Can an app help people with mental health issues? Elizabeth Tracey reports
Rates of mental health problems have reached epidemic levels during the Covid-19 pandemic. Now a new study shows that for some, use of an app rather than in person therapy provided nearly the same improvement. Eric Strain, a psychiatrist at Johns Hopkins, says this is a very practical approach.
Strain: At that outpatient care level we need to be thinking about electronically delivered services and there’s a lot of those out there now that are FDA cleared apps. We need to think about that as the very base of the triangle because if people can get services out of those rather than needing to go into outpatient care with a provider, then let’s use those services, those apps. It’s been shown to be effective, it makes a lot of sense, I think that they could start out with something like that to see if it could help them :30
Strain says it might be worth talking with a primary care physician to get started and perhaps trying more than one app to find a good fit for you. At Johns Hopkins, I’m Elizabeth Tracey.
When is it appropriate for someone with substance use disorder to be hospitalized? Elizabeth Tracey reports
Deaths due to substance use disorder are skyrocketing. Eric Strain, a substance use disorder expert at Johns Hopkins, says although it is tempting to think everyone with substance use disorder should be hospitalized, other forms of care may be more appropriate.
Strain: Hospitalization should be the peak of the triangle, so very small, and then we should be thinking about devoting more resources to thinks like residential services, which are lower cost on a per day basis, can treat a larger number of people and there’s probably more people with things like mental health substance abuse and general medical care that don’t need to be in a hospital but need to be in some supervised environment to get them stabilized. :28
Strain says that staff shortages are impacting hospital-based care in all specialty areas, including mental health and substance use disorder, and notes that residential treatment centers may also enable more coordinated services. At Johns Hopkins, I’m Elizabeth Tracey.
Getting more primary care providers involved may help integrate mental and physical health with substance use disorder treatment, Elizabeth Tracey reports
Managing the full breadth of health issues in someone with substance use disorder could help reduce the likelihood of a bad outcome, especially in the 40% of people who have both mental health issues and substance abuse. Eric Strain, a substance use disorders expert at Johns Hopkins, says beginning with full primary care integration would be a good start.
Strain: The fact of the matter is we’ve got a substantial number of kids with ADHD who are getting treatment from their pediatrician, we have a substantial proportion of adults with garden variety major depression who get antidepressants from their primary care physician, we need to look at a system where the relatively straightforward conditions that can be treated by primary care physicians, nurse practitioners, providers like that, can be cared for in those settings so our specialty services can care for the more complicated people. :31
Strain says such integration needs to begin with education of providers and patients. At Johns Hopkins, I’m Elizabeth Tracey.
How can care be coordinated for people with substance use disorder? Elizabeth Tracey reports
Substance use, mental health problems, and physical ailments are currently treated separately, but need to be integrated. That’s according to Eric Strain, a substance use disorder expert at Johns Hopkins.
Strain: You’ve got these complicated patients and we’ve got patients with substance abuse disorders and significant medical problems and we’ve got people with mental health problems and substance abuse problems and we’ve got all those combinations. We need to get away from thinking that each of those three areas is separate and needs to be defended by their own little fiefdoms. :23
Electronic medical records can help.
Strain: Things like integrated health records make a lot of sense to better coordinate care. We also need to look at the funding streams for mental health, substance abuse and general medical care, and see better integration of those funding streams. :16
At Johns Hopkins, I’m Elizabeth Tracey.
Fragmented health care may be a big reason why treatment for substance abuse doesn’t work, Elizabeth Tracey reports
If you’re receiving treatment for a substance use disorder, it’s likely that your other medical issues are being addressed elsewhere, including mental health issues. With a recent study showing that 40% of the time mental health issues and substance abuse occur together, that’s a problem. Eric Strain, a substance use disorder expert at Johns Hopkins, explains.
Strain: We have a fragmented healthcare system and which actually in some states such as New York has three bins to it. so there’s the mental health bin, there’s the substance use bin, and there’s what you might call the somatic therapy or the general medical care bin. Those bins or siloes need to be better integrated. It’s very tragic that way given the high comorbidity between substance abuse and other mental health conditions, that you’ve got this fragmented system. :29
Strain says the likelihood of bad outcomes, including death, is much higher when care isn’t coordinated. At Johns Hopkins, I’m Elizabeth Tracey.
Whatever happened to convalescent plasma to treat Covid-19? Elizabeth Tracey reports
Early on in the pandemic plasma collected from people who’d had Covid-19 and survived, so called convalescent plasma, was used to treat others, with mixed success. Now that new variants have emerged that can escape antibodies stimulated by vaccines and most monoclonals aren’t useful, Arturo Casadevall, a convalescent plasma expert at Johns Hopkins, says the treatment is being used again.
Casadevall: it’s now very clear that immunosuppressed individuals are not clearing this. it becomes chronic. It interferes with the rest of their therapy, and then the monoclonals are not there, Paxlovid has a lot of drug drug interactions, so then plasma finds a role. Plasma is being used today at Hopkins and Mayo largely as replacement therapy. Because people with B cell defects don’t make antibody and they are being treated with this, and the results are good, I mean people clear the infection when they are given plasma. :31
Casadevall says the plasma requires intravenous administration. At Johns Hopkins, I’m Elizabeth Tracey.