February 13, 2013
Dear Chairman Mullery and Members of the Early Childhood and Youth Development Committee,
As I am unable to attend this hearing in person, I appreciate your willingness to accept this written testimony on the mental health interventions proposed for funding in HF 357. I am writing as a mother of three, a pediatrician, and a policy analyst for the International Society for Ethical Psychiatry and Psychology and for Education Liberty Watch
While understanding and sharing the desire to help those who struggle with emotional issues, especially in light of the violent incidents involving those suspected to be mentally ill or under treatment for mental illness, for the sake of those this legislation is supposed to help, their families, and the taxpaying public, please beware of unintended consequences. Because of the uncertainties of psychiatric diagnosis, especially in youth and because of difficulties with psychiatric medication, things could well become worse if the focus of these efforts is strongly on medication as listed as the first item in the proposed interventions funded in this bill on lines 1.16 and 1.17 dealing with antipsychotic medication management
Let me begin with the diagnostic aspect of mental health in general and psychosis in particular. Here are two of many examples that I could give you of quotes from leaders in psychiatry:
Dr. Dilip Jeste, president of the American Psychiatric Association, in a December 2012 statement on the completion of the new, about to be published edition of the bible of psychiatric diagnosis, the Diagnostic and Statistical Manual (DSM-5), said, “At present, most psychiatric disorders lack validated diagnostic biomarkers, and although considerable advances are being made in the arena of neurobiology, psychiatric diagnoses are still mostly based on clinician assessment.”
In plain English, that means that psychiatric diagnosis is an educated guess. Dr. Allen Frances, chief editor of the current edition of the DSM put it much more bluntly in a 2010 interview:“…there is no definition of a mental disorder. It’s bull****. I mean, you just can’t define it.”
In fact in a December 2012 op-ed published in the Star Tribune, he said:
There are profound economic consequences to where boundaries are set between what is normal and what is considered a mental disorder. Diagnosis of mental illness brings on a cascade of costs, including doctor visits, tests, medications (and treatment for their complications), forensic and prison costs, disability obligations, the siphoning of educational resources and absenteeism.
We are already experiencing an inflation in psychiatric diagnosis and an explosion in the use of expensive, and often unnecessary and harmful, psychotropic drugs.
In his opinion, the new edition of the DSM will increase these already high costs enormously. In Minnesota, the Department of Human Services spends more on antipsychotic medication than any other pharmaceutical class.
Diagnosis is more complicated in children and adolescents. The World Health Organization said in the 2001 World Health Report, “Childhood and adolescence being developmental phases, it is difficult to draw clear boundaries between phenomena that are part of normal development and others that are abnormal.”
With regard to psychosis in particular, the problems of accurate diagnosis are even more acute. Committees of psychiatrists involved in creating the DSM-5 revisions had contemplated an entity called “psychosis risk syndrome” to try to identify adolescents and young adults who were at risk for developing the psychotic symptoms of delusions, hallucinations, and paranoia associated with schizophrenia and bipolar disorder. Proponents of this approach believe that “clinicians have long noted the existence of early indicators which act as a warning that a first psychotic episode may be imminent” and that, “Since delayed treatment for a first psychotic episode can often worsen the outcome, there is a very real need to act on prodromal symptoms as soon as possible.”
Thankfully, for the health and safety of American adolescents and young adults, the psychosis risk syndrome was abandoned for several very important reasons:
The same psychiatrists and psychologists that though it was important to treat these preliminary symptoms of psychosis as soon as possible acknowledged literally in the next sentence of the same article, “Unfortunately, given that the presence of prodromal signs do not invariably result in psychosis, acting prematurely can often do more harm than good.”
The DSM-V committee was ultimately never able to satisfactorily answer issues like “the ethics of false positives,” “ how soon biomedical interventions should begin,” and whether if “prodromal patients deoften attached to mental illness in most societies.”
The reputation of the DSM and psychiatry in general has been battered by the disastrous effects of broadening the diagnostic criteria for bipolar disorder to include children. This decision was the most regretted by Dr. Frances, the lead editor of the current version of the DSM, volume IV. That decision led to a 40 fold increase in the diagnosis of bipolar disorder in children, most notably in African American males and in some children as young as 18 months old. According to an August 2012 study, prescriptions of antipsychotics for children, including for off-label uses, such as for ADHD, increased seven and a half fold.
The other huge issue involved with expanding medication treatment of young people with early psychosis is both the lack of effectiveness and severe dangers of these drugs. In his book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, award winning journalist Robert Whitaker describes one of many studies cited:
In the 1980s, Martin Harrow, a psychologist at the University of Illinois, began a long-term study of 64 newly diagnosed schizophrenia patients. Every few years, he assessed how they were doing. Were they symptomatic? In recovery? Employed? Were they taking antipsychotic medications? The collective fate of the off-med and medicated patients began to diverge after two years, and by the end of 4.5 years, it was the off-medication group that was doing much better. Nearly 40% of the off-med group were “in recovery” and more than 60% were working, whereas only 6% of the medicated patients were “in recovery” and few were working. This divergence in outcomes remained throughout the next ten years, such that at the 15-year follow-up, 40% of those off drugs were in recovery, versus 5% of the medicated group. Harrow reported at the 2008 annual meeting of the American Psychiatric Association, “I conclude that patients with schizophrenia not on antipsychotic medication for a long period of time have significantly better global functioning than those on antipsychotics.” (Emphasis added)
This is not to mention very dangerous effects of these drugs, such as:
DEATH – A 2006 study found 45 deaths in children from 2000 to 2004 associated with these drugs, with that likely only representing one to ten percent of the total.
SHORTENED LIFE SPAN – Researchers believe that those diagnosed with mental illness and treated with medications face a 25 year shorter lifespan
SUICIDE & VIOLENCE – Although not as closely associated with violence as the antidepressants like Prozac, antipsychotics all cause akathisia, a severe inner agitation, “which means that persons who take them can’t sit still and feel like they are jumping out of their skin. They behave in an agitated manner which they cannot control and experience unbearable rage, delusions, and disassociation.” Below is a table of psychiatric drug associated school shootings that have resulted in many deaths just in the US.
|1||Zoloft + ADHD Med||Huntsville, AL||2011|
|6||Prozac||Northern IL Univ.||2008|
|33||Psych med found in shooter’s effects||Virginia Tech||2007|
|11||Prozac||Red Lake, MN||2005|
|3||Shooter admits not having medication||Appalachian Law School, VA||2005|
|5||Ritalin||West Paducah, KY||1997|
|2||Xanax + Several other drugs||South Carolina||1988|
BRAIN SHRINKAGE – “Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment.”
METABOLIC EFFECTS – “Children and adolescents seem to have a higher risk than adults for experiencing adverse events such as extrapyramidal symptoms, prolactin elevation, sedation, weight gain, and metabolic effects when taking antipsychotics. “ Continue reading »
Although Education Liberty Watch primarily deals with the effects of education programs and spending and their effects on academic excellence, parents’ rights and the propagation of the American heritage of freedom, we also monitor a number of issues in the health and human services realm that affect parents’ rights and family autonomy to have parents raise, educate and care for their children without government interference. Both the Minnesota House and Senate finished their massive health and human services policy and spending bills in recent days. Although spending remains a major problem in both the House and Senate bills and the House bill being significantly more bureaucratic than the Senate bill, there is still some very good news that should be trumpeted and for which the Republicans should be thanked. Contact information for the House is available here and the Senate information is available here.
1) Health Care Freedom of Choice Act Now in Both House and Senate Bills – This provision that asserts Minnesota’s state sovereignty to not force its citizens to buy health insurance as mandated by the federal government in the Affordable Care Act (a.k.a. Obama Care) is now in both omnibus bills. This is great news for freedom and for families struggling in this economy to not have to buy government mandated health insurance whose premiums will rise and coverage will shrink. The legislation was introduced by Rep. Steve Gottwalt (R-St. Cloud) and Senator David Hann (R-Eden Prairie). The provision was in the Senate bill. The amendment to add it into the House bill was offered by Rep. Glenn Gruenhagen (R-Glencoe) on the House floor. The vote was along party lines. The authors and all of the legislative Republicans should be thanked.
2) Protections Regarding State Collection, Storage, and Unconsented Research on Baby DNA in Senate Bill – Thanks to the excellent work of Senator David Hann, Twila Brase and Citizens’ Council for Health Freedom, and many concerned parents and citizens, protections from government acquisition, storage and use for research without consent are now in the Senate bill. Our genetic code contained in DNA is what identifies us as individuals and is the most intimate information we have. The last entity that should have possession and control of that information is government.
3) Parent Aware Quality Rating System for Child Care Now GONE from Both HHS Bills – The bureaucratic, ineffective, big government quality rating system about which we have warned you extensively was in the House bill in a watered down form at the behest of Democrat early childhood proponent Rep. Nora Slawik. House HHS Finance Chairman Jim Abeler (R-Anoka) removed the provision before the House bill went to the floor. Senate Chairman David Hann never had the provision in the Senate version at all. Both chairmen should be thanked.
“Institutionalized messages surrounding ECE claim that it has the potential to promote children’s life-long success, especially among low-income children. I examine the legitimacy of these claims by reviewing empirical evidence that bears on them and find that most are based on results of a small set of impressive but outdated studies. More recent literature reveals positive, short-term effects of ECE programs on children’s development that weaken over time.” – Lowenstein, Journal of Educational Policy, January 2011 – Emphasis added
“As with the 4-year-old cohort, there was no strong evidence of impacts on children’s language, literacy, or math measures at the end of kindergarten or at the end of 1st grade.” (Head Start Impact Study, Executive Summary, January 15, 2010, p. 21)
“…the achievement impact of preschool appears to diminish during the first four years of school…preschool alone may have limited use as a long-term strategy for improving the achievement gap…” – Rumberger, et. al, UCSB, 1/06, pp. 79-80
Using data from the (ELCS), researchers concluded that preschool has a positive impact on reading and mathematics scores in the short term and a negative effect on behavior. While the positive academic impacts mostly fade away by the spring of the first grade, the negative effects persist into the later grades. (Katherine A. Magnuson, Christopher J. Ruhm, Jane Waldfogel, “Does Prekindergarten Improve School Preparation and Performance?” National Bureau of Economic Research, April 2004)
Also using the ECLS data, Lisa Hickman at Ohio University, compared children in center care with children who were taught at home. She found that center care children had higher math and reading skills and poorer social skills prior to kindergarten entry. In first grade, however, preschool participants’ cognitive advantage disappeared and their social skills deteriorated. (Lisa N. Hickman, “Who Should Care for Our Children? The Effects of Home Versus Center Care on Child Cognition and Social Adjustment,” Journal of Family Issues 27 (May 2006: 652-684)
DFL Bills Promote Mental Health Curricula, Continue Child Care Takeover and Micromanage High School Counseling
Continuing the big government trend to spend money that neither the state nor federal governments have for ideas that are not only not at all needed, but are actually intrusive and harmful, a trio of bills will be heard in House education committees this week:
1. HF 664 (Welti)/ SF 1531 (Torres Ray) heard in the House Education Policy Committee on 2/17 at 8:30 AM – This bill as introduced required the commissioner of education to establish a model mental health curriculum for grades 7-12. The proposed substitute amendment instead encourages districts to develop these curricula and demands that the Minnesota Department of Education provide support based on the national health education standards and a bunch of Minnesota developed benchmarks that are not even easily available for public review.
This is a bad idea for numerous reasons. First, national and international groups like the World Health Organization, the US Surgeon General, and authors of psychiatry’s Diagnostic and Statistical Manual all admit that the definitions of both mental health and mental illness, especially in children and adolescents, is difficult to uniformly describe and is based on ever-changing societal and cultural norms. Secondly, this is further psychologization of curriculum open to political indoctrination and labeling. Thirdly, it is a diversion from academic curricula when math and reading scores are stagnant and there are large achievement gaps between poor students often from single parent families and middle class students. Finally, neither cash-strapped districts nor the state department that is subject to further budget cuts from the governor’s proposed budget balancing plan can afford this. Continue reading »
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