We need alternatives in mental healthcare
The trailer above introduces the film “Escape Fire”. You can now see it online: http://www.escapefiremovie.com/watch-online
Conventional psychology and psychiatry view mental health as a lack of symptoms like depression and anxiety. From this point of view if you are not ill, injured or reacting to something you don’t like, you are “healthy”. This is a very limited point of view. It completely misses the components of optimal mental health and wellness.
IMHU follows the World Health Organization’s definition of wellness:
Wellness is the optimal state of health of individuals and groups. There are two focal concerns: the realization of the fullest potential of an individual physically, psychologically, socially, spiritually and economically, and the fulfillment of one’s role expectations in the family, community, place of worship, workplace and other settings.
This expands the definition of mental health considerably. Notice spirituality has a dynamic role to play in creating and maintaining wellness. The person who is well has meaning and purpose in life. He/She has a dynamic spiritual life with a profound connection to spirit. Picture it like this:
Extracting ourselves from a limited view of mental health is one of the big problems IMHU addresses. We have to know the destination we are traveling to before we can sort out how to get there! Why stop at just removing symptoms? Let’s optimize mental health! There are few other websites that is a source of unbiased information about this journey, offering exposure to the practitioners who are leaders in that movement. IMHU may be unique.
Now, let’s take a closer look at the mental health problems in today’s world that need to be dealt with. This will help us see how we need alternatives that are effective.
With alarming numbers of school shootings and youth who are seriously mentally disturbed…more suicides and mental pathology in the military…increasingly psychiatric drugs negatively impacting our whole population and healthcare providers operating out of an obsolete paradigm…we must respond by employing more effective options for mental healthcare that aim high–for optimal wellness.
Click on one of the headings below to understand more about the extent of mental health issues in the USA and how we need alternatives:
Adam Lanza, a shy, bright, 20-year old, brutally murdered 27 people (most of them 6&7 year olds), including his mother and himself on December 14, 2012. The toxicology report from his autopsy has been withheld, but close friends of Adam’s mother indicated Adam was taking one or more psychotropic drugs to manage issues related to emotional disturbance. Could it be that his horrific behavior was a result of taking the psych meds…or being in the process of coming on or off of them?
In 2008 the US Government Accountability Office reported that one in every fifteen young adults 18-26 years old “is now “seriously mentally ill.” [ii]
Colleges and universities have to cope with extreme mental health issues in the student body for which they have received little or no training or preparation.
We need to help these young people and those in charge of helping them to effectively manage mental disturbances.
Since 1982, 61 mass murders involving firearms have occurred throughout the USA. (Note: we didn’t have these kinds of public shootings outside of war zones before the proliferation of psychiatric medications.) Dig deeply into these stories and you find that most of the murderers were taking psychiatric medications or withdrawing from them (a situation that can cause the same or worse violent impulses). Dr. David Healy, a British psychiatrist, believes psychiatric medications were involved in 90% of the school shootings. Healy is a founder of RxISK.org, an independent website for researching and reporting on the effects of prescription drugs.
According to the National Alliance for Mental Illness (NAMI), the U.S. Preventative Task Force recommends screening all teenagers for major depression, but we don’t yet have the screenings. In their coverage of the Newtown Massacre PBS reminded us that 1.8 billion dollars have been cut from the budgets of various states in the last 3 years and four thousand inpatient hospital beds have also been eliminated. The cutbacks are obviously affecting our ability to pay close attention and adequately provide for those who need mental healthcare.
Would educating consumers about the full expanse of options for mental healthcare help? Would skill building regarding how to take care of mental health problems be of assistance? Of course.
Since such education and training is rarely available, Americans are turning to the available (and very well advertised) menu of psychiatric medications at increasingly alarming rates, avoiding the higher cost of psychotherapy and the stigma attached to seeing a psychotherapist.
Robert Whitaker, who won the highest award in investigative journalism in 2010 for his book, Anatomy of an Epidemic, recorded the following: In 2002, one in every forty children under nineteen years of age in the US was taking an antidepressant, whereas in 1988 only one in 250 children under 19 were taking antidepressants. These drugs increase the suicide risk. In children taking SSRI (antidepressants)—22% suffered an adverse psychiatric event. 10% became psychotic and another 6% manic. Other physicians have reported younger patients treated with SSRIs suffering panic attacks, anxiety, nervousness and hallucinations.
Whitaker continued his report: If the children remain on the drugs for years they are at high risk of becoming chronically depressed. They may also develop an apathy syndrome characterized by a loss of motivation, increased passivity, and often feelings of lethargy and flatness. An epidemic of bipolar disorder (a fivefold increase of youth diagnoses from 1996-2004) is attributed to the prescribing of stimulants and anti-depressants to children as history reveals that the rise in this diagnosis is lockstep in the rise of the prescriptions for children taking stimulants for ADHD and antidepressants. Whitaker’s research has been validated by representatives of the Cochrane Collaborative, an organization that completes meta-research of the highest order in the world.
American soldiers have never been more medicated than they are today. In their December, 2012 issue, Men’s Journal reported that “In 2010, more than 213,000 service members – roughly 20 percent of the active-duty military – were taking medications the military considers “high risk.” This includes atypical anti-psychotics like Seroquel, which carry a warning label for suicide, and can cost as much as $10 a dose.
According to recent data released by the U.S. Department of Defense (DoD), from 2001 to 2009, the Army’s suicide rate increased more than 150 percent while orders for psychiatric drugs rose 76 percent over the same period. In the first 155 days of 2012, 154 soldiers committed suicide—about one per day – compared to the 139 soldiers who died in combat in the same period. This is an 18 percent increase from 2011 and a 25 percent increase from 2010.
More disturbing, though, is that the increased suicides are occurring during the withdrawal of troops from Iraq, when U.S. combat forces are at significantly reduced numbers; however, according to the DoD data, nearly one-third of the suicides in the military occurred among those who had never seen combat duty.
Despite the expenditures for psychiatric drugs for the military (2 billion spent from 2001-2012) and the growing number of mental health professionals recruited to care for the troops, “mental illness” remains the leading cause of hospitalization for active-duty troops. [iii] With so many human and financial resources being invested, we need to ask: Why isn’t anyone getting better?
Dr. Bart Billings, Ph.D., a retired Army Colonel and former military psychologist and founder and director of the military-wide Human Assistance Rapid Response Team (HARRT) program spoke to Kelly Patricia O’Meara who writes for the “Citizens Commission on Human Rights”. She asked him, “Why are the troops taking their lives at record levels?”
Billings believes that the cause of the suicides among the troops is the direct result of the overuse of psychiatric drugs.
“I’m 100 percent convinced,” Dr. Billings said, “I’ve seen it and talked to hundreds of these guys. These medications really interfere with the brain’s ability to normalize itself and adjust. It’s hard to make a choice on how to recover if your brain isn’t operating the way it should be…It’s kind of like working with someone who is drunk,” explains Dr. Billings, “you’re not going to get very far. It would be like me spinning you around fifty times and then asking you to walk a straight line. It’s not going to happen. These medications are a chemical lobotomy.”
We have to ask, “ What are the medications Dr. Billings is referring to as a “chemical lobotomy” and peddled to the troops as magic mental health bullets?” Through her research O’Meara found: According to the Department of Veterans Affairs, during the last decade, nearly $850 million has been spent on Seroquel, an antipsychotic, prescribed to the troops for sleep disorders at a rate of 6.6 million prescriptions. Seroquel was approved by the FDA for the treatment of schizophrenia and bipolar disorder, yet, the military wrote more than fifty-four thousand Seroquel prescriptions in 2011, with 99 percent of those prescriptions written off-label – for disorders not approved by the FDA.
Despite the FDA’s warnings about the potential for increased suicidal thoughts and behavior associated with antidepressants and antipsychotics (the psychiatric meds most often used in the military), the Army’s highest-ranking psychiatrist, Brig. Gen. Loree Sutton, reports seventeen percent of the active-duty force and 6 percent of deployed troops are on antidepressants.
Would a broad education about how to avoid or effectively cope with mental disturbances help our troops and the providers who care for them? A sound, “Yes.”
Recent analysis of pharmacy claims data by Medco Health Solutions, Inc., reveals that one in five American adults take at least one psychiatric drug and that the use of psychiatric drugs among adults grew 22 percent from 2001 and 2010. According to this Medco report, 10 percent of men and 21 percent of adult women used antidepressants.
According to Robert Whitaker, author of Anatomy of an Epidemic, long-term effects of psychiatric medications for the majority of users include systemic failure, cognitive decline, and shortening of lifespan by approximately 25 years. The current mental health care system is out of step with new research—what therapies work and which do not work– and there is a need to replace the long-term use of psychiatric medications with more effective therapies and life-style choices that do not have debilitating side-effects. Theoretically, this means replacing the concept of “the broken brain” because there are no biological markers that substantiate mental illness as a broken brain. (Researchers currently, find evidence for a “hungry brain”, a brain that needs naturally occurring micro-nutrients to function optimally, e.g. vitamins, minerals, amino acids, etc.)
Unfortunately, the obsolete information about ‘the broken brain theory’ remains in place leading to the over-use of psychiatric drugs—the therapeutic intervention considered the first and most important step in managing mental disturbances. When this standard is used as best practice, more drugs are used and this leads, in the long term, to a decline of both mental and physical health.
The first of the Baby Boomers, defined as Americans born between 1946 and 1964, turned 65 in 2011. Let’s remember that this group represents more than 75 million people (more than a third of the US population), the challenges to an already struggling health care system are enormous. Questions related to the ability of the mental health profession to accommodate this large subset of the health care population are mounting.
As Reinhardt (2000) noted, “The impending retirement of the Baby Boom generation sometime after the year 2010 is viewed with the apprehension normally reserved for an impending hurricane.” Challenges to clergy and mental health professionals to adequately meet the diverse needs of this group continue to rise as Baby Boomers age and seek “spiritually-related counseling services” and inspiration to face the challenges of aging with a positive attitude.
Abuse of alcohol and street drugs continues to be a tremendous drain on the health of our population with a success rate of recovery at 35% maximum. In a study of substance use in older adults [iv], researchers found that approximately 80% had used either alcohol, tobacco, or non-medical drugs (e.g., sedatives, tranquilizers, opioids) at some point in their lives and more than half had used at least one of these substances in the past 12 months. Increased sensitivity to medications due to the effects of aging on drug metabolism coupled with Baby Boomers’ acceptance of drug use poses a potential physical and mental health care crisis as this group ages. Community-based collaborations; a strengthening of outpatient services; and a focus on health, prevention, and education are the current suggestions for combating the predicted shortage of general and mental health resources for the large number of Baby Boomers.[ii]
We need more effective means of maintaining wellbeing. We need centers that offer encouragement for new perspectives and life style choices as well as continuity of care. We need to draw on models of care from diverse cultures that have worked.
Will classes and meetings help the Boomers? Without a doubt.
Many of the providers trained in the 1980s, 90s, and early 2000s were taught that most mental disorders, like physical illnesses, have a bio-marker, and should be considered to be a medical illness–even though we have not yet found those markers. (In April, 2013, Thomas Insel, MD psychiatrist and Director of the National Institute of Mental Health acknowledged that we do not have the bio-markers at this time.)
Those trained in the 80s and up to 2010, were to consider that psychiatrists who specialized in pharmaceuticals had the most astute role to play in helping people with so-called mental illness as well as researching the next level of cure—as they knew the physiology and mechanisms of the brain, brain chemistry, could use the full menu of psychotropic drugs, and could therefore put an end to mental/emotional pain. The idea that the “magic pill” would be forthcoming was the carrot on the stick keeping this paradigm going. Medical insurers wanted “brief therapy”, and usually frowned on claims for any course of therapy longer than 3 sessions, unless it was a 15-minute session by an MD to adjust psychiatric drugs.
Mental health care providers trained before the 1980s had the benefits of a broader base of theory to bring to bear for diagnosis and treatment objectives. They were able to practice psychotherapy in the 50-minute hour and many insurance companies would pay for a person to have months of psychotherapy for many different kinds of disorders. Most of these older providers have had to retrain themselves to function within the climate where only brief therapies will be paid for by insurance, and their clients who needed a longer term of care but could not afford to pay out of pocket, had to get along without professional help. The only other option was for providers to charge reduced fees for clients who could not otherwise afford their services.
The insurance companies and pharmaceutical companies have adjusted themselves to the paradigm of primarily pharmaceutical mental health care and gained much from it. However, the academics and health care providers who are up to date with research are recognizing that this paradigm is not only obsolete, but unfair to clients who truly want to find resolution for their mental health issues, i.e. recovery.
As the new research becomes more well known, increasing numbers of health care workers on all levels (students, nurses, school counselors, addiction specialists, psycho-therapists, psychologists, psychiatrists and general practitioners) will need to better understand the paradigm shift taking place, and acquire the skills necessary to keep up to date so they can deliver the best care possible and no longer participate in a paradigm of care that is not only obsolete but, over time, harms the majority of clients. Changes in how therapy is provided will not only change the way private practitioners work but also demand changes in whole programs and organizations dedicated to mental health.
Is continuing education to understand new evidence-based research important to help providers understand and practice best standards of care? Absolutely.
[i] For further information on the long term effects of psychiatric medication turn to Breggin, P. (2013) Psychiatric Drug Withdrawal; Bragdon, E. (2011) Spiritism and Mental Health; Bragdon, E. (2012) Resources for Extraordinary Healing; Williams, P. (2012) Rethinking Madness.
[ii] US Government Accountability Office, (June, 2008). “Young adults with serious mental illness.”
[iii] O’Meara, K. (October, 2012). “Psychiatric drugs and war: A suicide mission”. Citizens Commission on Human Rights.
[iv] Sorrell, JM, PhD, RN, FAAN; Cangelosi, PR, PhD, RN, CNE (September, 2011) “Baby boomers: Are we ready for their impact on health care?”. Journal of Psychosocial Nursing and Mental Health Services, Vol 49. Issue 9:15-17.