We should keep in mind that certain countries, particularly those within the former soviet sphere use or have use psychiatric diagnosis and treatment as a means of political repression.
http://en.wikipedia.org/wiki/Political_abuse_of_psychiatry . http://schizophreniabulletin.oxfordjournals.org/content/36/1/33.full One wonders whether this fact account for the higher number of beds per capita in some of these countries? Miguel ----- Original Message ----- From: "Jim Clark" <j.cl...@uwinnipeg.ca> To: "Teaching in the Psychological Sciences (TIPS)" <tips@fsulist.frostburg.edu> Sent: Sunday, June 19, 2011 4:48:31 AM Subject: Re: [tips] Money Changes Everything: Mental Health Treatment Edition ----- Original Message ----- From: "Jim Clark" <j.cl...@uwinnipeg.ca> To: "Teaching in the Psychological Sciences (TIPS)" <tips@fsulist.frostburg.edu> Sent: Sunday, June 19, 2011 4:48:31 AM Subject: Re: [tips] Money Changes Everything: Mental Health Treatment Edition Hello again (last time today!) I went to WHO site for psychiatric beds per 10,000 population and extracted Europe + Canada + USA into SPSS. Below is ranking from high to low. USA falls in the middle of the pack of these select countries, 26 out of 42. Many other parts of the world have far fewer beds than these generally more developed countries. country psybeds10k rank Belgium 22.1 1.000 Canada 19.3 2.000 Netherlands 18.7 3.000 Latvia 13.8 4.000 Switzerland 13.2 5.000 France 12.0 6.500 Norway 12.0 6.500 Russian Federation 11.5 8.000 Czech Republic 11.4 9.000 Luxembourg 10.5 10.000 Estonia 10.2 11.000 Croatia 10.1 12.000 Finland 10.0 13.500 Lithuania 10.0 13.500 Hungary 9.6 16.000 Serbia and Montenegro 9.6 16.000 Ukraine 9.6 16.000 Ireland 9.4 18.000 Slovakia 9.0 19.000 Greece 8.7 20.000 Slovenia 8.5 21.000 Bulgaria 8.3 22.000 The former Yugoslav Republic of Macedonia 8.2 23.000 Belarus 8.0 24.000 Poland 7.8 25.000 United States of America 7.7 26.000 Romania 7.6 27.000 Germany 7.5 28.500 Portugal 7.5 28.500 Azerbaijan 7.1 30.500 Denmark 7.1 30.500 Republic of Moldova 6.7 32.000 Austria 6.5 33.000 Sweden 6.0 34.000 United Kingdom of Great Britain and Northern Ireland 5.8 35.000 Iceland 5.0 36.000 Armenia 4.8 37.000 Italy 4.6 38.000 Spain 4.4 39.000 Bosnia and Herzegovina 3.6 40.000 Albania 2.5 41.000 Georgia 2.1 42.000 Take care Jim James M. Clark Professor of Psychology 204-786-9757 204-774-4134 Fax j.cl...@uwinnipeg.ca >>> "Jim Clark" j.cl...@uwinnipeg.ca> 19-Jun-11 10:30 AM >> Hi I was surprised by the high number of beds for the USA given all the concerns expressed about finding beds for people with psychiatric problems. When I went to the original source cited at the following link (the WHO Atlas for 2005), I found quite different values for number of psychiatric beds: 7.7 per 10,000 for the USA versus 19.34 for Canada. Not sure how source below came up with their figures (which also seem to be wrong for at least some other countries as well), unless it was some major error converting per 10,000 to per 100,000. Assuming expenditure figures were correct below, seems that money in USA goes to something besides psychiatric hospital beds. Take care Jim James M. Clark Professor of Psychology 204-786-9757 204-774-4134 Fax j.cl...@uwinnipeg.ca >>> "Jim Clark" j.cl...@uwinnipeg.ca> 19-Jun-11 7:19 AM >> Mike is correct to point out the more complete presentation in the article itself. I was just responding to the last comment emphasizing disempowerment in his post. On the matter of "money changes everything," I was curious about the state of mental health funding and services in the USA since it is known that the USA spends more per capita on health care than most other developed countries and the article only alluded to relative changes due to government cutbacks. I was also struck by the fact that the victim was very poorly paid by a company with a contract for $43 million (if memory serves me right). It would be interesting to know what percentage of that $43 million went to non-service costs. I found an interesting summary of relevant statistics at http://www.mentalhealthresearch.ca/Publications/Documents/AMHB_Statistics_pktbk07_eng.pdf The USA actual spends about an average percent of total health care spending on mental health (7.5%, p. 51) relative to the comparison countries. Canada spends 5%, UK about 12%. But given larger base for USA (i.e., larger health care expenditures), USA would rank higher on per capita expenditures on mental health. Not clear what an "ideal" figure would be, and of course this includes both public and private expenditures, which could mask considerable inequities in spending. Hollywood alone (Charlie Sheen?) must add considerably to USA expenditures. In any case, the amount of money in the "system" appears to be not out of line with other countries, although perhaps there is room for improvement in allocation. Given the difficulty of modifying the health care system in the USA, I'm not too optimistic about radical changes any time soon. Moreover, USA has more psychiatric beds (p. 31) than comparison countries despite trend to transfer services to communities. Not clear that everyone would have equal access to these beds. With respect to mental health professionals, USA has average per capita number of psychiatrists (p 33) and psychologists (p 35) but markedly fewer psychiatric nurses (p 37) and social workers (p 39). Latter might perhaps be ideally expected to provide the kinds of service involved in monitoring and staffing group homes? So, money might indeed change everything, IF properly distributed. Take care Jim James M. Clark Professor of Psychology 204-786-9757 204-774-4134 Fax j.cl...@uwinnipeg.ca >>> "Mike Palij" <m...@nyu.edu> 18-Jun-11 7:45 PM >>> On Fri, 17 Jun 2011 21:15:27 -0700, Jim Clark wrote: >Hi >I'm struck by the last sentence in Mike's quote from the panel. Is it >really the case that disempowerment is what leads people (in general or >just those with mental illness?) to be violent? How is that any less an >over-generalization and stigmatizing about poor people than asserting >that people with mental illness are likely to be violent? I don't think that the article asserts that the reduction/degradation/elimination of publicly available sources (the rich can take care of their own) is what causes people with schizophrenia or other psychotic disorder to be violent -- the article points out that these "consumers" in general are not violent and it is only those consumers who have a substance abuse problems that tend to have a higher rate of violence. I think that the article is trying to point out that if we are going to try to integrate the people with mental illness into the general population, then a certain level of services needs to be provided to make sure that they stay on appropriate medication, continue to learn how to deal effectively with problems or stressors in everyday life, and other supports that they need in order to engage in activities of daily living. If these services cannot be provided because of budgetary concerns, should one be surprised that consumers might stop taking their meds, might start to self-medicate with alcohol or illicit drugs, and might start to engage in behaviors that may be socially objectionable and possibly self-destructive as well as harmful to others? If the services are not there to prevent this cascade of negative events, isn't it clear that the lack of services played a critical role in allowing a series of bad events to occur? But what do I know, I'm not a clinician and I presume that a clinician on TiPS can explain this situation better than I. -Mike Palij New York University m...@nyu.edu --- You are currently subscribed to tips as: j.cl...@uwinnipeg.ca. To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13251.645f86b5cec4da0a56ffea7a891720c9&n=T&l=tips&o=11048 or send a blank email to leave-11048-13251.645f86b5cec4da0a56ffea7a89172...@fsulist.frostburg.edu --- You are currently subscribed to tips as: j.cl...@uwinnipeg.ca . To unsubscribe click here: http://fsulist.frostburg.edu/u?id=13251.645f86b5cec4da0a56ffea7a891720c9&n=T&l=tips&o=11050 (It may be necessary to cut and paste the above URL if the line is broken) or send a blank email to leave-11050-13251.645f86b5cec4da0a56ffea7a89172...@fsulist.frostburg.edu --- You are currently subscribed to tips as: j.cl...@uwinnipeg.ca . 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