Sisaket,Thailand,09 April 2019;Medical staff wearing face shield and medical mask for protect coronavirus covid-19 virus in CT scan room,Sisaket province,Thailand,ASIA.

The Future of Acute and Critical Care Nursing

By Sarah A. Delgado

We need to change the future for nurses. Even before the pandemic, nurses suffered high rates of burnout and a disproportionate risk of suicide. But the pandemic could be a tipping point that leads many nurses to change careers, leave their jobs, or retire early.

Moral distress, the consequence of feeling constrained from taking ethical action, was well-documented before the pandemic, particularly among critical care nurses providing end-of-life care. Additional research conducted before 2020 demonstrates that nurses were experiencing post-traumatic stress due to the suffering they witnessed and the demands of their work.

During the pandemic, surges in critically ill patients have led to untenable workloads. The distress of end-of-life care is heightened by restrictions on visitation and increased mortality rates. In addition, shortages of basic personal protective equipment contribute to fear and a sense of betrayal.

While the pre-pandemic state of the nursing profession was concerning, the pandemic creates imminent peril.

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LOMBARDIA, ITALY - FEBRUARY 26, 2020: Empty hospital field tent for the first AID, a mobile medical unit of red cross for patient with Corona Virus. Camp room for people infected with an epidemic.

The Fourth Wave of COVID-19: The Effects of Trauma on Health Care Workers

This post is the introduction to our newest digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce. All contributions to the symposium will be available here.

By Stephen Wood

On this day one year ago, World Health Organization Director-General Tedros Adhanom declared COVID-19 a pandemic, sounding the alarm about the international threat posed by the virus.

Today, one year later, I fear the end is not in sight. In fact, I believe that we are on the precipice of a fourth wave.

The fourth wave will strike the people on the frontlines of this pandemic — health care workers. It will be the effects of the trauma that health care workers entrenched in this pandemic have faced. And it is likely to have significant and lasting effects on our health care system.

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Illustration of a man and a woman standing in front of a DNA helix

Research Reveals Potential Concerns About Genetic Testing for Suicide Risk

By Brent Kious, Anna Docherty, Leslie Francis, Teneille Brown, Jeffrey Botkin, Douglas Gray, Brooks Keeshin, Louisa Stark, Brieanne Witte, and Hilary Coon

Companies that offer direct-to-consumer genetic testing (DTC-GT) will soon be able to provide scores that estimate suicide risk.

Our recent study, appearing in Genetics in Medicine, the official journal of the American College of Medical Genetics and Genomics (ACMG) raises ethical questions about how these risk scores will be understood.

The causes of suicide are complex. Many risk factors intersect: psychiatric symptoms like depression, different life stressors, family history, access to lethal firearms, and substance abuse, among many others.

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Washington, DC – October 16, 2020: One of the many official ballot boxes placed around the city for early voters to place their completed ballots to avoid lines due to the ongoing Covid-19 pandemic.

Psychedelics Helped Me Reclaim My Life and Push to Change Drug Laws

By Melissa Lavasani

In December 2019, I proposed a ballot measure, now known as Initiative 81, which would effectively decriminalize natural psychedelics – including psilocybin and ayahuasca, which had helped me overcome postpartum depression – in the District of Columbia.

This would help ensure that other D.C. residents benefiting from natural psychedelics are not targeted by law enforcement. After tumultuous months of hard work including collecting more than 25,400 signatures from voters, Initiative 81 is on the November ballot.

I am not the usual protagonist you’d imagine as an advocate for psychedelics: I am a married mother of two with two graduate degrees and an established career working for the District of Columbia government. But I had a psychedelic experience that changed my life. In 2018, I had taken psychedelics – first psilocybin mushrooms, and then ayahuasca and San Pedro cacti – because I was desperate to overcome severe postpartum depression that came to dominate my life.

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man lying on couch.

Psychedelics and America: A Digital Symposium

By Mason Marks

In 2020, the psychedelics research and policy reform renaissance is in full swing. Prohibited by federal law since the 1970s, psychedelic substances can alter how people see themselves, the world, and those around them. Clinical trials suggest they may help people overcome ingrained thought patterns associated with depression, anxiety, and addiction.

Acknowledging their spiritual and therapeutic potential, universities have established new psychedelics research programs. The Food and Drug Administration (FDA) has deemed them breakthrough therapies for depression and post-traumatic stress disorder. This designation means they could be significant improvements over traditional treatments such as selective serotonin reuptake inhibitors (SSRIs). Accordingly, the FDA has put some psychedelics on an accelerated course toward approval. Eventually, they could help millions who have not benefitted from existing therapies.

However, despite their breakthrough status, psychedelics will not become FDA approved for several years. Meanwhile, the COVID-19 pandemic is making the country’s mental health crisis worse. According to the Centers for Disease Control and Prevention, rates of depression, anxiety, substance use, and suicidal thoughts have risen in the past nine months.

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Dried psilocybe cubensis psilocybin magic mushrooms inside a plastic prescription medicine bottle isolated on white background.

As Cities Decriminalize Psychedelics, Law Enforcement Should Step Back

By Mason Marks

Amid rising rates of depression, suicide, and substance use disorders, drug makers have scaled back investment in mental health research. Psychedelics may fill the growing need for innovative psychiatric drugs, but federal prohibition prevents people from accessing their benefits. Nevertheless, some cities, dissatisfied with the U.S. war on drugs, are decriminalizing psychedelics.

In 2019, Denver became the first U.S. city to decriminalize mushrooms containing psilocybin, a psychedelic the FDA considers a breakthrough therapy for major depressive disorder (MDD) and treatment-resistant depression.

In a historic vote, Denver residents approved Ordinance 301, which made prosecuting adults who possess psilocybin-containing mushrooms for personal use the city’s “lowest law enforcement priority.” Since then, in Oakland and Santa Cruz, California, voters approved their own decriminalization measures.

As a Schedule I controlled substance, psilocybin remains illegal under federal law, and despite ongoing clinical trials, it is unlikely to become FDA approved for several years. Social distancing requirements due to COVID-19 are disrupting medical research causing further delays. But as the November election approaches, other U.S. cities prepare to vote on psychedelics.

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Author Q&A: “Association between State Minimum Wages and Suicide Rates in the U.S.”

Alex Gertner, BA
Alex Gertner,  University of North Carolina at Chapel Hill

As the suicide rate increases across the United States, researchers at the UNC Gillings School of Global Public Health approached the issue by considering the financial anxiety caused by low wages. Alex Gertner, Jason Rotter, and Paul Shafer used the LawAtlas minimum wage dataset to explore the associations between state minimum wages and suicide rates in the United States.

Their study was published in the American Journal of Preventive Medicine on March 21, 2019.

Temple University Center for Public Health Law Research spoke with Mr. Gertner about their study.

 

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Blue background that reads "facebook" with a silhouette of a person looking down on his phone in front

On Social Suicide Prevention, Don’t Let the Perfect be the Enemy of the Good

In a piece in The Guardian and a forthcoming article in the Yale Journal of Law and Technology, Bill of Health contributor Mason Marks recently argued that Facebook’s suicide prediction algorithm is dangerous and ought to be subject to rigorous regulation and transparency requirements. Some of his suggestions (in particular calls for more data and suggestions that are really more about how we treat potentially suicidal people than about how we identify them) are powerful and unobjectionable.

But Marks’s core argument—that unless Facebook’s suicide prediction algorithm is subject to the regulatory regime of medicine and operated on an opt-in basis it is morally problematic—is misguided and alarmist. Read More

image of hands texting on a smart phone

Artificial Intelligence for Suicide Prediction

Suicide is a global problem that causes 800,000 deaths per year worldwide. In the United States, suicide rates rose by 25 percent in the past two decades, and suicide now kills 45,000 Americans each year, which is more than auto accidents or homicides.

Traditional methods of predicting suicide, such as questionnaires administered by doctors, are notoriously inaccurate. Hoping to save lives by predicting suicide more accurately, hospitals, governments, and internet companies are developing artificial intelligence (AI) based prediction tools. This essay analyzes the risks these systems pose to safety, privacy, and autonomy, which have been under-explored.

Two parallel tracks of AI-based suicide prediction have emerged.

The first, which I call “medical suicide prediction,” uses AI to analyze patient records. Medical suicide prediction is not yet widely used, aside from one program at the Department of Veterans Affairs (VA). Because medical suicide prediction occurs within the healthcare context, it is subject to federal laws, such as HIPAA, which protects the privacy and security of patient information, and the Federal Common Rule, which protects human research subjects.

My focus here is on the second track of AI-based suicide prediction, which I call “social suicide prediction.” Though essentially unregulated, social suicide prediction uses behavioral data mined from consumers’ digital interactions. The companies involved, which include large internet platforms such as Facebook and Twitter, are not generally subject to HIPAA’s privacy regulations, principles of medical ethics, or rules governing research on human subjects.

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Taking action to prevent male suicide

By John Tingle

The issue of male suicide and prevention seems to have been an obscured or perhaps even a forgotten issue in reports discussing the care of vulnerable people. The UK media have recently focussed on this issue with the Project Eighty-Four campaign. This campaign  aims to raise awareness of male suicide with sculptures being placed on the top of a London tower block to mark this. The sculptures are on the top of ITV’s (Independent Television ) Buildings on London’s Southbank Promenade from 26th March 2018.The sculptures are designed to get people talking about the issue. Friends and families of the deceased men helped create them: “Each one, a poignant reminder of a real life lost and a call to society to come together and ultimately take a stand against male suicide.

BBC News has also covered the event. Project Eighty Four states that the statistics on male suicide are shocking. Every two hours a man in the UK takes his own life. Project Eighty Four is an initiative of the charity CALM (Campaign Against Living Miserably).CALM is dedicated to preventing male suicide and they say that male suicide and mental health is a big issue that cannot be ignored for any longer.

Interestingly they report in latest annual report and accounts a modest but noticeable increase in the number of female callers for help and advice. CALM’s focus is on men because of the high rate of male suicides.Helpline workers helped to directly prevent 409 suicides in 2016-17, up 19% on the previous year. Read More