Evidence-based medicine is the application of scientific evidence to clinical practice. This article discusses difficulties applying global ("average effects" measured as population means) local problems (individual patients or groups who might depart from average). It argues that benefit harm most treatments in trials can be misleading and fail reveal potentially complex mixture substantial benefits for some, little many, a few. Heterogeneity treatment effects reflects patient diversity...

This Viewpoint presents general principles about developing structural competency curricula from psychiatry residency programs at 3 institutions, including New York University, University of California, Los Angeles, and Yale University.

Health inequities stem from systematic, pervasive social and structural forces. These forces marginalize populations create the circumstances that disadvantage these groups, as reflected in differences outcomes like life expectancy infant mortality inequitable access to delivery of health care resources. To help eradicate inequities, physicians must understand racism, sexism, oppression, historical marginalization, power, privilege, other sociopolitical economic sustain inequities. A new...

Provisional records from the US Centers for Disease Control and Prevention (CDC) through July 2020 indicate that overdose deaths spiked during early months of COVID-19 pandemic, yet more recent trends are not available, data disaggregated by month occurrence, race/ethnicity, or other social categories. In contrast, emergency medical services (EMS) provide a source information nearly in real time may be useful rapid granular surveillance mortality.To describe racial/ethnic, social, geographic...

Recovery (also known as the “recovery orientation,” vision,” or philosophy”) has been dominant paradigm shaping current mental health policy for past decade. It is claimed to be a revolutionary departure from and guide that will transform outcomes of severe illness. This review looks critically at history recovery examines ways in which this shaped values, beliefs, practices recovery-based policies. treatment philosophy emerged ruins deinstitutionalization psychopharmaceutical revolution....

Community integration is recognized as a crucial component of recovery from serious mental illness. Although the construct community can be measured with structured instruments, little known about subjective and experiential meaning involvement for persons illness.In 2010, 30 individuals illness treated in two public health clinics completed semistructured interviews that elicited places people they associate experience larger their lives.Participants described four experiences integral to...

Background Human health and homelessness are incompatible with one another. People experiencing (PEH) experience extreme social inequities, including a significantly higher mortality rate lower life expectancy compared to the general adult population. While many studies have attempted identify most common causes of death, no study our knowledge has sought contextualize these deaths using death records. The objective this was conduct qualitative analysis Los Angeles County medical examiner...

Interview with Dr. Joel Braslow on how medicalization and demedicalization have affected patients, including those chronic mental illness. (12:39)Download In our first Case Study in Social Medicine, a man presents to the emergency department reporting auditory hallucinations suicidal thoughts. His case hinges interpretations of whether his problems are medical nature within institutions' scope practice.

This Viewpoint proposes that psychiatry should more closely attend to the poverty, justice system involvement, and housing issues of people with serious mental illness, supporting this view quotes from philosophers.

Why do physicians who've taken the Hippocratic Oath willingly cut into seemingly healthy patients? How you measure success of surgery aimed at making someone happier by altering his or her body? Sander L. Gilman explores such questions in Creating Beauty to Cure Soul, a cultural history connections between beauty body and happiness mind. Following these themes through an impressive range historical moments players, traces how aesthetic alterations have been used cure dissatisfied states In...

Community integration is integral to recovery for individuals with severe mental illness. This study explored the of illness into health and non-mental communities associations service intensity.Thirty-three ethnically diverse participants were categorized in high-intensity (N=18) or low-intensity (N=15) groups. was assessed measures involvement community activities, social capital resources, support, network maps, subjective integration.Although rated themselves as being more integrated...

Objective: The publication of the President's New Freedom Commission Report in 2003 led to hope and anticipation that system transformation would address barriers have impeded delivery integrated services for clients with co-occurring mental health substance use disorders. Have problems been resolved? This study analyzed providers' perspectives on serving disorders a large has undergone transformation. Methods: Six focus groups were conducted providers at specialty treatment organizations...

Objective: The authors’ objective was to determine how assisted outpatient treatment (AOT) has been implemented in actual practice the 45 states with AOT statutes. Methods: A national survey of programs conducted examine extent which have and variations implementation models. Results: Although current statutes, most active were identified 20 states. These varied considerably style implementation, criteria applied, agency responsible, use a plan, monitoring procedures, numbers participants...

During the 1930s, psychologists Gordon Allport, Gardner Murphy, and Lois Barclay Murphy emerged from fields of social personality psychology to challenge neo-behavioralist status quo in American science. Willing experiment with idea 'science' itself, these 'rebels within ranks' contested ascendent conventions that cast study human life image classical physics. Drawing on intellectual, social, political legacies William James' radically empiricist philosophy radical Social Gospel theology,...

In this article, the 2nd in a 2-part series, authors use patient records from California's Stockton State Hospital to explore changing role of gender norms and other cultural values care psychiatric patients. The show that are always imbedded practice their depends on patients, treatments, therapeutic rationales present given encounter. Because decade following World War II witnessed dramatic changes psychiatry's therapeutics, rationales, Hospital's time period allow not only extent which...

This article, the 1st in a 2-part series, uses patient records from California's Stockton State Hospital to unearth midcentury roots of contemporary American psychiatry. These allow authors examine 2 transformations: post-World War II expansion psychiatry include diagnosis and treatment not only psychotic patients but also nonpsychotic suffering problems everyday living, 1950s introduction first psychotropic drugs, which cemented medical status these new disorders, thus linking therapeutic...

The study evaluated the effect of California's Mental Health Services Act (MHSA) on structure, volume, location, and patient centeredness Los Angeles County public mental health services.