Tag: mental health

Success of Johnson County Civil Mental Health Court in its First Year

I’ve been looking for other ways that Iowa addresses mental illness and its impact on homelessness and other adverse outcomes since my last post on the issue.

It turns out that, despite Iowa ranking 51st out of all U.S. states for the low number of psychiatric beds according to the Treatment Advocacy Center statistics (in 2023, it had just two beds per 100,000 patients in need), a new mental health court established in in May of 2023 has made substantial progress in reducing the number of crisis contacts, psychiatric hospitalizations, and days in the hospital. Arrests, jailings, and days in jail were also reduced.

Participants in the new program include the University of Iowa Health Care, Iowa City VA Hospital, the Abbe Center, Guidelink Center, National Alliance for the Mentally Ill (NAMI), Shelter House, and several other mental health service agencies in Johnson County.

The Johnson Mental Health Court continues to operate since June of this year when the pilot program’s funding from the East Central Iowa Mental Health Region was supposed to have ended on June 30, 2025, due to the change in mental health regions. This is a program for patients under involuntary mental health commitment that avoids incarceration and placement in a state psychiatric hospital.

This civil mental health program didn’t exist until well after I retired and I hope for its continued success.

Luett, T. (2024, April 24). Civil Mental Health Court in Johnson County finds success in first year. The Daily Iowan. https://dailyiowan.com/2024/04/24/civil-mental-health-court-in-johnson-county-finds-success-in-first-year/ Accessed July 30, 2025

Mehaffey, T. (2024, April 14). News Track: ‘Challenging, rewarding’ first year of Johnson County mental health court. The Gazette – Local Iowa News, Sports, Obituaries, and Headlines – Cedar Rapids, Iowa City. https://www.thegazette.com/crime-courts/news-track-challenging-rewarding-first-year-of-johnson-county-mental-health-court/ Accessed July 30, 2025.

May Mental Health Awareness Month Calendar and Checklist (look below this sticky post for other new posts)

mental health checklist
mental health awareness calendar

May is Mental Health Awareness Month!

This is May and it’s Mental Health Awareness Month. I just found out about something exciting and it’s the Iowa Healthiest State Initiative.

See the Calendar of Events and the Checklist.

Members of the Human Club

I just read Dr. Moffic’s column, “Join This Club for Mental Health” in which he described the Clubhouse movement which got started in the 1940s to help those with mental health challenges to cope with their illness and, more importantly, to recover, grow, and achieve success in life.

It made wonder if there are any chapters of the Clubhouse model in Iowa. It turns out there is and it’s Carol House in Davenport, Iowa. It’s connected with the Vera French Mental Health Center. Its namesake is Carol Lujack, who was a member when the center was called “The Frontier Community Outreach Program” in the 1980s in downtown Davenport.

I was looking at the Carol Center website where you can find many interesting features of the people and activities that go on there. The April newsletter is fascinating and funny. You can find out in the April Newsletter about a few of the current members, April holidays (there’s a slew of them), and famous quotes. One of the quotes is familiar and it’s by F. Scott Fitzgerald,

“Vitality shows not only in the ability to persist, but in the ability to start over,” The quote is worded in various ways, but I remember it because I used it as an inspirational quote when The University of Iowa honored me and several of my colleagues with a Feather in Your Cap award back in 2011.

This was shortly after I returned to Iowa after an unsuccessful stab at trying private practice psychiatry in Wisconsin. And it was the second time I did that—the first time was in Illinois.

Did you know that April is National Humor Month? And have you heard the joke “What kind of candy is never on time?” Choco-Late.

One April holiday is not mentioned and that’s Arbor Day, which varies according to what part of the world you’re in as planting times differ. Sena planted a couple of new trees in the back yard.

Starting new chapters of Clubhouse is a little like planting new trees. They need watering.

Noteworthy Black Psychiatrists on the Last Day of Black History Month

I wanted to give a shout-out to Dr. H. Steven Moffic, MD for his article highlighting the career of a notable black psychiatrist, Dr. Alvin F. Poussaint, MD, who sadly died on February 24, 2025. I’m mortified that I hadn’t heard of him before now.

It reminded me of the time I mentioned another black psychiatrist I had never heard of either, Dr. Chester Middlebrook Pierce, MD, in a post about the book “Our Hidden Conversations” about a year ago.

I wondered if Dr. Pierce and Dr. Poussaint ever met. I looked this up but couldn’t find a definite link.

Dr. Moffic’s essay, in which he mentions antisemitism. also reminded me of an essay also published in Psychiatric Times in 2020 by Dr. Robert M. Kaplan, MD. The title is “Alois Maria Ott: I was Hitler’s Psychologist.”

It gives even more texture to Dr. Poussaint’s views on whether or when extreme racism should or should not be classified as a mental illness. My own residency training experience was marked by being assigned to a patient said to have schizophrenia—who angrily shouted when he saw me, “I don’t want no nigger doctor!” My faculty supervisor didn’t think I should be reassigned to an alternate patient, a decision I’m still ambivalent about.

FDA Approves Antipsychotic with New Mechanism of Action for Treatment of Schizophrenia

I just noticed the FDA announcment of the approval of an antipsychotic with a new mechanism of action for the treatment of schizophrenia.

The drug is Cobenfy and it interacts with cholinergic rather than dopaminergic receptors. It has a number of side effects which are anticholinergic. This could lead to psychotic symptoms that consultation-liaison psychiatrists might get called to evaluate due to the anticholinergic delirium that could occur, which can mimic psychosis.

It’s easy to get alarmed about the Cobenfy side effects. I just remember all of the side effects of the one antipsychotic that has sometimes been the only effective treatment for patients with treatment resistant schizophrenia-clozapine.

Clozapine has been associated with agranulocytosis, seizures, bowel obstruction, prolonged cardiac conduction time leading to arrhythmias, liver toxicity and more. In fact, clinicians are required to enroll in a Risk Evaluation and Mitigation Strategy (REMS) program to prescribe it.

Patients who have schizophrenia and take clozapine are often admitted to general hospitals for treatment of medical problems which may or may not be directly related to clozapine itself. This requires close collaboration of internists and surgeons with consultation-liaison psychiatrists.

What do you do for patients who don’t respond to clozapine but are willing to take oral medication? There are augmenting strategies, some of which can be helpful although they could add to the side effect burden.

What do you do for a patient with treatment-resistant schizophrenia who refuses to take oral psychotropic medication? In some cases, it may be necessary to use injections of medications which also can have uncomfortable and even potentially life-threatening side effects. This difficult situation is complicated further by the lack of insight some patients have about their illness and the need for court orders to administer antipsychotics against their wishes.

I hope Cobenfy is a step forward for patients and their families.

What About Bob?

The homeless guy camped next to the busy street just outside of our hotel is still here. I’m going to call him Bob because it’s awkward to keep calling him “the homeless guy.” I haven’t met Bob yet, but Sena got him some water. She had to give it to the hotel resident who so far is the only one who has been able to communicate with him.

Sena and I talked about what might be done for Bob. She noticed that his face was sunburned bad enough to cause the skin to peel off. Could a case be made for his being a danger to himself?

Of course, you could guess this issue would come up because I’m a retired psychiatrist. As an aside, I found an article published in the Daily Iowan early this year. The author interviewed several residents of a homeless camp who were displaced after a fire and subsequently the owners of the land closed the camp.

The homeless people at the camp were articulate and open to interview. Some of them were clearly choosing to be homeless and able to state how and why they did.

Bob might not be articulate enough to do that. He spends most of his time lying on the pavement with his blanket over him. It’s sometimes hard to tell if he’s out there until he moves. When he’s up, he usually stands up and waves his arms back and forth or sits on the grass. Occasionally, he moves in ways suggesting he’s acting out some kind of conversation with an invisible person.

A police officer stopped by, spoke briefly with Bob, and left. A woman stopped by and tried to help him clean up his room, so to speak. She picked up some of his trash and put it in a bag. She tried to get him to help, but he didn’t seem to understand.

What about Bob? Is he a danger to himself or others? Is he incapable of taking care of his basic self-care needs? Sooner or later, this would come up because the mental health laws would come into play. There are many homeless people out there living under bridges and camps. We’ve seen them when we go out for walks. Not all of them are definable as mentally ill.

There is guidance on the web about how to pursue a court-ordered psychiatric evaluation. I’m a retired psychiatrist and often was involved in those circumstances.

One way it works is that two people who are acquainted with the person go to the courthouse and complete paperwork to have someone ordered by a judge to be taken to the hospital for a mental health evaluation. If the judge signs an order, then typically the police would pick the person up and take them to the local emergency room. There aren’t vans with mental health professionals roaming the city looking for potential patients.

A psychiatrist performs a comprehensive mental health evaluation and later presents the report and testifies at a scheduled hearing. Attorneys are involved and give testimony for and against civil commitment. The patient also can speak. If the patient is court-ordered to inpatient treatment, that treatment is provided in the hospital usually. Periodic reports must be submitted to the court. Some people who are the objects of these interventions get better. Others don’t.

What’s missing here? You must at least know his real name to file for legal hold order. Although Sena says she saw Bob take out a cell phone, it’s not clear he knows how to use it or whether it even works. The only people who interact with him are those who are driving by and who show sympathy by buying food and water and other items for him. He usually tosses the empty water bottles in the parking lot where he sleeps. The police evidently didn’t think he needed an intervention from their perspective.

We don’t even know his real name. I haven’t tried to talk to him. I’ve never seen him act in a threatening way to anyone. Bob takes up one parking space and keeps his belongings within it. He usually lies under a blanket, often for several hours at a time. Bob doesn’t panhandle and I doubt he’s capable of that.

Am I Bob’s keeper?

Dirty Dozen on Psychodynamic Psychotherapy in WordPress Shortcode

May is Mental Health Month! Have I said that already? Anyway, this is yet another one of my Dirty Dozen lectures. It’s on Psychodynamic Psychotherapy.

It’s in WordPress shortcode. A few pointers: click in the lower right hand corner of the slide if you want to view the slides full size. Use the directional arrows on your keyboard to click through the slides. You can also just use the arrow handles on the slides if you don’t want to see them full size. If you see weblinks, right click the links to open them in a new tab.

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Dirty Dozen on Interpersonal Psychotherapy in WordPress Shortcode

Hey, because May is Mental Health Month, this is another one of my Dirty Dozen lectures. It’s on Interpersonal Psychotherapy.

It’s in WordPress shortcode. A few pointers: click in the lower right hand corner of the slide if you want to view the slides full size. Use the directional arrows on your keyboard to click through the slides. You can also just use the arrow handles on the slides if you don’t want to see them full size. If you see weblinks, right click the links to open them in a new tab.

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Dirty Dozen on Cognitive Behavioral Therapy in WordPress Shortcode

In keeping with May being Mental Health Month, here’s another slide set on psychotherapy. This one is on the basics of Cognitive Behavioral Therapy. Once again, it’s in WordPress shortcode. A few pointers: click in the lower right hand corner of the slide if you want to view the slides full size. Use the directional arrows on your keyboard to click through the slides. You can also just use the arrow handles on the slides if you don’t want to see them full size.

This slideshow could not be started. Try refreshing the page or viewing it in another browser.