Right to Fail: Abandoning the Mentally Ill

Right to Fail

PBS Frontline (2018)

Film Review

I disagree with the title of this documentary. It gives the impression the filmmakers disagree with a 2014 ruling in federal court granting New York mental patients the right to live independently (even if it leads to serious adverse consequences) – instead of being warehoused in poorly funded and managed group homes. The main adverse consequences the film identifies include homelessness, incarceration, physical abuse and death.

In my view, the problem isn’t that chronic mental patients need to remain in restrictive settings for their own good (as the title implies). The problem is New York is no different from any other state. No state lawmakers are willing to spend the necessary funds to ensure patients with chronic mental conditions receive the treatment and support they require to live meaningful lives.

In the film, ProPublica reporter Joaquin Sapien blames the decision to empty US mental hospitals in the fifties and sixties on their reputation for “warehousing” patients who could function better in the community. The real reasons for closing state mental hospitals were far more complex than this. In addition to a small patients’ rights movement, there was a much stronger movement by conservative state legislators to “privatize” mental health care. They saw an opportunity trim state budgets by closing state-run hospitals (and shutting down powerful the state unions that ran them ) and relying mainly on pharmaceutical control (newly created antipsychotic drugs) to control patients in the community.

In New York state, many were moved into for-profit “adult homes” or group homes, where their carers were poorly paid and received negligible training or oversight. During the ten years (2003-2014) the the lawsuit was in federal court, there were many examples of unchecked drug and alcohol abuse, pest infestation and physical abuse.

Following the 2014 ruling, approximately 4,000 residents became eligible to move into independent living with various non-profit organizations providing minimal support in the form of case management.

By 2018 when this film was made, 700 had moved into independent living. Of these 30 had died and 39 were forced to return to adult homes.

Sapien investigates the experience of three individual patients who had difficulty adjusting to independent living. The first has three failed attempts if living independently in an apartment. One relates to his benefits being cut off because the agency monitoring him lost track of where he lived, one relates to going off his medication and becoming psychotic, and one relates to a brutal beating by a roommate. Following a lengthy stay in the ICU and on a medical unit, the patient finally receives regular in-home support ad (four hours a day). He clearly thrives with this support, which, unfortunately, only has temporary funding.

The second patient dies of hypothermia after becoming psychotic and spending a night naked in the snow.

The third patient (who is diabetic) is returned to an adult home (at his own request) after he becomes severely dehydrated during a heatwave.

The full film can be viewed free at https://www.pbs.org/video/right-to-fail-fz7iaq/

Pill Pushers in Suits: The Addition Potential of Psychotropic Medication

 

Overpill: The Darker Side of America’s Mental Health

RT (2017)

Film Review

Overpill is a documentary based on the investigation of a Russian-born accountant into the massive overprescription of psychotropic drugs (medications for depression, schizophrenia, bipolar disorder and ADHD) in the US. He became aware of the issue while working for Health Care Communications, a company that markets prescription drugs to Americans for ordinary problems of living. He undertook this investigation after becoming romantically involved with a woman who was addicted to antidepressants and antispsychotics while, despite experiencing horrendous side effects.

The film features extended interviews with former patients who got their lives back after the excruciating ordeal of weaning themselves off medication, with others still struggling with side effects while weaning themselves off, with a malpractice attorney who represents patients experiencing permanent and painful psychotropic complications and Dr Peter Breggin, a controversial American psychiatrist and outspoken critic of the overuse of psychotropic medication.

Both men are alarmed by the deliberate effort by pharmaceutical companies to conceal the addictive potential of antidepressants and antipsychotics, as well as studies showing these drugs can permanently alter the submicroscopic architecture of the brain. This is of special concern with the growing number of psychotropics prescribed in children with developing brains. There are virtually no studies of the long term effect of these drugs in either adults or children.

While the film acknowledges that psychotropic medication can be literally life-saving in some patients with severe mental illness, it rightly points out there are far too many cases in which they’re being inappropriately prescribed.

As a class psychotropic drugs (which are heavily marketed to consumers), are the third most profitable for the pharmaceutical industry.

 

Drug Companies: Killing Kids for Profit

(Thanks to the corporatization of health care, Americans pay double what other countries pay for health care but have much worse health. The recent Obamacare roll-out has heightened public awareness about the role of private insurance companies in sucking billions of health dollars out of the health care system. There is far less scrutiny of the role of Big Pharma in driving up health care costs.

This is the second of several posts on “disease mongering” by pharmaceutical companies  – i.e. the invention of fictitious diseases to market drugs that supposedly treat them.)

Practicing psychiatry for eight years in New Zealand has given me a unique perspective on childhood bipolar disorder. Also known as pediatric bipolar disorder (PBD), this is a condition virtually unknown outside of the US. Australian psychiatrist Dr. Peter Parry has undertaken detailed research into this condition, and a “conspiracy” by Eli Lilly and other drug companies to promote off-label use of antipsychotic drugs to children under 12. Yet another example of “disease mongering” by Big Pharma (see link) to encance their profits.

As well as publishing numerous papers on the PBD controversy, Parry also has a Powerpoint presentation he gives at grand rounds and conferences around the world. It includes internal Lilly and Janssen memos (available from his Healthy Skepticism website) about their innovative campaign to “medicalize” children’s misbehavior.

Thanks to their aggressive marketing of PBD to US doctors and parents, American children as young as two are being started on antipsychotics for extreme anger and behavioral problems

Breaking the Law: Good Business Practice

Prescribing “off-label” refers to using medication for an indication that hasn’t been approved by the FDA. As yet no antipsychotics have been approved for use in children. Moreover, it violates federal law for drug companies to market medications to doctors or the public for “off-label” uses. Yet because the fines imposed are minuscule, compared to the massive profit potential of off-label marketing, it’s considered good business practice to pay the fine and keep on doing it anyway.

Diagnostic Criteria for Bipolar Disorder

Parry’s slideshow starts with studies comparing US attitudes about BPD in the UK, Germany, New Zealand and Australia. Most foreign psychiatrists either don’t recognize pediatric bipolar disorder as a diagnosis or regard it as extremely rare. According to Parry, the discrepancy revolves mainly around an insistence (outside the US) that both children and adults manifest symptoms of true mania to be diagnosed bipolar. Over the past 10-15 years, an increasing number of industry-funded psychiatric researchers have been claiming that extreme temper outbursts, rages and rapidly changing moods are a “manic” equivalent in children.

They also claim that children with extreme mood swings will go on to develop true bipolar illness in adulthood, making early treatment essential. This despite studies showing that most kids with PBD  “outgrow” it as adults. (Although it seems more likely they never had it to begin with.)

What Parry finds particularly horrifying is that American child psychiatrists are diagnosing kids bipolar and starting them on antipsychotics without taking a developmental history to rule out the most common cause of extreme anger and behavioral problems – namely child abuse and attachment difficulties.

Putting Psychiatric Experts on the Payroll

That being said, he puts the blame for the dangerous fad of prescribing unapproved antipsychotic drugs for children squarely where it belongs: on multinational drug companies. In the US, most child psychiatrists are naturally uneasy prescribing dangerous antipsychotic medication for kids. They have to be egged on by esteemed researchers issuing stern warnings about ruining a child’s future life by “missing” a the diagnosis of bipolar disorder.

Too bad these self-proclaimed PBD experts are so careless about disclosing conflicts of interest, in the form of hundreds of thousands of dollars in of drug company research grants and consultant fees. This has only come out in subsequent lawsuits and ethical investigations.

Death and Other Dangerous Complications

The complications of antipsychotic treatment in children fall into four broad categories: death, severe medical complications, social exclusion and delayed emotional development.

1. Death

15 years of FDA adverse incident reports (which typically capture only 1% of adverse drug events) directly implicates antipsychotic use in children with scores of deaths:

2000-2004: 45 deaths (source)

2006: 29 deaths (source)

2.  Severe Medical Complications

Antipsychotics tend to cause massive weight gain – often as much as 100 pounds – a common cause of diabetes. In addition a disfiguring neurological disorder called tardive dyskinesia that occurs in 6-9% of children who take antipsychotics. The tics and writhing movements associated with tardive dyskinesia often persist permanently, even after the medication is stopped.

3. Social exclusion

Labeling a child with a mental illness, particularly if they are taking a medications that cause sedation, extreme weight gain and/or tics has an extremely detrimental effect on social relationships that are absolutely vital to normal child development.

4. Delayed emotional development

Sedating a child who has difficulty regulating anger and extreme moods only further delays the process of learning to regulate their emotions themselves.

Below a video from a mom whose son died from antipsychotic complications:

photo credit: me and the sysop via photopin cc