Monitoring effects of psychotropic medications.

As a Psychiatric Social Worker, and not a physician, I still spend a lot of time and energy discussing with my clients their medications, especially their psychotropic ones with them. 

Knowing about the power of the placebo effect I am very cognizant and curious about what my clients think about their medications. Do they think they will help, are skeptical, or have mixed feelings? Will they be compliant and take them as prescribed or “forget” to take them or abuse them?

There is a fine line between medical and psychological effects of taking medications. Many of my clients expect medications to be a “silver bullet” and a “magical key” to ameliorate their symptoms and improve their experience of their quality of life.

Whether medications “work” has as much to do with psychological expectations as well as the pharmacological actions. Whose job is it to monitor the efficacy of the use of medications: the prescriber, the psychotherapist or both? 

Throughout my career as a Psychiatric Social Worker I have increasingly found that it is my job if I want to help my clients improve their functioning. I find myself surprised at the lack of supervision by the prescriber on the psychological dynamics of prescribing medications. They don’t seem to have the time for it or an interest or competence in this aspect of their patients' treatment. They leave it up to the psychotherapist if the patient has one.

For more on this topic click here.

Does availability of mental health services make a difference?

I asked myself  last week what I had to show for my work after 57 years as a Psychiatric Social Worker in New York State. I decided to investigate further and here is part of what I found. New York is ranked as #1 in mental health and well being among all the US states according to Mental Health America in 2025. There are seventeen indicators that are measured to determine these rankings one of which, is “thoughts of suicide in the past year.” New York is ranked third lowest suicide rate in the nation after District of Columbia and New Jersey. 

In my career I have estimated I have done over 15,000 suicide/homicide evaluations most of them in large urban emergency rooms after an attempt was made or the person was bought in with a mental hygiene arrest. How many lives working as part of a mental health system team have been saved? Compared to other states, very many.

The national average suicide rate stands at 13.7 deaths per 100,000 people. However, individual state rates vary dramatically—ranging from a low of 5.7 to a high of 29.7.

In general, the highest rates are concentrated in the Mountain West and Alaska, while the lowest rates are primarily found in the Northeast and California. The rate in New York is 8.3 far below the national average. 

If mental health professionals were to build a mental health system that prevented deaths from suicide what elements in that system would be beneficial to that goal?

The glaring discrepancy in suicide rates is rarely recognized and acknowledged let alone addressed. For example the suicide rates in the worst states: Alaska 29.7, Wyoming 27.8, Montana 26.8, Oregon 20,0 and the best states: New Jersey 6.7, New York 8.1, Massachusetts 8.3, and Rhode Island 8.9 is very significant with the rates in the worst states being three times higher than the best states.

One of the biggest factors in suicide rates is the quality of the infrastructure that supports personal functioning. In other words, does a person have a place to turn when they are down and out? Is there help available? 

Mr. Rogers said that his mother told him, “Freddie, if you are in trouble look for the helpers.” Mental health professionals are a type of helper. The concern is that they are available  to meet needs of ultimate desperation. In some states that are more available than in others. The public health data of suicide rates is one way of measuring the difference their availability makes in the health and life of a population,

Lula Dean's Little Library Of Banned Books

 I noticed this morning, July 2, 2026,  that Kirsten Miller's book, Lula Dean's Little Library Of Banned Books, kindle version, is on sale for $2.99. I read it a couple of months ago and it is very enjoyable and illuminates the dynamics of book banning in our current society.

How it works: Small talk is beneficial

When it comes to small talk it is the process not the topic that provides benefits to the participants.

An interesting study asked people to predict how satisfied engaging in small talk about things like the weather, current events, traffic, etc. People prior to the small talk conversations rated the satisfaction as being low, but after the conversations rated their satisfaction much higher. Why the discrepancy between predicted and actual satisfaction? 

One explanation is that people based their prediction of satisfaction on the topic not the dynamics of the social interaction.

Is it worth engaging in small talk with people? The research finds that yes for most people it is. Observe your own experience and report your findings in the comments. I would like to know what the results are if you intentionally observe your experience.

For more click here.

Good work noted: Mental Wealth project at University of Sydney

 

Mother Teresa said that the US while the wealthiest nation on earth is also the most spiritually impoverished. The Beatles sang "Money can't buy you love."  Americans are very focused on money as the measure of success. The Stoics taught that the development of virtue is the proper measure of success.

How it works: Conspiracy thinking

 

Conspiracy thinking considered from a cognitive developmental model is immature and based on an egotistical desire for security in what is perceived as a confusing and threatening world. People who engage in conspiracy thinking should be approached with compassion without condescension and a passive non threatening friendly suggestion to consider other optional understanding of the phenomena under consideration.

How do systems work?

One of the obstacles to satisfying and fulfilling functioning is the lack of understanding of how systems work. Most of the systems that comprise modern life are complicated and thus confusing, frustrating, anxiety inducing, and can seem overwhelming. As a Psychiatric Social Worker I spend a lot of effort and energy in helping clients navigate the various systems that can provide the resources for them to meet their needs and are requiring some degree of compliance, cooperation, and behavior. This assistance requires that the Psychiatric Social Worker understands how these systems work. This understanding requires education and experience. This understanding of how systems work is a major component of Social Work competence.

The assistance in navigating systems is sometimes referred to as “empowerment.” Empowerment involves three activities: providing information, teaching skills, and providing opportunities to use that information and those skills.

What are the major systems that people function within in our current society? Some of them are education, health, legal, economic, recreational, media, social welfare, and political. Within these domains there are multiple subsystems.

Here on Markham’s Behavioral Health we will be exploring how these various systems work and how they can best be navigated to obtain what resources they provide to improve a person and their family’s functioning.

The overarching question is how do these systems affect a person and community’s mental health?

Michel Foucault called these systems “discourses.” Discourse analysis involves several components of the discourse: knowledge, skills, values, expert representatives of the discourse. One of Foucault’s great contributions was to analyze discourses historically and trace their development in society over time usually involving a couple of centuries or more. Understanding discourse development historically gives the student a better understanding of how the discourse’s knowledge, skills, values, and expertise evolved and came to be what they are today.

The first discourse to be described on Markham’s Behavioral Health is the health care system in the United States which is, compared to other first world countries, very dysfunctional and increasingly difficult to navigate to get one’s health care needs met. It is hoped that by better understanding the system one can better manipulate it to get one’s health care needs met and to help change it to a system that better meets the needs of the American people.