Wellness Psychiatry

11/23/2025

Here’s the short version of what the new Emanuel et al. 2025 study actually shows about involuntary psychiatric hospitalization — and why the debate around it has gotten so heated.

A new study looked at “MARGINAL” FIRST-TIME PSYCHIATRIC EVALUATIONS — the cases where reasonable clinicians could disagree about whether someone needs to be hospitalized against their will.

The findings surprised everyone:

• A 10-point increase in a clinician’s tendency to hospitalize is linked to a 2.6-POINT INCREASE IN VIOLENT-CRIME CHARGES in the next 3 months.
• The same increase is linked to a 0.98-POINT INCREASE IN 3-MONTH MORTALITY.

Some commentators (like Freddie deBoer) say the study is “irresponsible” and that the authors treat deaths as “abstractions” and secretly want to weaken involuntary commitment. The psychiatrist writing this response says: that’s not what’s happening at all.

Clinically, MOST MARGINAL CASES ARE NOT FLORIDLY PSYCHOTIC OR IMMINENTLY DANGEROUS. They’re more like:

• Suicidal people with LONG-STANDING substance use who don’t want admission.
• People who make suicidal statements while drunk, but deny it when sober.
• Patients with BORDERLINE PERSONALITY DISORDER in acute distress who do not benefit from short stays.

Short-term hospitalization often DOES NOT FIX the problems driving these crises and can sometimes make them worse. That’s the real-world dilemma.

On top of this, psychiatrists must follow the law. O’CONNOR v. DONALDSON makes it unconstitutional to lock up someone just because they have mental illness. States require EVIDENCE OF DANGEROUSNESS OR INABILITY TO MEET BASIC NEEDS, and many interpret these standards so narrowly that even severely psychotic people do NOT qualify unless something catastrophic has already happened.

And even if the laws were looser, there’s a bigger problem:

THE SYSTEM HAS NOWHERE TO PUT THESE PATIENTS.

The US has:

• About 36,000 STATE HOSPITAL BEDS (half used for forensic cases).
• About 95,000 ACUTE PSYCH BEDS nationwide.
• Meanwhile, even institutionalizing just the SICKEST 10% OF PEOPLE WITH SCHIZOPHRENIA would require OVER 170,000 BEDS.

We would need MORE THAN DOUBLE the number of state-hospital beds in America. That’s before serving anyone with depression, bipolar disorder, suicidality, trauma, or substance use.

Building enough capacity would cost states about 2% OF THEIR ENTIRE YEARLY BUDGETS, every single year, indefinitely.

And long-term outcomes aren’t great either. In schizophrenia:

• Only 33% achieve long-lasting symptom remission.
• Only 4% achieve something like recovery.
• The sickest patients improve the least.

So here is the actual dilemma:

• Hospitalization helps some people.
• It harms or destabilizes others.
• Many “marginal cases” don’t benefit from short stays.
• The law limits what psychiatrists can do.
• The system doesn’t have the beds for long-term care.
• And the sickest patients are often the least likely to get better.

This is why data like the Emanuel study matters. Not to attack involuntary commitment — but to UNDERSTAND THE REAL TRADE-OFFS clinicians face every day in a system that is underbuilt, overburdened, and legally constrained.

See comments for the full article

11/04/2024

Major Psychiatric Disorders Risk is Elevated in Pediatric ICU Survivors
—A nationwide study in Taiwan found that children and adolescents who received intensive care treatment have a significantly increased risk of developing various major psychiatric disorders.
By Núria Waddington Negrão, PhD
Reviewed by Sejal Makvana Bhavsar, MD

A new study by Ping-Chung Wu, from the Department of Psychiatry at Taipei Veterans General Hospital in Taiwan, and colleagues published in the Journal of Affective Disorders has uncovered a concerning trend: children and adolescents who survive a stay in the intensive care unit (ICU) face a significantly higher risk of developing major psychiatric disorders (MPDs) later in life compared to their peers. This finding underscores the importance of recognizing the long-term mental health consequences of critical illness in young patients and developing appropriate interventions.1

While previous research has explored the potential for negative psychiatric outcomes following a pediatric ICU stay, much of this work has focused on post-traumatic stress disorder (PTSD) and depression or anxiety.2,3 Additionally, many prior studies had smaller sample sizes and focused on specific geographic regions, potentially limiting the generalizability of the results.4,5 Recognizing these limitations, this new study aimed to investigate the risk of a wider range of MPDs—including schizophrenia, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, and PTSD—in a large, nationwide sample of child and adolescent ICU survivors in Taiwan.1

A nationwide look at psychiatric risk

The researchers utilized data from Taiwan's National Health Insurance Research Database (NHIRD), a comprehensive dataset covering over 99% of the Taiwanese population. From 1996 to 2013, they identified 8704 child and adolescent ICU survivors with no prior history of MPDs and matched them with 87,040 controls based on age, s*x, family income, and residential area, excluding anyone who died prior to 2013. The researchers tracked the incidence of new MPD diagnoses in both groups from the time of ICU admission (or enrollment for controls) until the end of 2013.1

Compared to controls, child and adolescent ICU survivors (mean age 10.33 years) had a significantly higher risk of developing all five MPDs investigated (PTSD, schizophrenia, bipolar disorder, obsessive-compulsive disorder, and major depressive disorder). A subanalysis looking at the types of critical illness leading to ICU admission revealed that certain illnesses were associated with higher risks for specific MPDs. For example, survivors of respiratory system diseases showed the highest risk for bipolar disorder (HR 3.97, 95% CI 1.75–9.02), while survivors of injuries and poisoning had the highest risk for PTSD (HR 7.03, 95% CI 3.39–14.58). Interestingly, a longer ICU stay (≥3 days) was also associated with a significantly higher risk of developing several MPDs, suggesting that prolonged exposure to the ICU environment may be a contributing factor.1
Beyond the overall increased risk, the study also examined how the risk of developing each specific MPD varied across different types of critical illness leading to ICU admission. This analysis revealed a complex pattern of associations. For example, survivors of diseases affecting the nervous system and sense organs showed a particularly high risk for schizophrenia, while those who experienced pregnancy or childbirth-related complications had a higher risk of developing major depressive disorder. Interestingly, a diagnosis related to diseases of the genitourinary system was specifically linked to a heightened risk of obsessive-compulsive disorder. This granular analysis provides a more nuanced understanding of the potential long-term psychiatric risks associated with different types of critical illness experienced during childhood and adolescence.1

The study has several limitations inherent to its retrospective design. It relied on diagnostic codes within the NHIRD, meaning the true incidence of MPDs may be underestimated due to cases not seeking medical attention or receiving a formal diagnosis. Furthermore, the database does not provide information on potential confounding variables such as psychosocial factors, family history of mental illness, or specific treatments received, which could influence the development of MPDs.1

Early intervention is key
Despite the limitations, this study highlights a critical need for increased awareness and attention to the long-term mental health needs of this vulnerable population. As the authors state, “the development of appropriate MPD prevention strategies should be emphasized for child and adolescent ICU survivors.” The findings suggest that proactive screening for mental health issues following an ICU stay, particularly for those with longer stays or specific diagnoses associated with higher MPD risk, could be crucial for early identification and intervention.1

This research also points to a need for future studies to further explore the underlying mechanisms driving the association between critical illness and MPDs. Investigating the potential role of inflammation, stress, genetic predisposition, and other biological and psychosocial factors could inform the development of targeted preventive and therapeutic interventions to support the long-term well-being of young ICU survivors.1

Published: September 26, 2024

Núria Waddington Negrão, PhD, is a medical writer consultant specializing in bringing science to life.
References

1. Wu PC, Tsai SJ, Bai YM, et al. Risks of developing major psychiatric disorders among child and adolescent intensive care unit survivors. J Affect Disord. 2024;362:772-778. doi:10.1016/j.jad.2024.07.124
2. Davydow DS, Richardson LP, Zatzick DF, Katon WJ. Psychiatric morbidity in pediatric critical illness survivors: a comprehensive review of the literature. Arch Pediatr Adolesc Med. 2010;164:377-385. doi:10.1001/archpediatrics.2010.10
3. Ko MSM, Poh PF, Heng KYC, et al. Assessment of long-term psychological outcomes after pediatric intensive care unit admission: a systematic review and meta-analysis. JAMA Pediatr. 2022;176:e215767. doi:10.1001/jamapediatrics.2021.5767
4. Lopes-Júnior LC, Rosa MADRP, Lima RAG. Psychological and psychiatric outcomes following PICU admission: a systematic review of cohort studies. Pediatr Crit Care Med. 2018;19:e58-e67. doi:10.1097/PCC.0000000000001390
5. Rennick JE, Rashotte J. Psychological outcomes in children following pediatric intensive care unit hospitalization: a systematic review of the research. J Child Health Care. 2009;13:128-149. doi:10.1177/1367493509102472

10/25/2024

Here is an article about what we do this weekend. They even quote me:
“Historically at Long Beach Medical Center, like many cancer treatment centers, we’ve heavily focused on the most advanced technology and pharmacology to address the physical aspects of returning people to health,” said Dr. Mariusz Wirga, medical director of psychosocial oncology at the Institute. “However, the mental, emotional, and spiritual spheres of cancer treatment and recovery should also be addressed in a comprehensive way as they determine the experience of cancer diagnosis and treatment as well as their outcomes.”
“Unfortunately, despite their necessity, many supportive programs aimed at these spheres are not covered by insurance,” Wirga said in a press release. “Thanks to the support of our community and their dedication to the cause, we are able to provide these cancer support programs at the highest level in Southern California to all cancer patients and their families, regardless of their ability to pay.”

Hundreds throughout Long Beach and surrounding communities participate in the annual Team Spirit Long Beach Cancer 5K, which brings additional psychosocial programs and support for those with cance…

10/25/2024

👉I need your help! The 25th Annual Team Spirit Cancer 5k is this Saturday, and we are behind with fundraising. Why is it so important for me?
‼ 25th Anniversary of Team Spirit supporting our vital psychosocial services
‼ 20th Anniversary of the Beat the Odds survivorship program I introduced at the Todd Cancer Institute
‼ 15th Anniversary of my role as Medical Director of Psychosocial Oncology at TCI
🎯Please donate - links and info in the comments.
🏆 We’re also excited to share that we already have 800 registered walkers! If you’d like to join us, it’s not too late—registration is available on-site for $75.

04/19/2024

Psychedelics have more and more use in clinical trials as well as in practice. Ketamine as a 40-minute iv infusion, has been shown to relieve symptoms of depression even the same day of administration (it is an off-label use that means it doesn't have FDA approval for mental health indications). Ketamine lozenges and nasal sprays are also widely used (and relatively inexpensive). The esketamine - brand name Spravato (racemic S-isomer, ketamine has both S and R isomers) as a nasal spray is approved by the FDA for the treatment of depression. Psilocybin and M**A may be approved soon for the treatment of depression and PTSD. If you want to learn more about it in the comments, there is a link to a presentation by Dr Michael DeBernardi, who has more than 40 years of experience with psychedelics - strongly recommended.

03/10/2024

Maybe it's time to go cash only?

02/09/2024

Leading a grand rounds workshop on cognitive-behavioral laughter therapy at the invitation of dear friend and colleague Dr. Heather Clague

12/28/2023

Yes! Fruits and Veggies rule.
"“Increased fruit and vegetable consumption [appeared] predictive of increased happiness, life satisfaction, and well-being…up to 0.24 life-satisfaction points (for an increase of eight portions a day).” What does that mean? Is that a lot? Is that a little? That’s a lot: equal in size to the psychological gain of going from unemployed to getting a job."

"A systematic review and meta-analysis of dozens of studies found that “every 100-gram increased intake of fruit was associated with a 3 percent reduced risk of depression.” That’s about half an apple, yet “less than 10 percent of most Western populations [even] consume [a bare minimum].” Maybe the problem is we’re just telling people about the long-term benefits of fruit intake for chronic disease prevention rather than the near-immediate improvements in well-being. So maybe we should be advertising the happiness gains, but first, we need to make sure they’re real."

Check the link in the comments for the more info about these studies.

07/10/2023

For all those interested in ADHD or concerned with ADHD medications shortages we strongly recommend this information:

Many Americans with ADHD are scrambling for their prescription medication due to a months-long shortage. Why is the rate of adult ADHD diagnosis growing four times faster than diagnoses among kids?

07/09/2023

Strongly recommended

In this mega workshop, I will show you how to treat social anxiety quickly, using powerful and innovative techniques. Join me for some fun and personal / professional growth.

06/12/2023

For those who want to learn more about real people, about 2% of the population who are most often mutilated at infancy who are behind the "I" in LGBTQIA, here is a great interview that Amy Goodman conducted this morning
https://www.democracynow.org/shows/2023/6/12?autostart=109.0

06/11/2023

Cancer Survivorship Celebration is one of my most favorite events of the year and I have the honor to be among the speakers. Jacarandas in front of the hospital are in bloom matching the colors on the hospital logo. It is great to see so many familiar faces in person and hang out with the Beat the Odds Program alumni ❤️