Based on extensive and candid interviews with both those suffering from chemobrain and the physicians and scientists who have treated and studied this problem, Clegg cuts through the scientific jargon and explains in understandable terms how chemotherapy works at the most basic biological level. In doing so, she provides cancer survivors with the knowledge to understand what is happening to them and practical tips for coping with the aftermath of chemotherapy treatment.

Clegg’s extensive cross-analysis of chemotherapy survivors’ stories with the opinions of doctors who recognize the symptoms will provide the affirmation that so many who suffer from chemobrain so desperately need. She includes tactics for dealing with cognitive problems and other lingering side effects, strategies for multitasking at home and reentering the workforce, and even ways to deal with health insurance.

In addition to personal strategies and stories, Clegg also provides the history of the patient empowerment movement that brought chemobrain to the attention of the medical establishment in the first place. She also addresses the future of cancer research and the search for treatments that do less harm, and looks at chemobrain’s implications for the mental health of developing children.

Stewart B. Fleishman, MD, Director, Supportive Services, Continuum Cancer Centers of New York: Beth Israel and St. Luke’s-Roosevelt Hospitals, is a doctor at the forefront of a new movement to treat cognitive dysfunction as a real symptom with real potential solutions. “We will learn more about the causes of cognitive impairment soon, asking future patient generations to invest less of their quality of life to not only survive, but also thrive after diagnosis of cancer and its treatment,” he writes in the book’s foreword. “Many questions have yet to be answered. Further studies are now underway to do so.”

While survivor circles have acknowledged and debated chemobrain for years, this is the first and only book to delve into the cognitive problems many patients endure when they undergo chemotherapy. CHEMOBRAIN brings together cutting-edge science, the compelling stories of adults and children who have struggled for years with cognitive dysfunction, and the coping strategies being developed on the front lines of patient care. Clegg’s investigative study of chemobrain is both a required read for today’s upcoming medical professionals and a gospel for those suffering with this widespread symptom as well as for caring family members.

Notes:

About the Author: Ellen Clegg (Boston, MA) is a deputy managing editor of news operations at the Boston Globe, in charge of the Sunday paper. Her previous positions at the same paper include health and science editor, night news editor, and city editor.

McClatchy’s analysis — the first to compare mental disability payments to veterans by location — examined three million disability compensation claims records obtained under the Freedom of Information Act, as well as separate documents provided by VA. About 31,000 recent veterans are receiving payments for post-traumatic stress disorder, which has emerged as one of the “signature issues of the war on terrorism,” as well as one of the most severe, McClatchy/Herald reports.

McClatchy found that PTSD ratings — which range from 0 to 100 — are far more likely to be higher at certain regional offices. The analysis showed that among recent veterans processed at a mental disability office in Albuquerque, N.M., 56% were scored with the high ratings for PTSD. Among those processed in Fort Harrison, Mont., 18% were given such high ratings for PTSD. According to the analysis, a recent veteran in Albuquerque is likely to receive larger payments than one in Fort Harrison.

When a number of variables are factored in, average disability payments range from a high of $734 per month in Little Rock, Ark., to a low of $435 per month in Honolulu, according to McClatchy/Herald. Ohio veterans with mental illness were found to receive some of the smallest payments. “There’s no reason in the world that a veteran from Ohio should be shortchanged on benefits simply because he is from Ohio,” Rep. Zack Space (D-Ohio) said. He added, “And there’s no reason a veteran from New Mexico should be getting more benefits simply because he lives in New Mexico” (Adams, McClatchy/Miami Herald, 12/20).

Broadcast Coverage
NPR’s “All Things Considered” on Thursday reported on veterans with less than honorable discharges who are unable to receive benefits for treatment of PTSD. The segment includes comments from Sen. Kit Bond (R-Mo.); Gary Myers, an attorney and advocate; Patrick Uloth, an Iraq war veteran who received a less than honorable discharge; and Uloth’s roommate (Zwerdling, “All Things Considered,” NPR, 12/20). Audio and a partial transcript of the segment are available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

The psychological aspects of bariatric surgery are less well understood than the physical risks and benefits. Although the surgery is generally associated with improved mental health and quality of life, postsurgical psychological and behavioral changes are less predictable than physical changes.

The Harvard Mental Health Letter notes that mood disorders such as depression and anxiety affect many people who are eligible for bariatric surgery. The weight loss following surgery generally improves mood, at least initially. In studies, depression and anxiety scores were reduced significantly one year after surgery, but tended to be higher two and four years later. And some research has found higher-than-expected rates of suicide among surgery patients.

Eating disorders, such as binge eating, also affect many people considering bariatric surgery. And a highly controversial theory–as yet unproven–is that bariatric surgery may cause some people to lose weight but then “transfer” their food addiction to some other harmful addiction. Surgery may change the rate at which alcohol is absorbed, which may increase the risk of dependence in people who are vulnerable to becoming addicted. All of these factors underscore the need for mental health treatment before and after surgery, says the Harvard Mental Health Letter.

Harvard Mental Health Letter

http://www.health.harvard.edu

State Sen. Vincent Hughes (D), who helped raise funds to hold the conference, said, “There is not a community not impacted by the stigma, but it’s much more of an acute issue and problem within the African-American community.” He added, “Many in the community operate under the lack of insurance to get care, and for those who have insurance there are barriers to getting care. Those walls prevent a lot of people from getting help.”

Hughes also discussed the cost of not treating mental illness, saying, “If you don’t confront these issues at an early stage, then they can grow to become very significant down the line. The cost of not treating this lack of wellness is billions of dollars (more) in treatment and care than if it was treated in a much more open environment” (Parmley, Philadelphia Inquirer, 12/9).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Racial discrimination shows no improvement

Today’s patient research reveals the true state of mixed-sex wards: a disturbing 68 per cent of mental health patients were accommodated on these wards this year. This confirms what patients have been telling Mind for years (1), underlining the need for urgent action to address this situation. The Count Me In census (2), brought in as part of Delivering Race Equality in Mental Health Care, also shows no improvement in racial discrimination in the NHS, with some black men (Black Other) 79 per cent more likely than average to be secluded – locked away in a room by themselves.

Census data includes:

- Black Afro-Caribbean and Black Other: 3 times more likely to be detained than average
- Black Other (not Afro-Caribbean): over 10 times more likely to be detained
- Black Caribbean men: 33 per cent more likely to be secluded than average
- Black Other: 79 per cent more likely to be secluded than average
- Note: Black Other group is most likely to be second or third generation young men.

Paul Farmer, Mind’s Chief Executive says: “Mind is sadly unsurprised at this truly appalling picture of the mixed-sex wards scandal, with more than two-thirds of our most vulnerable people caught up in the worst of it. For too long, Government ministers relied on misleading figures (3), rather than listening to patients themselves. Such wards are notorious for incidents of sexual harassment and abuse: hospitals should be a place of safety and recovery, not of danger and deterioration.

“We are deeply concerned about the continuing high levels of racial discrimination in the NHS, and urge for the delivery of racial equality to be at the heart of all mental health service, with ring-fenced funding. We must have a joined-up approach to tackle the widespread issues around the experience of BME communities in the mental health system.”

Notes:

1) Mind condemns scandal of sexual abuse on mental health wards – data withheld by Government, Pressure forces Government into releasing shock sexual abuse report

Mind, 24 May 2005, Mind’s Ward Watch findings justified by new reports “Two new reports on inpatient conditions in the NHS for mental health service users justify Mind’s Ward Watch claims, previously dismissed by the Government as ‘unrepresentative’…”

2) Count Me In is the Healthcare Commission and Mental Health Act Commission’s nationwide 3rd census of acute psychiatric inpatient wards, conducted on 30 March 2007.

3) “99 per cent of trusts that provide mental health services meet single-sex accommodation objectives.” Lord Warner, DH Minister, Hansard, HL, 12 July 2006

http://www.mind.org.uk

The connector also instructed insurers to try to limit premium increases without shifting significant costs to plan members. The connector will ask insurers that cannot hold increases to 5% without changing benefits to submit an alternative plan detailing what benefit reductions or increases in copayments would be needed to meet the 5% limit.

Marylou Buyse, president of the Massachusetts Association of Health Plans, said, “Five percent is a really tough target,” adding, “Premiums reflect the underlying cost of care, which is going up 8% to 10% (per year). If the plans are going to meet the 5% target, providers are going to have to scale back their demands.”

The connector also has proposed several ways for insurers to hold down costs, including, steering patients to physicians and hospitals that provide lower-cost, high-quality care; encouraging the use of generic prescription drugs; and strengthening treatment and prevention programs for people with chronic illnesses (Dembner, Boston Globe, 12/5).

MAHP Recommendations
In related news, the Massachusetts Association of Health Plans on Monday made recommendations intended to control rising health plan premiums and provide consumers with more information about why rates increase, the Globe reports. The group also asked the state Legislature to hold annual hearings during which insurers would have to defend any rate increases.

The association recommended that member health plans voluntarily disclose financial information in an easy-to-read format, that insurers ask for public forums to discuss rate increases and that lawmakers pass 17 health care laws, including legislation that would require medical facilities to report preventable errors. The association this week plans to disclose easy-to-understand data for member plans on its Web site.

Richard Lord — CEO of Associated Industries of Massachusetts, the state’s largest business lobby — said, “There’s a real concern that if we don’t address the cost problem, our reform effort will not succeed, and everyone has invested a lot to make the law succeed.” Marylou Buyse, president of MAHP, in a statement said, “Consumers, employers, and the state depend on those of us in health care to keep health care affordable” (Krasner, Boston Globe, 12/4).

Boston Medical Center HealthNet Plan
Boston Medical Center HealthNet Plan, the largest insurer of beneficiaries in the state’s subsidized coverage plan, faces sanctions and a possible investigation by the state attorney general for attempting to “poach” beneficiaries from other insurers, the Globe reports. Boston Medical Center last month sent letters to 2,600 patients that incorrectly implied they could get care at BMC only if they enrolled in HealthNet, the hospital’s insurance plan. The letter stated, “To continue getting your care at Boston Medical Center, now is the time to switch.”

According to the Commonwealth Health Insurance Connector, which oversees the state plan, the language in the letter and the direct approach to beneficiaries enrolled in other plans violated HealthNet’s state contract, which prohibits insurers from directly soliciting beneficiaries of other plans.

The Globe reports that Boston Medical Center and the state are contacting patients to confirm that they have accurate information about access to care and providers, which also include Network Health, Neighborhood Health Plan and Fallon Community Health Plan.

Jean Haynes, HealthNet’s executive director, in a statement issued Monday said, “Both Boston Medical Center HealthNet Plan and Boston Medical Center are deeply sorry for any confusion this incident has caused to Commonwealth Care members,” adding, “Both the health plan and the hospital are implementing procedures to avoid a repeat of such an occurrence.”

According to a letter received by HealthNet, the state will penalize the insurer by reducing the number of beneficiaries it covers. In addition, Attorney General Martha Coakley’s (D) office is reviewing the insurer’s actions to determine if HealthNet violated state consumer protection law, according to a spokesperson for Coakley. The state also has notified the federal government, which helps fund the plan (Dembner, Boston Globe, 12/4).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved

They found that nearly half of New Orleans residents reported significant signs of anxiety in the first month after the storm and that women, young adults and people with lower incomes were hardest hit. The study found that most of the mental problems were caused by post-traumatic stress disorder. PTSD symptoms often were associated with incidents that occurred after the storm, including robberies, assaults and property loss.

The authors said that the symptoms — which include flashbacks, nightmares and hair-trigger temper — are expected to alleviate for most people over time. For 3% to 10% of people, the symptoms could continue for a year or longer. Experts said the study will help policymakers understand how to allocate resources after such an event.

Galea said, “The main message here is that the primary drivers of mental health risk were social and financial circumstances. So if we’re intent on minimizing psychopathology, it means mitigating those stressors quickly” (Carey, New York Times, 12/4).

An abstract of the study is available online.

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved

“It is important to note that regardless of where each state ranks, there is much room for improvement,” said Dr. David Shern, PhD, president and CEO of Mental Health America. “While a number of factors including biology and environment affect an individual’s mental health, this study shows that states can significantly improve their populations’ mental health status by adopting policies that expand access to treatments.”

In “Ranking America’s Mental Health,” Mental Health America found statistically significant associations between the following factors and better depression status and lower suicide rates:

– Mental health resources – On average, the higher the number of psychiatrists, psychologists and social workers per capita in a state, the lower the suicide rate.

– Barriers to treatment – The lower the percentage of the population reporting that they could not obtain healthcare because of costs, the lower the suicide rate and the better the state’s depression status. In addition, the lower the percentage of the population that reported unmet mental healthcare needs, the better the state’s depression status.

– Mental health treatment utilization – The higher the percentage of the population receiving mental health treatment, the lower the suicide rate.

– Socioeconomic characteristics – The more educated the population and the greater the percentage with health insurance, the lower the suicide rate. The more educated the population, the better the state’s depression status.

In addition, the report found the following factor to be significantly associated with the level of mental health service utilization in a state:

– Health insurance parity – Parity exists when state and/or federal law(s) require health insurers to provide mental benefits equivalent to those provided for other health conditions. The more generous a state’s mental health parity coverage, the greater the number of people in the population that receive mental health services.

“The findings of this study underscore the critical need to monitor the mental health status of Americans by examining depression and the states’ policies that may impact it,” said Shern. “Through regular and ongoing measurement of key indicators of depression, we will be able to understand how state public policies impact a population’s depression level and suicide rate – and make adjustments to benefit the millions of American affected by depression.”

In developing the state rankings of depression status, Mental Health America examined four measures: 1) the percentage of the adult population experiencing at least one major depressive episode in the past year, 2) the percentage of the adolescent population experiencing at least one major depressive episode in the past year, 3) the percentage of adults experiencing serious psychological distress, and 4) the average number of days in the last 30 days in which the population reported that their mental health was not good.

This report found significant variation among the states in the levels of depression and in its most tragic consequence: suicide. Rates of depression among the states vary from around seven percent in the least depressed states to over 10 percent in states where residents reported the highest levels of depression. This difference represents a nearly 40 percent variation from the least to the most depressed states.

To achieve top ranking in the country, South Dakota yielded the best results for the four measures used to develop a composite depression status indicator. Among adults, 7.31 percent experienced a major depressive episode in the past year and 11.16 percent experienced serious psychological distress. Among adolescents, 7.4 percent had a major depressive episode in the past year. On average, South Dakotans reported 2.41 poor mental health days per month. Even though South Dakota ranked well in overall depression status, it is also important to note that the state had an age-adjusted suicide rate of 14.85, ranking South Dakota 40th in the nation, which is 300 percent higher than the District of Columbia, which has the lowest suicide rate.

Utah ranked 51st in depression status. For both adults and adolescents, 10.14 percent reported experiencing a major depressive episode in the past year. Among adults, 14.58 percent experienced serious psychological distress. On average, residents of Utah reported 3.27 poor mental health days per month.

“Despite the fact that some states do better than others on rates of depression and suicide, no state can be satisfied with its current status,” continued Shern. “These rates can be driven lower by encouraging state policies designed to improve coverage, end discriminatory practices in insurance, and assure that qualified mental health professionals are available to serve everyone in need.”

The top ten “least depressed” states are: 1) South Dakota, 2) Hawaii, 3) New Jersey, 4) Iowa, 5) Maryland, 6) Minnesota, 7) Louisiana, Illinois, 9) North Dakota, and 10) Texas. The bottom ten “most depressed” states are: 42) Wyoming, 43) Ohio, 44) Missouri, 45) Idaho, 46) Oklahoma, 47) Nevada, 48) Rhode Island, 49) Kentucky, 50) West Virginia, and 51) Utah.

Mental Health America (formerly known as the National Mental Health Association) is the country’s leading nonprofit dedicated to helping all people live mentally healthier lives. With our more than 320 affiliates nationwide, we represent a growing movement of Americans who promote mental wellness for the health and well-being of the nation.

“Ranking America’s Mental Health: An Analysis of Depression Across the States” was supported through an unrestricted educational grant from Wyeth Pharmaceuticals.

“There’s no doubt that soldiers can suffer considerable trauma in conflict zones, and it goes without saying that for people experiencing trauma on a daily basis, mental health care should be an absolute priority.

In recent months more and more ex-servicemen have been contacting Mind not knowing where to go for help, highlighting that the need for specialist mental health care has become increasingly urgent.

The Government’s plans to extend mental health services to all war veterans are a considerable improvement on current policy, which has in the past excluded people from much needed after-care, and seen others queuing up for urgent treatment.

Whilst these plans are a step in the right direction, we now need the Government to invest new funds in long-term care and support, including regular mental health check-ups for servicemen, and increasing the range of support they can access so that this very unique need can be fully met.”

Notes:

Mind is the leading mental health charity in England and Wales.

We work to create a better life for everyone with experience of mental distress.