Disturbing Trends. Disturbing Trends.
This past Sunday an article appeared in the S.F. Gate "Insight" supplement concerning an ethical breach involving the U.S.'s preeminent child psychiatrists and his unreported millions from drug companies. Beneath this wholesale money grab is the crux of the true issue, which is the proliferation of psychiatric medications being routinely dispensed to children. Children. In my present employment, I face these individuals, all grown up, on a daily basis. The thought that they are being medicated as young as 2 years old, is shocking, heart-breaking and akin to the wave of barbaric lobotomy's that were practiced in the last century.
In this article by Dr. Lawrence Diller, he reveals that one in nine 11-year old boys are currently on Ritalin for ADHD. There is currently a "bi-polar" wave sweeping across the nation that currently has 2 year olds on 2-3 different psychiatric medications. The Doctor who is leading this charge is Dr. Joseph Biederman of Harvard University, and he was paid $1.6 million in drug company consulting fees, and his research, researchers, research MD's are all being paid by drug companies. The main problem with all of this, is that Dr. Biederman, who is a major trendsetter in terms of best practices and cutting edge treatments, didn't bother to tell anyone, including Harvard, his patients, employees, or organizations he consults with and lectures to, that he had this arrangement.
Dr. Diller states: "The fortune 500 drug companies, by their sheer economic clout have become the single most dominant influence in our health care system. the ambiguities of children's mental health and illness make child psychiatry the most vulnerable branch of medicine open to such influence... direct advertisements to parents tilt families and doctors to biologically brain based solutions rather than non drug... approaches."
The level of carnage is even greater than Dr. Diller states, for every community mental health center, community care center, youth authority, juvenile detention facility, jail and prison is now one of the largest cash cows in the entire mental health system. Inmates who use and abuse drugs, have traumatic childhoods, depression, brain damage, and issues dealing with their incarceration are being tossed psychiatric medications faster and easier than any group of individuals in the U.S.
The MD's that dispense these medications do not have to worry about getting paid, or the state of the inmates insurance, or their co-pay, or ability to pay, or if they need a low costs generic, or if they can get to the pharmacy or even make the next appointment. The more they prescribe, the less they have to talk, while at the same time, the more invaluable they become to the system. and the drug companies can direct market to the psychiatrists in the system. In addition, the Psychiatrists in these settings are, by a large margin, the highest paid psychiatrists in the State, County and City government. in 2007, 38 of the top 100 highest paid California State Employees were psychiatrists.
The Budget for the Alameda County Jail is over $1.2 million, just for medications for the last year, and has increased by over 10% a year for the last 10 years. At any given time 18% of the jails population is being served by the Mental Health Unit (700 of 3,800).
The more we diagnose, the more people we will label, and the more diagnoses we will develop. In psychiatry, the trend is that anyone who feels sad, excited, confused, distraught, can't sleep, can't stay awake, doesn't behave as desired, does not progress as the "average" is a candidate for psychiatric medications.
There was a show that profiled Dr. Kiki Change of Stanford University, who had begun to dispense medications to children, not because they had a psychiatric condition, but rather, because they exhibited signs that lead this MD to believe that one day they may develop a mental health condition, and so, this MD was prescribing adult anti-psychotic, mood stabilizing and anti-depressants to children in an effort he described as "protecting them".
from the website:
As Director of the Pediatric Bipolar Disorders Program, Dr. Chang conducts research into various facets of bipolar disorder. He is currently conducting phenomenologic, biologic, pharmacologic, and genetic studies of bipolar disorder in adults and children. These studies include brain imaging (MRI, MRS, fMRI) and medication and therapy trials. He is particularly interested in detecting prodromal bipolar disorder in children who might then be treated to prevent the development of full bipolar disorder. To do this, he has been studying children of parents with bipolar disorder who are at high risk for developing the disorder themselves.
All of these trends are inter-related. Once we have lowered the bar on what children are liable to do, and are expected to do, and what is appropriate for them to do, then what we have in effect done, is leave them out in the cold and vulnerable to be diagnosed as something being "wrong" with them. In our jails and prisons, mental hospitals and outpatient centers where these children may end up, they are much more likely to be diagnosed.
The problem I face on a daily basis is maintaining a highly trained and discriminating workforce that has the ability to function outside of the bounds of the DSM-IV, and has the interest and capacity to engage in a discussion with an individual about their lives and choices they've made and what resources they have at their disposal. We need workers who can understand what's going on in people's lives. Recognize patterns, discuss options and solutions, instead of merely taking dictation and then an order for medications.
Having gained an appreciation for the issue of persons with mental illness on the streets and in outpatient centers and inpatient locked mental health facilities, I appreciate the value of major psychiatric medications in combination with therapy, counseling and social services, to allow individuals who would otherwise be in locked settings or in a dilapidated social condition, to live and work in society. But even with that, the number of individuals who require this type of intervention constitutes at best 1-2% of a given population.
How did we get to a point in our society, where we have such little faith in our ability to resolve our issues, solve our problems and live, learn and grow that we must throw a pill at anyone that isn't experiencing an inner subjective feeling other than contentment? As long as we continue to spiral down in ever increasing budgets for high costs psychiatric medications and the even more highly inefficient infrastructure that supports the psychiatric/mental health system, we will be robbed of our ability to make an effective change in the lives of individuals who need the guidance and support of society at large.
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