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States may now broaden mental health treatment under Medicaid

(CNN)The Centers for Medicare and Medicaid Services may now allow for states to pursue Medicaid reimbursements for short-term inpatient treatment in mental health facilities despite a decades-old exclusion, Health and Human Services Secretary Alex Azar announced Tuesday.   In a letter to state Medicaid directors, CMS detailed a new Medicaid waiver opportunity through which states may bypass...

Penn Ethicist Proposes New Category for Psychiatric Patients to Justify Instances of Compulsory Treatment

“Nonvoluntary treatment,” would distinguish psychiatric patients who refuse help but likely would have accepted it in a healthy state of mind from the traditional “involuntary treatment”   August 24, 2017   PHILADELPHIA — The “involuntary treatment” of unwilling psychiatric patients has long been accepted as necessary in some cases, for the sake of patients and society, though it can raise...

Commentary: Is President Trump Causing Toxic Stress?

Dominic Sisti & Cynthia Baum-Baicker   “The presidency is supposed to age the president, not the public.” And with that Jon Stewart, former host of the Daily Show and comic genius, touched on an overlooked but very serious public health question.    Is Donald Trump, with his daily Twitter harangues, impulsive and outrageous executive orders, and all around nastiness harming the health of...

Recovering Inside? Ethical Challenges in Correctional Mental Health Care

Commissioner Charles Ramsey speaking at the Recovering Inside Conference held on October 20,2016 at the National Constitution Center  in Philadelphia, Pennsylvania. Agenda

8:00-8:45am | Registration & Continental Breakfast

8:45-9:00am | Dominic Sisti: Welcome & Business

9:00-9:15am | Arthur Evans: Opening Comments & Introduction of Commissioner Ramsey

...

Psychosis Risk: What Is It and How Should We Talk About It?

By: Dominic A. Sisti, PhD, and Monica E. Calkins, PhD Abstract Schizophrenia and other psychosis spectrum disorders do not develop de novo but emerge from prodromal stages that are named and operationalized differently depending on the research group or consortium and its theoretical orientation. As a result, a complex lexicon now exists for characterizing individuals’ risk of subclinical...

Giving Asylum? The Ethics of Long-Term, Structured Care for People with Severe, Refractory Mental Illness

There are hundreds of thousands of individuals in the US who have serious mental illness. Most of these individuals thrive in the community, but there remains a population who do not. Because the number of long-term psychiatric hospital beds has largely evaporated over the past 50 years, they often cycle between homelessness, acute care, and prison. Of the 2.5 million individuals incarcerated in...

Diagnosing, Disclosing, and Documenting Borderline Personality Disorder: A Survey of Psychiatrists' Practices

Dominic Sisti, PhD1; Andrea G. Segal, MS1; Andrew M. Siegel, MD2; Rebecca Johnson, MA3; John Gunderson, MD4   1 Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia. 2 Department of Psychiatry, Perelman School of Medicine. 3 Department of Sociology, Princeton University, Princeton, New Jersey. 4 Harvard Medical School, Boston,...

From Alienism to ACOs: Integrating Psychiatry, Again

By: Dominic A. Sisti, Ph.D., Chethan Ramamurthy, M.D. View Author and Article Information at http://dx.doi.org/10.1176/appi.ps.201500400 Abstract This column describes the gradual integration of psychiatrists into mainstream general medical care, from their exile as “alienists” in isolated asylums to their current roles in accountable care...

Halloween attraction dishonors mentally ill who lived at hospital

DOMINIC SISTI AND ANDREA SEGAL   The earliest psychiatric hospitals date back to 15th-century Spain, where they were conceived and constructed to give poor, homeless individuals with mental illness a safe place to live and, it was hoped, recover.   The next two centuries saw the degradation of asylums essentially into dungeons where mentally ill people were confined, living in chains and squalor...

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