam Room" - The Issue
"The Diagnosis" - What's Ailing Us?
"The Prescription" - Dr. Fisher's Solution
The Patient File - Press Release
"Get Your Dr. Fisher Prescription Filled" - Upcoming Appearances

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Dear Adam,

Thank you for reading this week's edition of "The Fisher Rx." Today, we're talking about Mental Illness and Health. I look forward to hearing from you on this issue and others that are important to you. Please take the opportunity to forward this email to others by clicking the "Forward Email" link at the bottom of this email. Doing so will help us make the 12th District the best place to live in America. I welcome your vote, your financial support, and your comments.

Sincerely,

Dr. Ada M. Fisher

"The Exam Room" - The Issue
Who Fits the Category?

“Neurotics build castles and psychotics live in them" was a maxim taught in medical school regarding the difference between those having adjustment difficulties vs. those who are mentally ill. There is probably no home or family exempt from the effects of mental illness at some point in their lives. 20% of individuals are likely to be affected by mental illness and its attendant thought difficulties. For those who are disabled, mental illness is the leading diagnosis for 4 out of 10. Additionally, 40% of residents in adult nursing care suffer from mental illness. Finally, less than half of people with a mental illness are being treated.

The DSM-4 (Diagnostic and Statistical Manual of Mental Illness, 4th Edition) book from the American Psychiatric Association attempts to put some standardization to the diagnosis of mental illnesses. The categories of diseases range from psychosis such as schizophrenia to manic depression or to neurosis including situational adjustment reactions or lack of coping skills. Sadly we are expanding the diagnosis into school age children with concerns about ADD, ADHD, Emotionally and Physically Abusive Behavior and an alphabet soap of diagnosis some of which have a poor body of research to support the diagnosis.

The causes of mental illness embrace genetics with family links shown for schizophrenia and suicide. Environmental insults can result from drugs inducing for some paranoia or hallucinogenic effects experienced from LSD. Violence direct and witnessed can produce things like head trauma which will produce Organic Brain Syndrome not unlike thought problems seen with Alzheimer’s or Dementia or long term sequelae in war such as a Post Traumatic Stress Syndrome. Ones culture can influence the likelihood of being diagnosed as mentally ill. And even hormones are suspect in Post Partum Depression. We are in danger of labeling everything as a mental illness, thereby exempting people from some aspects of their behavior which must be controlled if they are to function in society.

"The Diagnosis" - What's Ailing Us?
Who's First In Line?

Though improved medicines have allowed many to function outside of a hospital setting, in the 70's and 80's the move to deinstitutionalization forced many mentally ill persons with minimum family supports, flagrant thought disorders, and neglect of personal hygiene to the streets adding to the homeless, the helpless and the panhandlers. It has been too easy to step over, overlook and put laws in place to remove these people from the vision of "proper society."

Those with no money and those who live in remote or non-urban areas are most likely to have limited access to mental help. It is estimated that over 40% of those incarcerated suffer from some undiagnosed and untreated thought disorder. And as people are laid off or find themselves with inadequate skills for the global economy, more emotional problems will crop up.

Health Insurance as presently issued is totally inadequate to deal with mental health issues. Socializing the system or nationalizing it may take care of some; however, there isn't enough money printed to pay the bill for what is needed.

"The Prescription" - Dr. Fisher's Solution
New Thinking and Community Supports

It is real easy to label those who don't act, think or look normal as mentally ill. What is hard it to find effective affordable cures. The sad fact is there is no cure for mental illness. We can treat the problem and make people more functional and acceptable to society, but that doesn't cure the pathology.

There are groups who should benefit immediately from help.

Those with deficit coping skills may be helped with group therapy, communal involvements and treatments which aren't always radical.
Those who are delusional, are a threat to themselves or posing a danger to others must have direct medical interventions by people who know what they are doing. I part company here with those sending these folks to social workers, non- prescribing psychologist or others who can't treat medically for these patients can become violent and can kill. Restraining orders must be enforced for them.
Those who cannot do their activities of daily living due to catatonia and other states must also have help and a place to stay.
Lastly the self-indulgent substance abusers are a nightmare in denial for us and them. We keep saying they need to be treated, but the sad truth is treatments haven't worked. Those programs which are good such as Durham, NC's TROSA or Pritchard Farms in the mountains rely on voluntary compliance from those who too often still just want to get high. Company run programs like those of Xerox, IBM, and those I was involved with at AMOCO worked. These abusers had jobs which were used for leverage in getting compliance with treatment plans. The non- employed don't have this luxury and short term therapy is of limited benefit. Cocaine addicts need 2 years of intensive detoxification and insurance isn't covering this. Recidivism rates are high for all types of abusers.

The Fisher Rx

Scientific research into mental illness treatments must be a national priority. Part of the money in the war on drugs should go to stopping the flow of drugs into the country, but mental illness research and treatment should get some of these resources.

Law enforcement should focus on the pushers and dealers not the users. Methamphetamines are being manufactured like chemical bombs waiting to destroy the body. People who run the labs should receive 20 years minimum without parole. Crack and cocaine should legally be treated the same since they are the same substance.

Residential mental health care facilities may be a cheaper alternative for housing for the mentally ill than nursing homes. Long term care for each patient must be evaluated to determine if this is a viable option.

Mental health services should be a part of each county's offerings. Those providing the service must demonstrate they work by decreasing recidivism, return to workforce data, and improvements in providing for self and family and measurable quality of life improvements.

Finally, looking towards the future, we must encourage young people to pursue careers in mental health services as viable options for employment while giving back to society.

The Patient File - Press Release
Fisher says Blacks Don’t Have to be Victims

Dr. Fisher attended an August 5, 2006 Guilford County 6pm Black Community Meeting at the Genesis Baptist Church chaired by Ms. Simms, mayor-Pro-tem of High Point and co-chaired by Rev. Cardes Brown of New Light Baptist Church in Greensboro. Pulpit Forum chairman Ms. Mazie Ferguson, as well as NAACP presidents Joe Alston from High Point and Mrs. Gladys Shipman from Greensboro were also backers of “A Call to Act” targeted at efforts to support their July 4, 2006 Declaration Against Intolerable Racism in Guilford County. The group presented a Draft-For Approval As the Community Working Document hitting upon Jobs and Economics, Education, Criminal Justice and Prisons, Democracy and Politics, and Media and Communications.