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1.
Healthcare (Basel) ; 12(17)2024 Aug 31.
Article in English | MEDLINE | ID: mdl-39273765

ABSTRACT

Behavioral health professionals are at high risk for burnout and poor mental health. Our objective was to understand the impact of the Behavioral Health Providers Workforce Resiliency (BHPWR) ECHO Program on the resilience and burnout of participating behavioral health professionals. We assessed the first two years (March 2022 to March 2024) of the BHPWR ECHO, a national program operating from the University of New Mexico (N = 1585 attendees), using a mixed-methods design. We used a retrospective pre/post survey (n = 53 respondents) and focus interviews with 1-3 participants (n = 9 participants) to assess for changes in knowledge and confidence and assess changes in burnout and resilience. We found that participants increased their knowledge of how to respond when (1) their workload was more than they could manage, (2) they felt that they lacked control, (3) their work did not feel rewarding, and (4) they were experiencing compassion fatigue. They increased their confidence in (1) building a support system and (2) using the wellness tools taught in the course. Respondents were less burnt out (score: 26.0 versus 17.8, p < 0.01) and more resilient (29.9 versus 34.9, p < 0.01) compared to when they started attending the program. Tele-mentoring programs like the BHPWR ECHO Program may improve wellness among health care professionals.

3.
Curr Opin Psychiatry ; 37(4): 277-281, 2024 07 01.
Article in English | MEDLINE | ID: mdl-38726805

ABSTRACT

PURPOSE OF REVIEW: The pace of psychedelic treatments continues to increase. Regulation and coherent clinical guidance have not been established. A philosophical divide limits effective resolution of a practice delivery quandary: is this primarily a pharmacological or psychotherapeutic intervention? RECENT FINDINGS: Lykos (formerly MAPS) has submitted its new drug application (NDA) request to the FDA for 3-4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for PTSD and is expecting a response by the summer of 2024. Australia endorsed psilocybin and MDMA for regulated use in 2023. Multiple phase II and III clinical trials are also being conducted in the United States and Europe to study the use of psilocybin. Currently, Colorado and Oregon have legalized psilocybin in different manners. In Colorado, plants containing psilocybin, ibogaine, dimethyltryptamine (DMT) and mescaline (other than peyote) are now legal to possess, share and cultivate. Guidelines for regulated treatment with psilocybin containing mushrooms are in process with service delivery to begin early in 2025. In Oregon, clients must complete a preparation session with a licensed facilitator before consuming psilocybin products at a licensed service center. A prescription is not required. It is expected that other states will follow suit with a ballot measure likely in Massachusetts this year. Additionally, in the United States, the DEA, state boards, pharmaceutical distributors, and professional liability carriers all share mounting concerns about the in-home use of compounded ketamine used as a psychedelic therapeutic via remote prescribing. SUMMARY: Psychedelic treatments are rapidly entering the mainstream of medical care delivery in the United States. Clinical guidelines are urgently needed to ensure well tolerated practice and coherent regulation. The delivery of this guidance is limited by a core philosophical disagreement. Resolution of this conflict will be needed to deliver coherent clinical guidelines. Current research and clinical experience provide a solid foundation for practical clinical guidance and the introduction of psychedelics into healthcare.


Subject(s)
Hallucinogens , Hallucinogens/therapeutic use , Humans , Psilocybin/therapeutic use , Psychotherapy/methods , United States , N-Methyl-3,4-methylenedioxyamphetamine/therapeutic use , Stress Disorders, Post-Traumatic/drug therapy
4.
Neuropharmacology ; 219: 109214, 2022 11 15.
Article in English | MEDLINE | ID: mdl-35973601

ABSTRACT

There is mounting evidence suggesting psychedelic and entactogen medicines (namely psilocybin and 3,4-methylenedioxymethamphetamine [MDMA]), in conjunction with proper psychosocial support, hold the potential to provide safe, rapid acting, and robust clinical improvements with durable effects. In the US, both psilocybin and MDMA have been granted Breakthrough Therapy designations by the US Food and Drug Administration and may potentially receive full FDA approval with similar regulatory considerations occurring in multiple countries. At the same time, regulatory changes are poised to increase access to legal or decriminalized psychedelic use in various non-medical settings. This review provides a brief discussion on the historical use of psychedelic medicines, the status of the empirical evidence, and numerous significant policy considerations that must be thoughtfully addressed regarding standards-of-practice, consumer protection, engagement of communities, safeguarding access for all, and developing data standards, which supports the responsible, accountable, safe, and ethical uses of these medicines in clinical, faith-based, and other contexts. We provide suggestions for how public health and harm reduction can be supported through a public-private partnership that engages a community of stakeholders from various disciplines in the co-creation and dissemination of best practices and public policies.


Subject(s)
Hallucinogens , N-Methyl-3,4-methylenedioxyamphetamine , Substance Withdrawal Syndrome , Hallucinogens/therapeutic use , Humans , N-Methyl-3,4-methylenedioxyamphetamine/therapeutic use , Policy , Psilocybin/therapeutic use , Substance Withdrawal Syndrome/drug therapy
7.
J Am Acad Psychiatry Law ; 45(3): 311-315, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28939728

ABSTRACT

There is no agreement on how to manage hunger strikers. The health professionals called to intervene in a hunger strike are faced with a dilemma: commit themselves to good order and discipline or comply with best practices for providing healthcare. Handling cases of hunger strikers confronts practitioners with the ethics dilemma of managing apparent intentional behavior that carries serious morbidity or mortality, but recognizing that hunger striking is a military and political tactic, and not a medical condition. The study by Reeves, et. al published in the Journal enhances our understanding of the motives and psychology of hunger strikers. Their analysis indicates that improving communication with custody administration and mitigating unnecessarily aversive housing environments can likely reduce the incidence of hunger strikes.


Subject(s)
Conflict, Psychological , Ethics, Medical , Fasting , Prisoners/psychology , Humans
8.
Psychiatr Clin North Am ; 39(4): 623-631, 2016 12.
Article in English | MEDLINE | ID: mdl-27836156

ABSTRACT

Understanding the occurrence and nature of violence in the military entails appreciating military culture, the sociology and demographics of its personnel, military training, combat experiences, and injuries and illnesses that veterans suffer. The military is grounded in the principles and practice of conducting violent operations, and the psychology of violence fundamentally anchors its professionalism. The occurrence of unwanted violence and tragic incidence of suicides, homicides, and abuse expose the challenges to containing the behavior outside of the combat and training theaters.


Subject(s)
Military Personnel/psychology , Violence/psychology , Homicide , Humans , Suicide
12.
PLoS Med ; 8(4): e1001027, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21559073

ABSTRACT

BACKGROUND: In the wake of the September 11, 2001 attacks on the US, the government authorized the use of "enhanced interrogation" techniques that were previously recognized as torture. While the complicity of US health professionals in the design and implementation of US torture practices has been documented, little is known about the role of health providers, assigned to the US Department of Defense (DoD) at the US Naval Station Guantánamo Bay, Cuba (GTMO), who should have been in a position to observe and document physical and psychological evidence of torture and ill treatment. METHODS AND FINDINGS: We reviewed GTMO medical records and relevant case files (client affidavits, attorney-client notes and summaries, and legal affidavits of medical experts) of nine individuals for evidence of torture and ill treatment and documentation by medical personnel. In each of the nine cases, GTMO detainees alleged abusive interrogation methods that are consistent with torture as defined by the UN Convention Against Torture as well as the more restrictive US definition of torture that was operational at the time. The medical affidavits in each of the nine cases indicate that the specific allegations of torture and ill treatment are highly consistent with physical and psychological evidence documented in the medical records and evaluations by non-governmental medical experts. However, the medical personnel who treated the detainees at GTMO failed to inquire and/or document causes of the physical injuries and psychological symptoms they observed. Psychological symptoms were commonly attributed to "personality disorders" and "routine stressors of confinement." Temporary psychotic symptoms and hallucinations did not prompt consideration of abusive treatment. Psychological assessments conducted by non-governmental medical experts revealed diagnostic criteria for current major depression and/or PTSD in all nine cases. CONCLUSION: The findings in these nine cases from GTMO indicate that medical doctors and mental health personnel assigned to the DoD neglected and/or concealed medical evidence of intentional harm.


Subject(s)
Health Personnel/ethics , Military Medicine/ethics , Prisoners/psychology , Torture , Adult , Complicity , Cuba , Depressive Disorder, Major/diagnosis , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/psychology , Humans , Male , Medical Records , Physician's Role , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/psychology , Surveys and Questionnaires , Torture/ethics , Torture/legislation & jurisprudence , Torture/psychology , United States , Wounds and Injuries/diagnosis , Wounds and Injuries/epidemiology , Wounds and Injuries/pathology
15.
Virtual Mentor ; 9(10): 681-7, 2007 Oct 01.
Article in English | MEDLINE | ID: mdl-23228575
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