12 ms·

The Moral Urgency of Mental Health

55 points by arikr 9y ago

DanBC 9y ago
> In the United Kingdom, it costs about £650 per patient to provide psychotherapy, which is effective for about 50% of patients. That figure indicates how much governments would need to spend, but does not take into account what they might get back. they don't appear to provide a source for this. The English NHS collects, and publishes, a lot of data for the IAPT (Improved access to psychological therapies programme). IAPT provides access to short forms of therapy such as cognitive behaviour therapy (which would normally be about 7 weeks). http://www.digital.nhs.uk/catalogue/PUB30153 http://www.digital.nhs.uk/catalogue/PUB30153 > In August 2017 there were: > 113,541 new referrals > 83,330 referrals entered treatment > 47,100 referrals finished a course of treatment, of which: > 88.5 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment > 43,922 started treatment at caseness, with 50.8 per cent moving to recovery there's a large unweidly spreedsheet with results for each provider. the latest figures are here: http://content.digital.nhs.uk/iaptmonthly http://content.digital.nhs.uk/iaptmonthly
- jorgec 9y ago
  psychotherapy is less than 10% effective. In fact, its almost no science.
  - phkahler 9y ago
    And when it goes wrong the practitioner will lie in your medical records to cover it up. When it goes even more wrong and the person is dead they'll just say "s(he) had serious issues". Having said that, I've seen it do wonders for some people.
    - jschwartzi 9y ago
      It worked really well for me, but I probably wasn't as mentally ill as a lot of people who would seek psychotherapy. Either that or my therapist was just really good or we had a good working relationship. Trying to act on how I feel continues to be the hardest thing I have ever had to do.
      - phkahler 9y ago
        Not sure if you're religious it not, but let me phase it like that. God put you on Earth to be you and do it your way. In an evolutionary context, it's a random process where the value of an individual can only be determined in hindsight after you're gone. Hence you need to be you and leave judgement to the ages. If you're at all concerned about that, you're a long way from being cluster B or dark triad, so don't sweat it.
  - hyolaris 9y ago
    Citation please, preferably a meta-analysis.
- nitwit005 9y ago
  It does provide a source, if you click on the anchor for the cost, which seems to be the basis for the whole article given that the summary sounds so similar: https://www.penguin.co.uk/books/184573/thrive/ https://www.penguin.co.uk/books/184573/thrive/ I'm sure that number conveniently omits continuing costs, and provides no standard for what effective means.
chris_wot 9y ago
Mental Health for those in crisis is fucked. If you feel suicidal, you get locked up. It’s as simple as that.
- icantdrive55 9y ago
  Since it is terrible, and so many people end up self medicating; I would like to see certain drugs OTC. The benzodiazepine with the long half life would be first on my list. Second would be the opioid with the long half life, and yes put the antagonist in the pill. Maybe a required consultation with the pharmacist, on the dangers of mixing drugs? I purposely didn't mention the drugs. Why--because this isn't the forum, and I'm not an expert. And, most of you can easily look up these drugs. That said, relying on Alochol, and Street drugs to alleviate the misery of a mental malady is just wrong! (I know there's a bunch of you rolling your eyes. My hope is you never have a nervous breakdown--without good insurance. I don't want to debate today with someone who hasen't been there either. I'm appalled at the way mental illness is treated in America. It's embarrassing. It's been horrid forever. To those reading this in abject missery; hang in there. Time will cure most of you. I have no reason to lie. I've been there. I know the misery. Don't give up. Give it time, and try to work the system. If it's an emergency, call 911. I know it seems outlandish, but we are just victims of the System. Oh, how I would like to see the System change.)
- DubiousPusher 9y ago
  While simultaneously, you can have a person clearly unable to provide self care who is denied access to any kind of inpatient care because they are not "a danger to themselves or someone else."
- mjevans 9y ago
  My own personal theory on this matter is that a lot of emotional state is feedback loops. Have a positive environment where things tend to go well and everyone else likes you? Then you share in to that same environment (drink the Koolaid). Have a mostly neutral or slightly negative environment? Then you end up circling the drain hoping to have an energy exchange that allows you escape velocity in to the above rather than... Having a mostly negative environment; even if it's just a little. The slow crushing weight of reality and those around you chips away at every part of your being and self until there is nothing left but a broken and hateful individual. May become either a neutron star (hermit) or go supernova (usually leading to jail or death).
jes 9y ago
I am hopeful that we will soon see AI-based psychotherapy available at scale at a price such that anyone who wants it will be able to get it. I can imagine that it would be more or less like having a telephone conversation with a real therapist, except in this case the therapist is an AI application running in a datacenter. I think we will see something like this in the next five to ten years. Thoughts?
- lazerpants 9y ago
  Are you familiar with: https://woebot.io/ https://woebot.io/ It acts as a cognitive behavioral therapy tool.
  - jes 9y ago
    I was not. Thank you for that link.
  - sincerely 9y ago
    Thank you for sharing this!
- aaavl2821 9y ago
  It would be great if that were possible, but a lot of the value of therapy comes from the therapeutic relationship rather than a specific type of therapy. Most types of psychotherapy tend to have the same level of effect in studies, suggesting there is no "recipe" for the type of therapy that works. This phenomenon also suggests (but does not prove) that the human relationship, rather than therapeutic program, accounts for the measured improvement in outcomes Not to say an AI tool wouldn't be helpful for some people, but it isn't clear it would be that useful. And i don't know of any evidence or plausible hypotheses that an AI tool could work for anything other than mild anxiety or depression AI + human therapy could potentially be better than human therapy alone however
  - DubiousPusher 9y ago
    I thought Cognitive Behavioral Therapy was actually the only kind of talk therapy that showed greater effect than placebo.
aaavl2821 9y ago
This doesn't touch on a potentially even bigger barrier to adoption of better mental health care: that those who benefit from better mental health care often aren't the people paying for it, and that it is really really hard to measure the specific financial benefits of improving mental health in a way that will convince payers / employers / government to actually put real money on the line
DoreenMichele 9y ago
Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. If we want to reduce misery in the developed world, then mental health is the biggest challenge we need to overcome. Everything I have ever seen suggests that the chronically poor have intractable personal issues, such as medical problems, mental health problems, learning disabilities or other personal issues. So this seems like a false dichotomy to me.
- pacaro 9y ago
  I would see it as less a false dichotomy than just recognizing that these issues are not always orthogonal.
  - DoreenMichele 9y ago
    I don't really understand that use of the word orthogonal. But for clarity's sake: I have read about issues like poverty for decades. In any given year, about 10 to 15 percent of Americans are below the federal poverty level. But only about 2 percent of Americans are chronically poor. This is typically defined as below the federal poverty level for at least 5 years out of 10. In fact, I have even seen stats that suggest that being in the bottom 20 percent in one year is actually a reasonable predictor for being in the top 20 percent the following year. Some people below the federal poverty level in a given year are temporarily unemployed and job hunting. In some cases, they are actually starting a new business. So, most folks don't stay below the poverty level. The people who are chronically poor are the ones that have significant personal challenges. These personal challenges both make them miserable and are also a root cause of their poverty. If they can't resolve their personal issues in some manner, they remain poor. I have not only studied such things, I have lived it. Misery is not just having X problem, but knowing that you may never be able to resolve it and that the world does a really sucky job of providing some means for people like you to have some kind of baseline level of comfort. It is a kind of personal hell.
    - jschwartzi 9y ago
alfithehermutt 9y ago
Mental health needs to be a huge priority. I have several teenager relatives all depressed. The constant social media and comparisons to the top 10% of people in beauty, intelligence, money, and etc are destroying them. Ive caught my teenage nephew and niece watching tons of plastic surgery qa on youtube. We really need to get our primate impulses in check. Im hoping the research on brain implants will help overcome our ugly genetic history.
pdkl95 9y ago
> Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. When you truly don't know how your are going to afford next week's food/medication/rent, survival instinct kick in causing anxiety and huge mental burden that can make it difficult to focus on anything else. One of the easier ways to fix a large amount of depression and anxiety is financial stability. > If your neighbor becomes richer, you feel poorer. While, I completely support increased funding to mental health services for everyone, as someone trying to figure out how to pay for a new $100/month insulin prescription with a laughably tiny disability check and a medicare "donut hole", this is pretty offensive. Feeling bad because you can't keep up with the consumerism rat race isn't "misery".
- x3n0ph3n3 9y ago
  > Why are these framed as independent factors? Because people have lived in poverty for thousands of years without debilitating depression and anxiety.
  - Raphmedia 9y ago
    One can live in poverty without living in misery.
- Riseed 9y ago
  > as someone trying to figure out how to pay for a new $100/month insulin prescription Last weekend, another internet stranger recommended prescriptionhope.com, which charges $50/mo/script. [0] > Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. Not only that: - poverty "can change your genes and increase your chances of depression" [1] - relieving poverty (by $73/mo) "significantly improves mental health" [2] - "anxiety disorders in poor moms likely to result from poverty, not mental illness" [3] Of course, not everyone agrees. Some researchers found that improving mental health led to improved financial situations (and not the other way around.) [4] Regardless of which has a larger causal effect on the other, studies continue to show the two are certainly linked, and not independent factors. [0] https://imgur.com/gallery/ROYXD https://imgur.com/gallery/ROYXD [1] https://www.independent.co.uk/news/science/depression-anxiety-genes-epigenetic-changes-dna-poverty-a7047201.html https://www.independent.co.uk/news/science/depression-anxiet... [2] blog/news writeup: https://www.madinamerica.com/2015/11/relieving-poverty-significantly-improves-mental-health/ https://www.madinamerica.com/2015/11/relieving-poverty-signi... abstract: https://link.springer.com/article/10.1007/s10597-015-9950-9 https://link.springer.com/article/10.1007/s10597-015-9950-9 [3] https://www.sciencedaily.com/releases/2012/07/120720083312.htm https://www.sciencedaily.com/releases/2012/07/120720083312.h... [4] https://www.theatlantic.com/health/archive/2011/10/poverty-and-mental-health-can-the-2-way-connection-be-broken/247275/ https://www.theatlantic.com/health/archive/2011/10/poverty-a...
Molkar 9y ago
I don't see the urgency in drugging the bottom 10% when they have natural reasons to feel miserable.

55 points by arikr 9y ago

> In the United Kingdom, it costs about £650 per patient to provide psychotherapy, which is effective for about 50% of patients. That figure indicates how much governments would need to spend, but does not take into account what they might get back. they don't appear to provide a source for this. The English NHS collects, and publishes, a lot of data for the IAPT (Improved access to psychological therapies programme). IAPT provides access to short forms of therapy such as cognitive behaviour therapy (which would normally be about 7 weeks). http://www.digital.nhs.uk/catalogue/PUB30153 http://www.digital.nhs.uk/catalogue/PUB30153 > In August 2017 there were: > 113,541 new referrals > 83,330 referrals entered treatment > 47,100 referrals finished a course of treatment, of which: > 88.5 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment > 43,922 started treatment at caseness, with 50.8 per cent moving to recovery there's a large unweidly spreedsheet with results for each provider. the latest figures are here: http://content.digital.nhs.uk/iaptmonthly http://content.digital.nhs.uk/iaptmonthly

jorgec 9y ago
psychotherapy is less than 10% effective. In fact, its almost no science.
- phkahler 9y ago
  And when it goes wrong the practitioner will lie in your medical records to cover it up. When it goes even more wrong and the person is dead they'll just say "s(he) had serious issues". Having said that, I've seen it do wonders for some people.
  - jschwartzi 9y ago
    It worked really well for me, but I probably wasn't as mentally ill as a lot of people who would seek psychotherapy. Either that or my therapist was just really good or we had a good working relationship. Trying to act on how I feel continues to be the hardest thing I have ever had to do.
    - phkahler 9y ago
      Not sure if you're religious it not, but let me phase it like that. God put you on Earth to be you and do it your way. In an evolutionary context, it's a random process where the value of an individual can only be determined in hindsight after you're gone. Hence you need to be you and leave judgement to the ages. If you're at all concerned about that, you're a long way from being cluster B or dark triad, so don't sweat it.
- hyolaris 9y ago
  Citation please, preferably a meta-analysis.
nitwit005 9y ago
It does provide a source, if you click on the anchor for the cost, which seems to be the basis for the whole article given that the summary sounds so similar: https://www.penguin.co.uk/books/184573/thrive/ https://www.penguin.co.uk/books/184573/thrive/ I'm sure that number conveniently omits continuing costs, and provides no standard for what effective means.

chris_wot 9y ago

Mental Health for those in crisis is fucked. If you feel suicidal, you get locked up. It’s as simple as that.

icantdrive55 9y ago
Since it is terrible, and so many people end up self medicating; I would like to see certain drugs OTC. The benzodiazepine with the long half life would be first on my list. Second would be the opioid with the long half life, and yes put the antagonist in the pill. Maybe a required consultation with the pharmacist, on the dangers of mixing drugs? I purposely didn't mention the drugs. Why--because this isn't the forum, and I'm not an expert. And, most of you can easily look up these drugs. That said, relying on Alochol, and Street drugs to alleviate the misery of a mental malady is just wrong! (I know there's a bunch of you rolling your eyes. My hope is you never have a nervous breakdown--without good insurance. I don't want to debate today with someone who hasen't been there either. I'm appalled at the way mental illness is treated in America. It's embarrassing. It's been horrid forever. To those reading this in abject missery; hang in there. Time will cure most of you. I have no reason to lie. I've been there. I know the misery. Don't give up. Give it time, and try to work the system. If it's an emergency, call 911. I know it seems outlandish, but we are just victims of the System. Oh, how I would like to see the System change.)
DubiousPusher 9y ago
While simultaneously, you can have a person clearly unable to provide self care who is denied access to any kind of inpatient care because they are not "a danger to themselves or someone else."
mjevans 9y ago
My own personal theory on this matter is that a lot of emotional state is feedback loops. Have a positive environment where things tend to go well and everyone else likes you? Then you share in to that same environment (drink the Koolaid). Have a mostly neutral or slightly negative environment? Then you end up circling the drain hoping to have an energy exchange that allows you escape velocity in to the above rather than... Having a mostly negative environment; even if it's just a little. The slow crushing weight of reality and those around you chips away at every part of your being and self until there is nothing left but a broken and hateful individual. May become either a neutron star (hermit) or go supernova (usually leading to jail or death).

jes 9y ago

I am hopeful that we will soon see AI-based psychotherapy available at scale at a price such that anyone who wants it will be able to get it. I can imagine that it would be more or less like having a telephone conversation with a real therapist, except in this case the therapist is an AI application running in a datacenter. I think we will see something like this in the next five to ten years. Thoughts?

lazerpants 9y ago
Are you familiar with: https://woebot.io/ https://woebot.io/ It acts as a cognitive behavioral therapy tool.
- jes 9y ago
  I was not. Thank you for that link.
- sincerely 9y ago
  Thank you for sharing this!
aaavl2821 9y ago
It would be great if that were possible, but a lot of the value of therapy comes from the therapeutic relationship rather than a specific type of therapy. Most types of psychotherapy tend to have the same level of effect in studies, suggesting there is no "recipe" for the type of therapy that works. This phenomenon also suggests (but does not prove) that the human relationship, rather than therapeutic program, accounts for the measured improvement in outcomes Not to say an AI tool wouldn't be helpful for some people, but it isn't clear it would be that useful. And i don't know of any evidence or plausible hypotheses that an AI tool could work for anything other than mild anxiety or depression AI + human therapy could potentially be better than human therapy alone however
- DubiousPusher 9y ago
  I thought Cognitive Behavioral Therapy was actually the only kind of talk therapy that showed greater effect than placebo.

aaavl2821 9y ago

This doesn't touch on a potentially even bigger barrier to adoption of better mental health care: that those who benefit from better mental health care often aren't the people paying for it, and that it is really really hard to measure the specific financial benefits of improving mental health in a way that will convince payers / employers / government to actually put real money on the line

DoreenMichele 9y ago

Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. If we want to reduce misery in the developed world, then mental health is the biggest challenge we need to overcome. Everything I have ever seen suggests that the chronically poor have intractable personal issues, such as medical problems, mental health problems, learning disabilities or other personal issues. So this seems like a false dichotomy to me.

pacaro 9y ago
I would see it as less a false dichotomy than just recognizing that these issues are not always orthogonal.
- DoreenMichele 9y ago
  I don't really understand that use of the word orthogonal. But for clarity's sake: I have read about issues like poverty for decades. In any given year, about 10 to 15 percent of Americans are below the federal poverty level. But only about 2 percent of Americans are chronically poor. This is typically defined as below the federal poverty level for at least 5 years out of 10. In fact, I have even seen stats that suggest that being in the bottom 20 percent in one year is actually a reasonable predictor for being in the top 20 percent the following year. Some people below the federal poverty level in a given year are temporarily unemployed and job hunting. In some cases, they are actually starting a new business. So, most folks don't stay below the poverty level. The people who are chronically poor are the ones that have significant personal challenges. These personal challenges both make them miserable and are also a root cause of their poverty. If they can't resolve their personal issues in some manner, they remain poor. I have not only studied such things, I have lived it. Misery is not just having X problem, but knowing that you may never be able to resolve it and that the world does a really sucky job of providing some means for people like you to have some kind of baseline level of comfort. It is a kind of personal hell.
  - jschwartzi 9y ago

alfithehermutt 9y ago

Mental health needs to be a huge priority. I have several teenager relatives all depressed. The constant social media and comparisons to the top 10% of people in beauty, intelligence, money, and etc are destroying them. Ive caught my teenage nephew and niece watching tons of plastic surgery qa on youtube. We really need to get our primate impulses in check. Im hoping the research on brain implants will help overcome our ugly genetic history.

pdkl95 9y ago

> Overall, the researchers claim, eliminating depression and anxiety would reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%. Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. When you truly don't know how your are going to afford next week's food/medication/rent, survival instinct kick in causing anxiety and huge mental burden that can make it difficult to focus on anything else. One of the easier ways to fix a large amount of depression and anxiety is financial stability. > If your neighbor becomes richer, you feel poorer. While, I completely support increased funding to mental health services for everyone, as someone trying to figure out how to pay for a new $100/month insulin prescription with a laughably tiny disability check and a medicare "donut hole", this is pretty offensive. Feeling bad because you can't keep up with the consumerism rat race isn't "misery".

x3n0ph3n3 9y ago
> Why are these framed as independent factors? Because people have lived in poverty for thousands of years without debilitating depression and anxiety.
- Raphmedia 9y ago
  One can live in poverty without living in misery.
Riseed 9y ago
> as someone trying to figure out how to pay for a new $100/month insulin prescription Last weekend, another internet stranger recommended prescriptionhope.com, which charges $50/mo/script. [0] > Why are these framed as independent factors? For many people the lack of financial stability is a primary source of depression and anxiety. Not only that: - poverty "can change your genes and increase your chances of depression" [1] - relieving poverty (by $73/mo) "significantly improves mental health" [2] - "anxiety disorders in poor moms likely to result from poverty, not mental illness" [3] Of course, not everyone agrees. Some researchers found that improving mental health led to improved financial situations (and not the other way around.) [4] Regardless of which has a larger causal effect on the other, studies continue to show the two are certainly linked, and not independent factors. [0] https://imgur.com/gallery/ROYXD https://imgur.com/gallery/ROYXD [1] https://www.independent.co.uk/news/science/depression-anxiety-genes-epigenetic-changes-dna-poverty-a7047201.html https://www.independent.co.uk/news/science/depression-anxiet... [2] blog/news writeup: https://www.madinamerica.com/2015/11/relieving-poverty-significantly-improves-mental-health/ https://www.madinamerica.com/2015/11/relieving-poverty-signi... abstract: https://link.springer.com/article/10.1007/s10597-015-9950-9 https://link.springer.com/article/10.1007/s10597-015-9950-9 [3] https://www.sciencedaily.com/releases/2012/07/120720083312.htm https://www.sciencedaily.com/releases/2012/07/120720083312.h... [4] https://www.theatlantic.com/health/archive/2011/10/poverty-and-mental-health-can-the-2-way-connection-be-broken/247275/ https://www.theatlantic.com/health/archive/2011/10/poverty-a...

Molkar 9y ago

I don't see the urgency in drugging the bottom 10% when they have natural reasons to feel miserable.