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San Francisco launches new conservatorship measures to help patients with mental illness

San Francisco Mayor Mark Farrell recently announced the addition of more conservatorship beds to help individuals who suffer from serious mental illnesses. He said with more than double the number of beds, there will be “real results” for ill patients.

The San Francisco Healing Center at St. Mary’s Medical Center received 54 new locked psychiatric beds. The beds are an effort to help people who are placed in conservatorship because they are unable to live independently due to their illnesses, but do not need constant hospital care. They provide an alternative to placing patients in out-of-county facilities, hospitals or jails.

State senators are also working on legislation to expand and strengthen California’s conservatorship laws. Conservatorships are currently limited to elderly individuals vulnerable to abuse as well as people with severe disabilities or cognitive limitations. The bill seeks to give counties more options to address homeless individuals who are trapped in a cycle of going in and out of jails, hospitals and other government services.

San Francisco Board of Supervisors President London Breed also introduced a measure that decriminalizes mental health conservatorship. It puts the city attorney in charge of overseeing such cases instead of the district attorney.

Conservatorships may be needed in circumstances where a person is unable to make one’s own financial and health care decisions due to physical or mental incapacity. In California, a civil court judge establishes a conservatorship by appointing someone to make decisions on behalf of the incapacitated individual. While a conservatorship may be necessary in some cases, it can typically be avoided if the person has previously signed an Advance Health Care Directive or Durable Power of Attorney.

Why the young and healthy should think about advance directives?

Young people are likely to shy away from making decisions about their future health care, thinking they can put it off until later. The truth is, one can never be too young or too healthy to engage in advance health care planning.

Such planning is no longer just about aging or end-of-life care. It addresses the hypothetical situation in which a medical emergency leaves a person unable to communicate their particular health wishes.

People often mistakenly assume that close family members will instinctively know their preferences regarding end-of-life care or medical treatments. However, without having specific instructions, loved ones are left to rely on guesswork. This can cause conflict among families and uncertainty as to whether the right decision was made.

The only way to ensure that one’s choices will be respected is to put them in writing in a legal document. An advance health care directive allows individuals to outline their preferences about various health care decisions ahead of time so that others know about them. It covers matters such as life support, organ donation, palliative care and medical treatment. A durable power of attorney for health care gives a person, such as a loved one, the authority to make health decisions on one’s behalf.

Advance directives are not just for the terminally ill. Having such a document in place is vital regardless of age or health status. Without one, a person’s wishes are likely to be ignored if he or she is unable to speak or make decisions for themselves.

While it may never feel like the right time to draft health care documents, it is important to get organized now rather than later. To best protect oneself, it is best to address the topic advance directives head-on.

Studies Indicate That Late-Life Depression Can Contribute To Dementia

The results of an analysis of more than 50,000 people in 23 different population studies indicates that depression later in life is associated with an increased risk for dementia and Alzheimer's disease.

Analysis of the studies also indicates that there is a significant risk of vascular dementia (stroke-based dementia), in older adults who have "late-life depression." According to the authors of the study, late-life depression is extremely common among older adults. The occurrence of that depression has been found to be highly reoccurring, difficult to treat and chronic, significantly affecting an individual's ability to function.

The study, published in the May 2013 issue of the British Journal of Psychiatry, shows a strong association between depression and developing Alzheimer's disease. Researchers stated that they believe one or more depressive episodes can increase someone's risk for dementia syndromes such as vascular dementia as well as Alzheimer's disease. Connecting the two may help researchers help develop proactive preventative measures as well as long-term predictive models for patients.

Researchers also stated that the prevention of even a fraction of the number of cases of depression might reduce the development of Alzheimer's disease in the tens of thousands. They also stressed that the risk for vascular dementia appeared to be much higher than the risk for Alzheimer's disease in the individuals who were late-life depressed.

The study looked at 23 different cohort studies which followed patients 50 and older who did not display any signs of dementia during baseline testing. The studies followed up every five years for dementia and Alzheimer's disease, vascular dementia studies were followed at six-year intervals. Depression was scored on a ratings scale without structured interviews.

Though it is not definitive that late-life depression is a cause of dementia, says paper co-author Meryl Butters, associate professor of psychiatry at the University Of Pittsburgh School Of Medicine, it seems likely to contribute to it. Current theory holds that depression can cause minor brain damage, which can lead to the degenerative process of dementia.

The study authors stated that public health policies which focus on the prevention or delay of dementia in older adults should focus on working to prevent depression and healthy behaviors which reduce cardiovascular risk factors. They also urged for clinical trials which would look at how preventing depression in older adults lowers the risk of cognitive impairment and dementia later.

A large body of research has amassed which also links late-life depression to increased health risks, social isolation and an increased risk of death.

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