Written Testimony on HF 357 – Youth Mental Health Intervention

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[1] 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[2]:“…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.[3]

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.”[4]

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.”[5]

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)[6]

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.[7]

SHORTENED LIFE SPAN – Researchers believe that those diagnosed with mental illness and treated with medications face a 25 year shorter lifespan[8]

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.”[9]  Below is a table of psychiatric drug associated school shootings that have resulted in many deaths just in the US.[10]

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.”[11]
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. “[12] Continue reading »

Written Testimony Against Childcare Unionization – SF 778

Dear Chairwoman Pappas, Ranking Member Hall, and Members of the Senate State and Local Government Committee,

Thank you for accepting this written testimony and for your concern for families in childcare and the providers that care for them.  I am submitting this testimony as President of Education Liberty Watch, which is also a part of the Childcare Freedom Coalition.

We oppose this legislation for the following reasons:

1)      This bill abrogates the First Amendment right of freedom of assembly  – It will force small businesses that are run predominantly run by women or family members taking care of sick or elderly relatives  to unionize against their will or to pay fair share fees.

2)      Increased costs for working families – Providers will be forced to pass along the increased costs of union dues or fair share fees to their clients or in the case of home care providers caring for their own family members, have to absorb these increased costs when premiums, taxes on medical devices, etc. are increasing, the economy is still struggling and unemployment is still higher than it should be.

3)      Decreased choice, especially for families receiving subsidies – If taking children who receive any kind of childcare subsidy, including the proposed Early Childhood Scholarships, or hiring any kind of homecare provider results in unionization, many of these small business owners will cease to take these children or provide care for these sick people  – analogous to what is happening with  the Affordable Care Act and doctors not being able to afford to care for Medicare and Medicaid patients.

4)      Politically unpopular across a wide spectrum – This is not popular even among Democrats!! KSTP/Survey USA poll from 2011: “Should daycare workers in the state of Minnesota form labor unions and be considered as public employees?” 68% or survey respondents said no, with only 19% in favor of the idea. Opposition was the majority opinion across all noted demographics, including political affiliation. 73% of Republicans opposed the plan as well as 60% of Democrats and 70% of independents. (See the poll results at Survey USA, especially Question 3 at http://www.surveyusa.com/client/PollReport.aspx?g=98e06008-a002-4bda-b2dc-d5093903734a). Many states that have had unionization laws have repealed them.  Governor Jerry Brown, a Democrat governor of the, or one of the most liberal states in the nation, vetoed a childcare unionization bill.  When Minnesota House Democrats had the opportunity to vote to amend the unionization vote legislation into a bill, even Democrat legislators voted overwhelmingly against it. The vote on that was 16 in favor (all DFL members) to 114 opposed. (See House Journal, page 9336 at http://www.house.leg.state.mn.us/cco/journals/2011-12/J0428112.htm#9336)

5)      This could lead to teacher evaluations for preschool teachers and providers – As with unionized teachers dealing with the Common Core standards and their evaluations based on those standards and test results in K-12, even pro union childcare providers may not like all of the bureaucracy and loss of autonomy from being turned into teachers and assessors of young children having to teach, assess and be rated by one set of government mandated standards  as the use of Parent Aware spreads across the state.

Thank you again for your consideration of our views in this important issue.

Social Studies Standards Hearing Report

Many thanks to all who were able to give oral testimony at the December 20th social studies standards hearing. The large hearing room at the Minnesota Department of Education building was nearly full.  The vast majority of testifiers were overwhelmingly opposed to the new standards.  Witnesses were armed with facts and passionate eloquence.  Department officials seemed surprised and a little dismayed at the level, intensity and detail of the opposition. Although we do not have all the testimony that was presented, we were able to obtain some of it from those that graciously provided it. See below for links and quotes from some of this excellent testimony.  In addition, negative comments about the standards are coming in from several important groups and individuals.  The judge has granted the full 20 days period for written comments, meaning the record will close on January 9th.  Details for submitting written comments may be found here. If you cannot do written comments, we will have more information about a petition just after Christmas. Thank you for your support!  May all of the joys and blessings of Christmas, Hanukkah, and the New Year come to you and yours.

Witnesses against the standards included parents, grandparents, business owners, a former citizen of communist Poland, two college professors, a former AP biology teacher, and two legislators.  Education Liberty Watch’s testimony was delivered by attorney Marjorie Holsten.

In addition, there have been important comments from the Minnesota House Republican leadership,  new commentary from Dr. John Fonte of the Hudson Institute as we previously mentioned, and important testimony from the American Principles Project about the link of these social studies  to the Common Core English standards. All of these are also quoted and linked below.

As witnessed by the length of time it has taken to get out this report, we know it is very busy this time of year. To that end, we hope to introduce some sort of petition mechanism to help you weigh in against these awful standards and still spend this important time with your family and friends.  More news will be forthcoming.

Finally, we do know that it is a busy time of year and this is a bad economy, but there are monetary costs to the work that we do.  Any tax deductible financial help that can be directed to Education Liberty Watch as you consider your year end giving so that we may continue to stand for academic excellence, perpetuating our republic and protecting the rights of parents to raise their children would be most appreciated.

ORAL TESTIMONY QUOTES AND LINKS:

Education Liberty Watch Prepared Oral Testimony Delivered by Marjorie Holsten 

“Based on the forgoing as well as the more detailed information we will submit, we believe that for the sake of academic rigor, the cultural literacy and ability of Minnesota students to function as citizens able to maintain the freedoms of our republic, the fulfillment of legislative intent, and state autonomy, that these standards should be rejected or at least significantly modified and that the 2004 standards should be kept until that happens. Thank you.”  

Remarks Prepared for Oral Testimony of Representative-Elect Cindy Pugh

“Finally as a newly elected legislator about to be sworn in for the first time, it pains me to see violations of legislative intent, as well as how state sovereignty is being violated in education both by the mandates of No Child Left Behind and the creeping imposition of a national curriculum via the linking of the Common Core English standards to the social studies standards.”

Continue reading »

Social Studies Standards Hearing Prepared Remarks of Donald Lee

Thank you for the opportunity to address these important issues.

It seems impossible to satisfy all the stakeholders. Some testimony heard today is from special interests seeking to add “one more thing” to the standard, believing that if not in the standard, it won’t be taught. Those who actually have to do the teaching complain that there is far too much in the standard to do a decent job of covering the material.  I respect the 40 people and their efforts, but their job is very difficult.

I’d like to step back and ask a vital question.  Why do we teach “social studies” – civics, geography, economics and history?  What is the purpose?

We teach our children these things in order to explain and inculcate the intellectual and ideological foundations on which our culture rests.

History is especially important because it gives to our young the wisdom of human experience. It tells where we’ve been, and how we came to be where we are, not just physically, but intellectually and spiritually. It tells our students what has worked, and what failed.  It inspires them with the amazing accomplishments of those who went before us, and cautions them against repeating old mistakes.  It provides perspective to help put new events in their proper place.  History reminds us that deceptively simple solutions to complex problems have been tried before, and are almost always wrong.

Civics is basic training in citizenship. Without instruction in how our republic works, and full understanding of what can go wrong, our republic will wither into the certain tyranny that marks the rest of human history.  Citizens need to understand their vital role. More importantly, they need motivation — reasons to care about doing the hard work of citizenship.

So, I come to this hearing asking a question: Do these proposed new standards enhance the effort to teach our children these absolutely essential things?

Unfortunately, the answer appears to be an emphatic “no”.

Do not misunderstand.  I recognize and appreciate all the work that has gone into these standards, and realize that the authors are every bit as dedicated to producing a good outcome as I am.  There is much to like in these new standards, but fatal flaws demand correction.

Continue reading »