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Parity & Access: CO Medicaid is a Pretty Mixed Bag

4/10/2018

Like so many things in life ---including ourselves --- CO Medicaid Compliance with mental health parity is a "MIXED BAG."

CHALLENGES

State denial of its legal responsibility to "CHANGE RATE SETTING" in order to come in compliance with Parity.
Network Inadequacy for both inpatient and intensive community mental health treatment
Network Inadequacy for both inpatient and intensive community substance use treatment.
Processes, strategies, evidentiary standards, and other factors that discriminate against people with mental illness and substance use issues resulting in incarceration.
This also includes the homeless population, many of whom have mental health or substance use issues
Our Medicaid processes and strategies for ACCESS to services have to be reasonably designed to fully address the needs of the population in question.

CO Medicaid Has Made Some Big Steps in the Right Direction

CO Medicaid does have a presence in the County Jails and with the Homeless population-- It needs to be A LOT BIGGER if it is going to meet the need.
Our understanding is that on paper Assertive Community Treatment is now available to all where there is "reasonable medical necessity." We don't think Colorado has Network Adequacy for that, a screening tool, or adequate access.
Normally, we wouldn't be that concerned about a screening tool -- but historically both the State and the Mental Health Centers have resisted addressing the needs of the neediest clients -- that's how they wind up in the Criminal Justice System and Homeless. Coloradans with intensive mental health needs --- need protection.
Further, Assertive Community Treatment is little bit like Open Heart Surgery --nobody asks for it [further most people have never heard of it -- it's the gold standard in intensive community mental health treatment].
Rather a mental health professional recommends it because it is better than the alternatives, namely incarceration, homelessness, the mental institute, or the nursing home.-

HHS Gives a Glimpse of Mental Health Parity Enforcement

February 16, 2018

The key takeaways are:

Make sure your plan is being administered consistently for mental health/substance use disorder benefits and for medical/surgical benefits. If you get wind of a requirement that seems to be imposed more restrictively on mental health/substance use disorder benefits, raise it with your insurer or third party administrator.
Make sure your plan documents reflect reality. If you are imposing rules on participants, the plan documents should reflect that.

https://www.hubinternational.com/products/employee-benefits/compliance-bulletins/2018/02/mental-health-parity-enforcement/

HCPF is Misstating Parity Law on Youtube We Have A Big Problem with that, We've Got An Even Bigger Problem with HCPF's Misapplication of Parity in CO Medicaid

CMS Parity Toolkit, p. 34

As a result, the NQTL [Non-Quantitative Treatment Limitations] analysis can be divided into two parts:

1. Evaluate the comparability of:

the processes,
strategies,
evidentiary standards, and
other factors

(in writing and in operation) used in applying the NQTL to MH/SUD benefits and M/S benefits.

2. Evaluate the stringency with which:

the processes,
strategies,
evidentiary standards and
other factors

(in writing and operation) are applied to MH/SUD benefits and M/S benefits.

Psychiatric News from the American Psychiatric Association

Enforcement of Parity Law Broadens to Include New Areas of Insurer Violations

"Irvin “Sam” Muszynski, J.D., APA’s [American Psychiatric Association] senior policy advisor and director of parity enforcement and implementation, said that the encompassing problem is “network inadequacy”—health plan provider networks that have few mental health professionals available to treat patients.

"In some cases, health plans have been found to have “phantom networks” that may include physicians who are no longer accepting patients, have moved out of a geographic area, or—in some cases—are deceased.

Hufford and Muzsynski said that an especially prominent problem that contributes to network inadequacy is the practice of discriminatory reimbursement for mental health.

“We hear constantly of inadequate provider networks resulting in patients being on extraordinarily long waiting lists or otherwise having great difficulties finding in-network providers,” Hufford said.

"We think that a big cause of this problem is that reimbursement for behavioral health providers is so poor.

"If we can collect evidence of the fact that reimbursement for behavioral health is much more restrictive than it is for medical care, we believe this can serve as an important part of a parity law claim.”

https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.201 0 7.5b30

Think Advisor

"Consultants at Milliman Inc. have come up with hard numbers that may back up an allegation patients and providers have been making for years: that many health insurers have skimpy mental health and addiction treatment services provider lists."

https://www.thinkadvisor.com/2017/11/30/milliman-finds-huge-mental-health-care-access-gap/?slreturn=20180310202644

HCPF is Misstating Parity Law on Youtube We Have A Big Problem with that, We've Got An Even Bigger Problem with HCPF's Misapplication of Parity in CO Medicaid

4/10/2018

Let's Look @ the CFR

The State is relying on 2 sections of the CFR for their arguments that really parity doesn't require States to provide any additional MH/SUD benefits kinda no matter what if it is outside "contractual obligations," 42 CFR 438.920 (c) (1) and (2)

What does 42 CFR 438.920 (c) (1), (2), AND (3) actually say?

(1) Require a MCO, PIHP, or PAHP to provide any mental health benefits or substance use disorder benefits beyond what is specified in its contract, and the provision of benefits by a MCO, PIHP, or PAHPfor one or more mental health conditions or substance use disorders does not require the MCO, PIHP or PAHP to provide benefits for any other mental health condition or substance use disorder;

(2) Require a MCO, PIHP, or PAHP that provides coverage for mental health or substance use disorder benefits only to the extent required under 1905(a)(4)(D) of the Act to provide additional mental health or substance use disorder benefits in any classification in accordance with this section; or

(3) Affect the terms and conditions relating to the amount, duration, or scope of mental health orsubstance use disorder benefits under the Medicaid MCO, PIHP, or PAHP contract except as specifically provided in §§ 438.905 [Parity requirements for aggregate lifetime and annual dollar limits] and 438.910 [Parity requirements for financial requirements and treatment limitations].

Let's Look @ 42 CFR 438.910(d)?

(d)Nonquantitative treatment limitations -

(1)General rule. A MCO, PIHP, or PAHP may not impose a nonquantitative treatment limitation for mental health or substance use disorder benefits in any classification unless, under the policies and procedures of the MCO, PIHP, or PAHP as written and in operation, any processes, strategies, evidentiarystandards, or other factors used in applying the nonquantitative treatment limitation to mental health orsubstance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation for medical/surgical benefits in the classification.

(2)Illustrative list of nonquantitative treatment limitations. Nonquantitative treatment limitationsinclude -

(i) Medical management standards limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative;

(ii) Formulary design for prescription drugs;

(iii) For MCOs, PIHPs, or PAHPs with multiple network tiers (such as preferred providers and participating providers), network tier design;

(iv) Standards for provider admission to participate in a network, including reimbursement rates;

(v) MCO, PIHP, or PAHP methods for determining usual, customary, and reasonable charges;

(vi) Refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective (also known as fail-first policies or step therapy protocols);

(vii) Exclusions based on failure to complete a course of treatment;

(viii) Restrictions based on geographic location, facility type, provider specialty, and other criteria that limit the scope or duration of benefits for services provided under the MCO, PIHP, or PAHP; and

(ix) Standards for providing access to out-of-network providers.

(3)Application to out-of-network providers. Any MCO, PIHP or PAHP providing access to out-of-network providers for medical/surgical benefits within a classification, must use processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for mental health or substance use disorder benefits that are comparable to, and applied no more stringently than, the processes, strategies, evidentiary standards, or other factors in determining access to out-of-network providers for medical/surgical benefits.

"
According to HCPF:

"What the Law Does NOT Require?"

A MCO or BHO to provide MH/SUD benefits outside the contractual Obligations. (42 CFR 438.920 (c)(1)"

That is just FALSE and/or MISLEADING --- According to CMS, It's Really about "Changing Rate Setting" "States will include the cost of providing additional services or removing treatment limitations in their capitation rate methodology for affected managed care plans." [See CMS Document below] .

"A MCO or BHO that provides MH/SUD benefits to provide additional MH/SUD benefits due to the parity rule. (42 CFR 482.920 (c)(2)

This is also FALSE and/or MISLEADING for the reasons stated above.

Quoting From CMS Document Above:

Frequently Asked Questions: Mental Health and Substance Use Disorder Parity Final Rule for Medicaid and CHIP
October 11, 2017:

The final rule requires that all beneficiaries who receive services through managed care organizations, alternative benefit plans, or CHIP be provided access to mental health and substance use disorder benefits that comply with parity standards, regardless of whether these services are provided through the managed care organization or another service delivery system.

States are required to include contract provisions requiring compliance with parity standards in all applicable contracts for these Medicaid managed care arrangements that provide services to enrollees in managed care organizations, including prepaid inpatient health plans or prepaid ambulatory health plans.

In contrast to the proposed rule, this final rule also extends parity protections to apply to long term care services for mental health and substance use disorders in the same manner that they are applied to other services.

Key Provisions for Medicaid Managed Care Organizations Under the final rule, states that have contracts with managed care organizations are required to meet the parity requirements regarding financial and treatment limitations consistent with the regulation applicable to private insurers.

States will include the cost of providing additional services or removing treatment limitations in their capitation rate methodology for affected managed care plans.

By allowing changes to the managed care rate setting process, the rule also provides each state with flexibility to enable Medicaid managed care organizations to fully comply with the rule by including additional costs necessary to include extra services or remove treatment limits without changing the state’s non-alternative benefit plans and state plan.

In addition, the final rule requires managed care entities to make available upon request to beneficiaries and contracting providers the criteria for medical necessity determinations with respect to mental health and substance use disorder benefits.

The rule also directs managed care plans to make available to the enrollee the reason for any denial of reimbursement or payment for services with respect to mental health and substance use disorder benefits.

Inter-Generational Trauma: Confirming the Wisdom of Indigenous People To Consider the Impact of Our Decisions on the 7 Generations

4/9/2018

There is so much that INTERGENERATIONAL TRAUMA has to teach us.
One of those things is how we need to be making Laws & Public Policy with future generations in mind.
I think that appreciation that what we are doing or not doing can affect generations to come is:

centering and grounding
it is humbling, and
it gives each human being an enormous responsability and duty.

With such heavy responsibilities, we'll need plenty of time for:

healthy food
music
dancing, and
FUN.

Trauma, Intergenerational Trauma, the Complicated Nature of Mental Disorders & Human Behavior --- & Due Process of Law

4/8/2018

Trauma is an extremely important factor in mental illness-- it is one of many complicated factors.
What do findings on "Intergenerational Trauma" and just the complicated nature of mental disorders and human behavior have to do with the criminal law.
Well, it means we still have to provide safety for the community. BUT letting go of punishment and make placement decisions based on our best assessments of safety is really ethically and morally required.
How can we say we are providing due process, if we're pretending to knowledge regarding human behavior we don't have?
There are a lot of things that can assault our immune systems and ultimately our brains and those assaults over a lifetime may be more individual than a fingerprint --- hence, the incredible need for personalized integrated physical and mental health care.
"Lives Are In the Balance" -- let's address the problems -- including Safety -- and let go of punishment.

Dr. Robert Sapolsky is a professor of biology, neurology and neurological sciences, and neurosurgery @ Stanford University

"You are never really going to understand what is going on if you get it into your head that you're going to be able to explain everything with this is--

the part of the brain
the childhood experience
the hormone
the gene
or the evolutionary mechanism

---That explains everything.

"It doesn't work that way. Instead any behavior is the result of biology that occurred a second ago, hours ago, days ago -- a million years ago."
. . . .

"O000h it's complicated. Well, that's very useful.

"How 'bout, 'OOOh it's complicated and you better be really careful and really cautious before you think you understand the causes of a behavior, especially if it's a behavior you judge harshly.' "
. ------Prof. Robert Sapolsky Stanford

Suicide Ideation and Attempts among First Nations Peoples Living On-Reserve in Canada: The Intergenerational and Cumulative Effects of Indian Residential Schools

Canadian Journal of Psychiatry (June 2017)

Conclusion:

Findings support the existence of linkages between intergenerational exposure to IRS [Indigenous Residential Schools] and risk for suicidal ideation and attempts and for a potential cumulative risk in relation to suicide attempts across generations.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455875/

Trauma, mental health, and intergenerational associations in Kosovar Families 11 years after the war

European Journal of Psychotraumatology
(2013)

Conclusion

Eleven years after the Kosovo war, the presence of posttraumatic stress, anxiety, and depressive symptoms in civilian adults and their children is still substantial.

As symptoms of parents and children are associated, mental health problems of close ones should be actively screened and accounted for in comprehensive treatment plans, using a systemic approach.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3744842/

Physical and mental health of Afghan, Iranian and Somali asylum seekers and refugees living in the Netherlands.

BMC Public Health (2004)

A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms.

CONCLUSIONS:

Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands.

Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC385239/

Integrated Physical & Mental Health Part 6: Even CO's Mental Health Waiver Doesn't Have Mental Health Services & We Think Violates the Mental Health Parity & Addiction Equity Act

4/7/2018

For a lot of people with Mental Illness who are in nursing homes, mental institutes, homeless, or incarcerated, they have both housing needs and sometimes pretty intensive service needs.
For people in the:

nursing homes
mental health institutes

There is sometimes a fair amount of concern that "supervision" needs won't be adequately provided in the community.
In 2015, the CO Department of Health Care Policy & Financing determined that "SUPERVISION" was no longer enough to qualify for the CMHS Waiver-- one needed assistance with Activities of Daily Living (ADLs).
We think this is a violation of the Mental Health Parity and Addiction Equity Act.
There are probably a lot of reasons for that change in targeting criteria -- MONEY being #1.
Putting Assertive Community Treatment as a waiver service we think might be a good way to target it and make it's availability known.
We have asked the State numerous times to re-visit this waiver and create a stakeholder group to do it We never heard anything on that.
We are pretty CHALLENGED in our ability to work with this State -- we don't want to come off as BELLIGERENT or IMPOLITE and we need a fair number of things addressed. Below are just 2 of many:

Somebody is going to have to re-work the CMHS waiver to make it more relevant to people with mental health issues.
Also it appears to discriminate against people with substance use issues in violation of the Mental Health Parity & Addiction Equity Act.

Montana—Home and Community Based Waiver for Adults With Severe Disabling Mental Illness • Section 1915(c) waiver

• Services:

case management,
adult residential care,
supported living,
adult day health,
personal assistance and "specially trained" attendant care,
habilitation,
homemaking,
respite care,
outpatient occupational therapy,
psychosocial consultation including extended mental health services,
chemical dependency counseling,
dietetic and nutrition services,
nursing services,
personal emergency response systems,
specialized medical equipment and supplies,
nonmedical transportation,
illness management and recovery, and
wellness recovery action plan

• Objective: allow an individual with a severe, disabling mental illness a choice of receiving long-term care services in a community setting as an alternative to a nursing home setting.
• Eligibility: individuals with mental illness aged 18 years and older; the consumer must meet nursing home level of care requirements and reside in an area of the state where the waiver is available.

CO Community Mental Health Supports [CMHS] Waiver

CO's Elderly, Blind & Disabled [EBD] Waiver

Integrated & Physical Health Part 5: Coming To Terms with the Needs of People with Significant Physical Disabilities on the Psych Ward

4/5/2018

Power wheelchairs have been a big issue in Assisted Living Residence.
Most of those cases are analyzed under:

the Fair Housing Act
the Americans with Disabilities Act (ADA), and
Section 504 of the Rehabilitation Act of 1973

With respect to power wheelchairs in hospitals, that would be analyzed we think primarily under:

the ADA and
Section 504 of the Rehabilitation Act of 1973

So one of my very good friends and colleagues that I first met through Atlantis started telling me about problems that she had @ a major Denver Hospital.
My friend said that the hospital would not admit her to the psych ward because she had a power wheelchair -- this even though her doctor had referred her to the hospital.
It should also be said that my friend and colleague has significant attendant care needs involving transferring, feeding, etc.
Well, so the Hospital just put her in a different area of the hospital -- right? It may not be ideal but its better than nothing.
Wrong, this major hospital would NOT admit a person with a power wheelchair and significant physical needs based on her mental health issues.
Now that happened at least 5 years ago.
Whenever I see my friend and colleague, I always ask is getting hospital level psychiatric care for people with significant physical disabilities still a problem?
She has always answered, "Yes and let tell you what happened to a friend of mine."
  So I think there are at least a couple of issues:

the power wheelchair, and also
Attendant Care

I think it might be helpful to create a Stakeholder Group through the CO Department of Health Care Policy & Financing.
I'm pretty sure my friend and colleague would like to be a part of that group

Physical & Mental Health Integration Part 4: Dragging Colorado Acute Treatment Units into the 21st Century-- Diabetes and MI

4/4/2018

So failure to accommodate PHYSICAL DISABILITY for people with mental illness is unfortunately very common.
We're going to break this into 3 Parts and include it in the multi-part series on Physical & Mental Health Integration.
So the three parts are primarily going to look @ diabetes and power wheelchairs involving situations we are personally familiar with:

Part 1: Diabetes in the ATU [Acute Treatment Unit]
Part 2: Power wheelchairs on the Psych Ward of a Hospital
Part 3: Sliding Scale or Fragile Diabetes in the Community

The important thing to remember with the Americans with Disabilities Act (ADA) is that it mandates "reasonable accommodations."
More often than not blanket prohibitions are NOT reasonable.
There really needs to be an individual assessment.
Further, just because it might cost some money --- doesn't mean it's an undue hardship. What's reasonable is determined by the context, etc.
If someone is running an ATU they need to be able to serve people with mental illness who have other disabilities and
illnesse---that definitely includes DIABETES.
Do we really have to say that, we think we do.
When it comes to diabetes, we have to have ATUs that can handle that --- diabetes is a big part of a lot of people's lives with mental illness.
A lot of this is about complying with the ADA -- but a big chunk of it is just dragging ourselves into the 21st Century.

"Psychiatrists and diabetologists need to work together"

http://www.thelancet.com/diabetes-and-mental-health-disorders#

40% of people with Type 1 Diabetes have a Mental Health Condition.

Schizophrenia linked to increased risk of Type 2 Diabetes

Long Video from Australia's Mental Health Professionals Network

"By watching this webinar recording you will:

Improve your understanding of the bi-directional relationship between diabetes and mental health
Identify the role of different disciplines in contributing to the screening and diagnosis, assessment and treatment of mental illness in people with diabetes

Explore tips and strategies for interdisciplinary collaboration in supporting people with diabetes and mental illness."

Integrated Physical & Mental Health: Part 3 Expanded Care Teams & Cross Training

4/3/2018

Psychoneuroimmunology--is made up of many disciplines:

neurosciences,
immunology,
pharmacology,
psychiatry,
behavioral medicine,
infectious diseases,
endocrinology and
rheumatology,

addressing the interactions between the nervous system and the immune system, and the relationship between behavior and health.

We would like to see Medicaid Integrated Physical & Mental Health have Expanded Teams, including quarterly updates on significant issues and the latest research thru integrated trainings.

On those teams we would like to see the disciplines associated with psychoneuroimmunology. In addition, we would want to see included:

gastro-enterology
dietetics and nutrition, and
neuro-pharmacology

This is a short video with Frank DeGruy, MD, MSFM, Chair of the Department of Family Medicine at the University of Colorado School of Medicine, on the components of the integrated care core team:

primary care provider
behavioral health provider; and
care manager

As a core team, that may make a lot of sense-- yet we really feel it is important to bring the specialists in as an Expanded Team -- if nothing else to learn from one another.

Mental Health Care is expanding rapidly in the fields of:

immunology
gastroenterology; and
dietetics and nutrition

Just for 2018, PubMed is making available hundreds of new research articles on the topics above.

Ultimately, there will probably be a lot of cross training in the medical schools and universities--but right now professionals are needing those kinds of cross training opportunities NOW.

CO's Integrated Physical & Mental Health System: Part 2 -- the Immune System -- There's A Lot to Integrate

4/2/2018

"The Immune System Does Produce Behavior"
-----------Prof Sir Robert Lechler, President of the Academy of Medical Sciences, United Kingdom

"The key issue . . . is what's driving the mental ill health is not so much a change in the brain, but a change in the immune system, an auto-immune disease that's causing the aberrant behaviour,"

------------Professor Ian Hickie of the University of Sydney's Brain and Mind Centre, Australia

What should the Research below mean for Colorado's Integrated Physical & Mental Health System. I'll share some ideas tomorrow.

Prof. Sir Robert Lechler, President of the Academy of Medical Sciences, United Kingdom

The Telegraph (UK)

“You can’t separate the mind from the body,” said Prof Sir Robert Lechler, President of the Academy of Medical Sciences.

“The immune system does produce behaviour. You’re not just a little bit miserable if you’ve got a long term condition, there is a real mechanistic connection between the mind, the nervous system and the immune system.

“Our model of healthcare is outdated.

"We have a separation. Mental healthcare is delivered by mental health professionals, psychiatrists, mental health nurses and so on, often in separate premises from where physical health care is delivered and that is simply wrong and we need to find ways to ever more closely integrate and train amphibious healthcare professionals who can straddle this divide.”

"Research has also shown that people who have suffered severe emotional trauma in their past have inflammatory markers in their body, suggesting their immune system is constantly firing, as if always on guard against abuse."
. . .

One promising treatment for depression on the horizon is the use of electrical stimulation to change the signals between the brain and the immune system.

Prof Kevin Tracey, President and CEO, of the US Feinstein Institute for Medical Research, discovered that the brain controls production of a deadly inflammatory chemical called TNF, which if released in high doses can be fatal, causing people to, literally, die of shock.

He has recently developed a electrical device which reproduces the connection and switches off the chemical. Three quarters of patients with rheumatoid arthritis recovered following trials.

“This is the tip of the iceberg of a new field called bio-electric medicine,” he said.

“This is a new way of thinking about medicine. We’re using electrons to replace drugs. This will not replace all drugs. But there will be many drugs that are either too expensive, too toxic which may be replaced by these devices.”
http://www.telegraph.co.uk/science/2017/09/08/depression-physical-illness-could-treated-anti-inflammatory/

Prof. Ian Hicke with the University of Sydney's Mind Brain Institute, Australia

ABC News Australia

"The key issue there is what's driving the mental ill health is not so much a change in the brain, but a change in the immune system, an auto-immune disease that's causing the aberrant behaviour," he said.

Professor Hickie said immune therapies had already worked for a significant number of cases.

He said the link between a poor immune system and mental illness had previously been thought to be an unusual one, and only present in certain cases.

"It's not rare, we don't often look hard enough," he said.

"We haven't had in the past the technologies or the laboratory tests to confirm that a number of these disorders, a significant minority of these disorders actually have an immune basis."

He said the challenge now was to find the right combination of therapies for an individual, as some might require a boost to the immune system, while others a suppression.

The research provided a strong argument for early intervention he said.

http://www.abc.net.au/news/2016-05-27/mental-health-study-a-boon-to-patients-immune-system/7455310

‘Drain Pipes’ in the Brain: Lymphatic Vessels Act As Pipeline Between Brain and Immune System
http://neurosciencenews.com/lymphatic-vessels-brain-7646/

Learn more about Psychoneuroimmunology
https://www.sciencedirect.com/topics/neuroscience/psychoneuroimmunology

Oslo University Hospital, Norway

The Brain-Immune -Gut Triangle: Innate Immunity in Psychiatric & Neurological Disorders
https://www.researchgate.net/publication
/261994663_The_Brain-Immune-Gut_Triangle_Innate_Immunity_in_
Psychiatric_and_Neurological_Disorders

See Also: The Emerging Link Between Autoimmune Disorders and Neuropsychiatric Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3086677/

What Does The Environment Have To Do With Diseases Affecting The Immune System
https://ensia.com/features/environment-diseases-immune-system/

University of California @ San Francisco,Psychiatry Dept. & VA

Elevated Risk for Autoimmune Disorders in Iraq and Afghanistan Veterans with Post-Traumatic Stress Disorder (2014)

http://www.biologicalpsychiatryjournal.com/article/S0006-3223(14)00457-0/fulltext

Childhood Trauma Can Result in Chronic Inflammation which can affect the Immune System (2012)

http://www.medicaldaily.com/childhood-trauma-can-result-chronic-inflammation-241114

Houston Methodist Research Center

Summary: A major finding from researchers at Houston Methodist reveals a significant number of people diagnosed with schizophrenia or bipolar disorder may actually have a treatable immune system disorder.

The condition causes NMDA receptors to stop functioning properly and can result in symptoms commonly associated with neuropsychiatric disorders.

Source: Houston Methodist.

“We suspect that a significant number of people believed to have schizophrenia or bipolar disorder actually have an immune system disorder that affects the brain’s receptors,” said Joseph Masdeu, M.D., Ph.D., the study’s principal investigator and a neurologist with the Houston Methodist Neurological Institute.

“If true, those people have diseases that are completely reversible – they just need a proper diagnosis and treatment to help them return to normal lives.”
Houston Methodist Research Center
http://neurosciencenews.com/schizophrenia-immune-disorder-bipolar-8179/

Possible linkages between Childhood Trauma -- Inflammation -- Damage to Immune System -- & Ultimate Mental Illness

Social Behavior & the Immune System

Integrated Physical & Mental Health: Part 1 -- The Gut

3/31/2018

Note August 2, 2024:

My current views are more complicated than represented by this blog.

Especially with regard to "diet" we have gone through and continue through various recommendations.

Diet and Exercise are important but if there is not an appreciation of Neuro-Developmental Disorders, and there often isn't, the results can be less than helpful if not harmful.
------------------------------------------

There is enormous irony in this blog --pontificating on the benefits of healthy eating when I myself have gone to great lengths to resist the practice. My parents if they were alive would think this is hilarious.
Nonetheless, it is because I have been such a poor and picky eater for most of my life, that I understand how severe the consequences can really be: affecting not just one's physical health but
mental health as well.
Throughout history the recognition of the connection between mental health and diet has fluctuated. It is currently gaining a new sense of urgency with the increased understanding of the IMMUNE-GUT-BRAIN triangle.
So that diet and the gut microbiome, don't just affect one's mental health a little bit -- BUT A LOT.
Further with the recognition of the IMMUNE-GUT-BRAIN Axis, it is not a huge leap to view immune and gut problems as potential indicatiors of mental health problems.

"W]e need to reconsider nutritional recommendations to focus on fibre in an attempt to restore proper composition and function of the ‘disappearing’ gut microbiome."

http://www.gutmicrobiotaforhealth.com/en/conserving-restoring-human-gut-microbiome-increasing-consumption-dietary-fibre/

https://articles.mercola.com/sites/articles/archive/2015/11/12/mental-health-gut-flora.aspx

Why the Mediterranean Diet Could Save Your Life
https://www.everydayhealth.com/sanjay-gupta/what-makes-the-mediterranean-diet-a-keeper.aspx

Stephen Covey

Well, I've certainly tried to break Light House Principles, most notably thinking I could eat whatever I wanted and it didn't matter. Well, it did break me and I think it may be breaking other people as well.

How Does Diet Effect Gut Health
https://www.bbcgoodfood.com/howto/guide/how-does-diet-affect-gut-health

How Artificial Sweeteners Wreak Havoc on Your Gut
https://chriskresser.com/how-artificial-sweeteners-wreak-havoc-on-your-gut/
(As I'm writing this, I'm drinking Seltzer Water and trying to resist a Diet Coke temptation)

How Trauma Effects Your Gut
https://saludmovil.com/how-trauma-affects-your-gut/3/

Georgia State University: "Social Stress Leads To Changes In Gut Bacteria"

March 2018

http://news.gsu.edu/2018/03/08/social-stress-leads-changes-gut-bacteria-study-finds/

Yale: "Gut Bacteria Drives Auto-Immune Diseases"

March 2018
http://neurosciencenews.com/gut-bacteria-autoimmune-disease-8614/
reported in the magazine "Science" and on the website Neuroscience News)

Links of gut microbiota composition with alcohol dependence syndrome and alcoholic liver disease

Oct. 17, 2017

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645934/

Gut microbiome interactions with drug metabolism, efficacy, and toxicity

"[T]herapeutic drugs themselves can have effects, both intended and unwanted, which can impact the health and composition of the gut microbiota with unforeseen consequences."

Published in Translational Research
Jan. 2017

https://www.sciencedirect.com/science/article/pii/S1931524416301591

Bidirectional Interactions Exist Between the Central Nervous System and the Gut Microbiota

"Bidirectional interactions exist between the central nervous system and the gut microbiota.

"During exposure to stressful stimuli, the physiological stress response can lead to alterations in gastrointestinal functioning, such as alterations to gastrointestinal motility and the secretion of factors like gastric acid and bile. The physiological stress response is also known to impact immune system activity.

"Both alterations to gastrointestinal functioning and immune system activity can significantly change the composition of the gut microbiota.

"These alterations to the microbiota can feedback and impact gastrointestinal functioning, immune system activity, as well as the physiological stress response and stressor-induced behavioral states."

https://www.frontiersin.org/articles/10.3389/fpsyt.2015.00005/full

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