Written Testimony – Mandated School Mental Health Curricula

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Written Testimony on SF 261 – Mandated School Mental Health Curricula
Karen R. Effrem, MD
President – Education Liberty Watch

Thank you, Senator Torres-Ray, for your concern for children and youth and for the mentally ill.  Although the intentions are good, Education Liberty Watch has many concerns with SF 261, including dilution of academic curriculum content, loss of local control and cost for already strapped districts, our biggest ones are the subjectivity of mental health diagnosis, controversies in treatment, huge potential for political bias in diagnosis and treatment, and conflict of interest of the pharmaceutical industry, none of which are discussed in the national health education standards.  We believe that this bill would create a biased and potentially dangerous curriculum for students. Here are a few examples:

• Even the top echelon of experts in psychiatry admit that diagnosis is very subjective:

Dr. Dilip Jeste, president of the American Psychiatric Association, in a statement on the completion of the new about to be published edition of the bible of psychiatric diagnosis, the Diagnositc and Statistical Manual (DSM-V), said last December:  “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 all 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.”

• The DSM-5 committee debated adding extreme racism and homophobia as a new diagnosis in the most recent version of the diagnostic manual set to come out this Spring (2013).

“Doctors who treat inmates at the California State Prison outside Sacramento concur: They have diagnosed some forms of racist hatred among inmates and administered antipsychotic drugs. ‘We treat racism and homophobia as delusional disorders,’ said Shama Chaiken, who later became a divisional chief psychologist for the California Department of Corrections, at a meeting of the American Psychiatric Association. ‘Treatment with antipsychotics does work to reduce these prejudices.’” (Vedatam, 12/10/05, Washington Post, emphasis added)

“As doctors increasingly weigh the effects of race and culture on mental illness, some are asking whether pathological bias ought to be an official psychiatric diagnosis.  Advocates have circulated draft guidelines and have begun to conduct systematic studies. While the proposal is gaining traction, it is still in the early stages of being considered by the professionals who decide on new diagnoses.” (Vedatam, 12/10/05, Washington Post, emphasis added)

• The latest changes in the DSM are very controversial and according to experts like Dr. Frances and others will lead to even more over-diagnosis and more over-treatment with medications that have very limited efficacy and severe or fatal side effects

The decision to create a pediatric bipolar diagnosis in the current DSM-4 led to a 40 fold increase in that diagnosis in children, affecting African-American children most severely.  This is probably because Medicaid is the largest purchaser of antipsychotic medications used to treat those labeled with this disorder.

In the new DSM, about to be published this year, temper tantrums are now to be labeled as Disruptive Mood Dysregulation Disorder and the manifestations of the normal process of grief are now considered symptoms of Major Depressive Disorder.

• The side effects of medications used to treat mental illness are very significant and severe:

To varying degrees,  all psychiatric drugs are associated with both increased suicidal thoughts and ideation as well as akathesia, an extreme inner sense of agitation, which can and has been associated with at least 64 incidents of violence at schools, including mass shootings like Columbine, Red Lake, and as it appears, Newtown.  There are at least two reports that have not been discredited that Adam Lanza was on some type of medication.  Here is a chart showing the gun related incident resulting in deaths in the US derived from www.ssristories.org:

Antipsychotics (Zyprexa, Seroquel, etc.) – 25 year shorter life span, brain shrinkage, severe neurological problems in 60% of children that take them, more severe metabolic problems than in adults that include diabetes, weight gain, male breast development, as well as heart attack and stroke in young people.

Antidepressants (Prozac, Paxil, etc.)– For young people under 24, these drugs carry the FDA’s black box warning, the most severe warning short of a ban because of suicidal thoughts and attempts.  They also cause akathesia, even more so than the antidepressants.

ADHD Drugs (Ritalin, Adderall, etc.) – Associated with psychosis, hallucinations, sudden cardiac death and weight loss Continue reading »

Pre-K Scholarships Mandate Curriculum, Aid Unionization & Decrease Choice

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Written Testimony SF 481/ HF 1058 – Early Childhood Scholarships

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Written Testimony on SF 481/HF 1058 – Early Childhood Scholarships

Karen R. Effrem, MD

President – Education Liberty Watch

Although this bill is less onerous than the language in the governor’s education finance bill regarding parental rights, family sovereignty, and the rights of conscience, we still have a number of concerns

1)      Internal language inconsistency  – Lines 1.10-1.14 of the bill say:

1.10 Subd. 2. Duties. The Office of Early Learning shall administer the early learning

1.11scholarship program, establish participation standards for children and their families,

1.12develop criteria for qualifying providers based on section 124D.142, and contract for

1.13administrative services as necessary with a resource and referral organization under

1.14section 119B.19, or other nonprofit or public entity.

If the Office of Early Learning determines “criteria for qualifying providers” how does that square with lines 3.9-3.10 that say:

 Subd. 7. Scholarship recipient choice of programs. A scholarship recipient may
3.10choose to apply to any rated program or prospective program for acceptance.

What is to say that the Office of Early Learning won’t say later that recipients must choose a 3 or 4 star rated program such as required in the governor’s finance bill?  We are particularly concerned about the Parent Aware requirement to align curriculum and assessments to the Early Childhood Indicators of Progress (ECIP) in order to receive a three or four star rating, which I will discuss more below.  We also want to know whether it is the language of this bill or the governor’s bill that will be included in final legislation and which part of the language of this bill.

2)      Childcare and preschool programs that accept scholarship recipients will be considered subsidized for the purposes of unionization – This will increase costs and decrease access for these poor and middle class families analogously to what is happening to physicians who cannot afford to take care of Medicaid and Medicare patients under the Affordable Care Act.

3)      Cost – The governor’s finance bill calls for a 733% increase in funding for these scholarships over current levels.  This bill’s funding for 2014 is a 1,300% increase and a 1,750% increase in 2015 when there is still a deficit in Minnesota, much less the federal government, the threat of unionization and higher taxes, other needs in education, little proof that they will work, and a still quite shaky national economy.

4)      Many large centers and Head Start programs receive automatic four star ratings putting small programs at a disadvantage – According to the Parent Aware evaluation two thirds of programs received automatic four star ratings.  This is especially problematic for Head Start, when the most recent of over 600 studies released in 2010 and 2012 showed that there was no benefit to the program after 1^st grade and harm to math skills of three year old participants. Smaller programs and individual providers will find it harder to compete.

5)      Mandated curriculum standards for early childhood that apply to private and religious programs that take subsidies – If the 3 or 4 star rating requirement remains, all programs that take subsidized students must align their curriculum and assessments to the ECIP.  This is especially problematic in the social and emotional area, because the state is now mandating one set of standards for thought, behavior, and belief that, no matter one view’s on any given subject, it is the right and authority of parents to inculcate those values in their children, not taxpayer funded education institutions.  Doing ratings and assessments of little children and eventually teacher/caregiver merit pay systems on one set of very subjective standards like this is extraordinarily problematic.  It could also lead to unnecessary over diagnosis and treatment for mental health issues.   We have heard through the grapevine that these standards are being rewritten to remove some of the more controversial items.  That is good, but we still question the authority of the state to be determining norms in this area at all and imposing them of private and religious providers.  Some of the more egregious examples of the ECIP, with definitional quotes and my comments are as follows: Continue reading »

Written Testimony on HF 357 – Youth Mental Health Intervention

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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 »