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Reading of the Week: High Tech and Low Tech Opportunities for Mental Health Care

From the Editor

Social media. Bots. VR.

When I applied to psychiatry residency programs in my last year of medical school at the University of Manitoba, none of these were mentioned when we talked about mental health care. But technology is changing our world. We are seeing a digital boom in mental health care – or is it really a digital mirage?

In the first selection, we move past the big rhetoric with a thoughtful paper by Dr. John Torous (of Harvard University) and his co-authors. In World Psychiatry, they review the literature and make insightful comments about the potential and reality of digital mental health care. “It now seems inevitable that digital technologies will change the face of mental health research and treatment.” We discuss the paper and its implications.

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Woebot: Too cool to be clinical?

If the first selection considers cutting-edge technology for bettering patient care, the second is very different. Dr. Thomas E. Smith (of Columbia University) and his co-authors study “the strength of associations between scheduling aftercare appointments during routine psychiatric inpatient discharge planning and postdischarge follow-up care varied by level of patient engagement in outpatient psychiatric care before hospital admission” in a paper for Psychiatric Services. Spoiler alert: there are no chatbots mentioned. “Discharge planning activities, such as scheduling follow-up appointments, increase the likelihood of patients successfully transitioning to outpatient care, regardless of their level of engagement in care prior to psychiatric inpatient admission.”

DG

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Reading of the Week: COVID & Mental Health Access in China (AJP); also, Transformational Care (EBMH) and Psych Wards (New Yorker)

From the Editor

What’s the latest in the literature on COVID and mental health? This week, we focus again on the pandemic with three selections.

In the first, we consider a paper on mental health services at a Chinese hospital during the pandemic. In this American Journal of Psychiatry study, Dr. Junying Zhou (of Sichuan University) and co-authors report on a survey of existing and new outpatients, finding major problems with access. Among the findings: one in five found that their mental health had deteriorated due to a lack of access to care. The authors advocate further study to “ameliorate the negative impact of viral outbreaks in the general public, especially among those vulnerable patients with mental problems.”

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Will COVID change health care once the virus has burned out? In the second selection, we consider a new EBMH editorial by Dr. Katharine Smith (of Oxford University) and her co-authors. They write: “In order to reappraise effectively our new ways of working, both in the immediate management of issues during the pandemic and also during the longer-term aftermath, we need fast-track implementation of evidence-based medicine techniques in mental health to supply the best evidence to clinicians on specific questions in real time.”

Finally, in the third selection, we look at an essay from The New Yorker. Reporter Masha Gessen argues that psychiatric wards are particularly vulnerable during the pandemic. Gessen speaks to several doctors who offer a similar if haunting story: “how a lack of testing, P.P.E., and seclusion protocols were making a difficult task – maintaining the safety of a highly vulnerable population and their care workers during a pandemic – virtually impossible.”

DG

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Reading of the Week: How Do University Students Use Cannabis? Also, the Life and Legacy of Richard Green, and Scott Gottlieb on E-Cigs

From the Editor

I don’t quite remember when I changed my interview questions, but at some point – more than a decade ago – I stopped assuming that if I asked about street drugs, patients would tell me about cannabis. Long before legalization, people stopped seeing cannabis as illicit. Today, not only is cannabis legal for recreational use, many see it as a drug to be taken for their health.

In a new Canadian Journal of Psychiatry paper, the authors write about cannabis use for medicinal purposes among Canadian university students. Drawing on a survey, they find wide use – but not exactly the use that follows the guidelines.

We also consider two other pieces: an obituary for Dr. Richard Green, a prominent psychiatrist who challenged the DSM’s inclusion of homosexuality, and an interview with Dr. Scott Gottlieb, the outgoing FDA Commissioner, who worries about e-cigarettes.

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Enjoy these selections.

And an invitation: the Reading of the Week series invites guest contributions. If this is of interest to you, please let me know.

DG

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