Archive for June, 2008

Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts

Saturday, June 21st, 2008

Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course

JAMES B. GOTTSTEIN
Law Project for Psychiatric Rights (PsychRights®); International Center for the Study of Psychiatry and Psychology (ICSPP); National Association of Rights Protection and Advocacy (NARPA); Law Offices of James B. Gottstein

 

 

Citation: Gottstein, James B., “Involuntary Commitment and Forced Psychiatric Drugging in the Trial Courts: Rights Violations as a Matter of Course” . Alaska Law Review, Vol. 25, No. 51, 2008 Available at SSRN: http://ssrn.com/abstract=1138743

 

Abstract: 
A commonly-held belief is that locking up and forcibly drugging people diagnosed with mental illness is in their best interests as well as society’s as a whole. The truth is far different.

Rather than protecting the public from harm, public safety is decreased. Rather than helping psychiatric respondents, many are greatly harmed. The evidence on this is clear.

Constitutional, statutory, and judge-made law, if followed, would protect psychiatric respondents from being erroneously deprived of their freedom and right to decline psychiatric drugs. However, lawyers representing psychiatric respondents, and judges hearing these cases uncritically reflect society’s beliefs and do not engage in legitimate legal processes when conducting involuntarily commitment and forced drugging proceedings.

By abandoning their core principle of zealous advocacy, lawyers representing psychiatric respondents interpose little, if any, defense and are not discovering and presenting to judges the evidence of the harm to their clients. By abandoning their core principle of being faithful to the law, judges have become instruments of oppression, rather than protectors of the rights of the downtrodden.

This article weaves legal analysis with the scientific evidence, as well as describes how the recipients of these unwanted interventions experience them. While this Article focuses on Alaska, similar processes are found in other United States’ jurisdictions, with only the details differing.

You may also download this paper by clicking here.

Cost Effective Solutions Can Replace Abusive and Exhorbitant Psychiatric “Care”

Sunday, June 15th, 2008

Replacing the Vermont State Hospital with Humane Community-based Recovery—and Saving Millions of Dollars for Vermont Taxpayers

A report from Vermont’s Ethan Allen Institute (EAI) shows that there are low-cost, humane alternatives to sending emotionally or mentally troubled individuals to Vermont State Hospital (VSH), the state’s public psychiatric facility.

VSH has been decertified by the federal government for poor care three times since 1986. Decertification means that Medicaid no longer participates in treatment coverage, leaving the entire burden on Vermont’s taxpayers. The most recent decertification occurred in 2005, following a condemnatory report by the U.S. Department of Justice (DOJ) that called VSH “dehumanizing” and “prison-like.”

The results of the DOJ’s report have created on one side, a call for a new facility to be built (strongly supported by the state employee’s labor union) and on the other side, support for the abandonment of the state facility in favor of far less expensive, humane and community-based services (strongly supported by civil rights groups, psychiatric patients and legislators responding to taxpayers.)

However, the issue for closure of the 110-year-old VSH goes back to at least 1987 (following the hospital’s first decertification), when researchers led by a former Vermont commissioner of mental health concluded that it was both feasible and desirable to have “community support and rehabilitation services to replace the state hospital.”

Based on two subsequent decertifications, it is still both feasible and desirable.

VSH costs vs. benefits

According to the EAI’s report, the cost to treat a patient at VSH is $1,050 per day, or $383,250 per year. Among specific violations noted by the DOJ in their most recent investigation of VSH:

  • Over-reliance on drugging of patients on PRN (pro re nata, “as needed”) basis with no physician monitoring.1
  • Consistent use of seclusion and restraint as an intervention of first resort, when the patient is neither an immediate danger to himself nor others. More than 90% of such incidents involved strapping patients to a bed in five-point restraints in a seclusion room—the most restrictive and dangerous form of intervention. The percentage of restrained VSH patients substantially exceeds the national average.
  • Insufficient risk management system and unsafe conditions in the building’s physical structure that could facilitate suicide or self-injury. The DOJ’s report notes “the history of suicides at VSH.”
  • There is nothing in the DOJ’s report (or publicly available elsewhere) that speaks of the benefits of treatment at VSH or of the institution’s statistic for patient rehabilitation. Their report does however state that due to its inadequate review process, “patients are likely being unnecessarily institutionalized and potentially deprived of a reasonable opportunity to live successfully in the most integrated, appropriate setting.”

The solution is peer support programs

The solution presented by EAI is that of the “peer support” model of treatment. Such programs are operated in communities, in residential housing—no locked wards, no forced drugging, restraint or seclusion and, in many cases, no mental health professionals—and provide a safe, non-coercive environment where a patient can rest, eat right and in some cases work.

The EAI report makes a distinction between forensic (criminal or potentially violent patients) and non-forensic populations—acknowledging that the peer support system is for non-forensic populations and that forensic patients belong in a more secure setting, for the safety of the public.

Examples of Vermont peer support programs:

Safe Haven houses six patients and is funded partially by a U.S. Housing and Urban Development (HUD) program for the homeless and routinely accepts patients discharged from VSH that have no home to return to. An analysis of patients housed at Safe Haven in 2006-07 showed that each of them successfully transitioned to the community, to either senior housing or a private apartment. Former patients often return to college, get degrees in the field and come back to work in recovery programs. Cost: $32 per day or $11,680 per year. This is a 3181% savings over VSH.

Second Spring serves up to 11 discharged VSH patients, and is staffed by peers and non-peers. Former patients come on a voluntary basis to learn how to live again in the community, something impossible to learn in a hospital setting. Cost: Approximately $750 a day—still less than VSH’s $1,050 daily rate—and a 40% savings.

The EAI’s report gives numerous examples of such programs in other states, such as Minnesota, Alaska and New York.

In addition to the savings, these programs provide recovery—something the state hospital model does not often approach. A 2003 report by the King County (Washington) Department of Community and Human Services showed that of 9,302 people who received publicly funded mental health services over a one-year period, less than 1 percent recovered.2 Mental health watchdog Citizens Commission on Human Rights could find no reports from any county or state agency from any time period that painted a different picture.

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Compared to the state hospital’s failings and high cost, the benefits and low cost of the peer support model bring one to the inescapable conclusion that such a change in the treatment of the emotionally/mentally disturbed would result in a level of patient recovery that rarely, if ever, is attained in the state hospital model—not to mention significant savings to the state and thus, relief for taxpayers.

State legislators and others with budgetary or state hospital concerns owe it to themselves and their constituents to read it and examine the alternatives, which can be utilized or established anywhere.

To read the EAI report, “Don’t Send Me to Waterbury,” go to www.ethanallen.org/home.html and then select “Publications” from the list on the left side.

 

  

1 “Re: CRIPA Investigation of the Vermont State Hospital,” U.S. Dep’t of Justice, 5 July 2005.
2 King County Ordinance #13974, Second Annual Report: Recovery Model, King County Department of Community Services, 2003.

 

Universal Health Services: Profits Over Patients

Sunday, June 1st, 2008

In October 2007, news stories appeared on the death of a 17-year-old boy at the hands of staff members in a Tennessee psychiatric facility. The death was ruled a homicide. A month later, another story appeared, exposing the circumstances surrounding the death of a 14-year-old who was violently restrained by a 260-lb. staff member in the same Tennessee facility. That same month, Fox News broke the story of the death of another 14-year-old in a Massachusetts psychiatric facility, from failure to receive proper medical attention.

Investigation of these reports by the mental health watchdog Citizens Commission on Human Rights (CCHR) found that the facilities these children died in are owned by Universal Health Services (UHS). Further research turned up numerous abuses in their psychiatric hospitals across the United States. There are 114 UHS psychiatric facilities in 33 states, two of them in Missouri: St. Louis Behavioral Medicine Institute and Two Rivers Psychiatric Hospital Kansas City.

The cruel and violent deaths of three children in UHS psychiatric facilities — as well as an extensive list of abuses and violations found from CCHR investigation — seems sufficient evidence that perhaps UHS is not as focused on patient welfare as they are on the bottom line, a common finding with psychiatric facilities around the world.

CCHR is not the only agency to notice these troubles at UHS. In December 2006, the Service Employees International Union issued the report “Failure to Care, A National Report on Universal Health Service’s Behavioral Health Operations,” which declares, “This report finds that UHS has disregarded the safety and recovery of the patients it serves, as well as the communities in which it operates.” A preface from the National Alliance of Professional Psychology Providers, states, “There is a crisis in our nation’s mental health care system…of placing earnings and exorbitant profits above the public interest at the expense of quality services to those in need. Using Universal Health Services (UHS) as an example, this report clearly documents why mega healthcare corporations such as UHS need to be held accountable….”

Read the full CCHR report Universal Health Services: Profits Over Patients at www.psychcrime.org.

If you know about abuses at a UHS psychiatric facility, or if you want to know if a particular facility in your state belongs to UHS, contact CCHR St. Louis.

Marijuana use could worsen depression

Sunday, June 1st, 2008

According to a new report from the White House Office of National Drug Control Policy (ONDCP), marijuana use can worsen depression and lead to more serious mental disorders, such as schizophrenia, anxiety, and even suicide.

Because The Diagnostic and Statistical Manual for Mental Disorders, 4th Edition (DSM-IV), published by the American Psychiatric Association (APA), is used by psychiatrists to diagnose disorders and derive treatment, a real danger for misdiagnosis and mistreatment exists.

In the absence of a known physical cause, a group of symptoms seen in many different patients is called a disorder or syndrome. Harvard Medical School psychiatrist Joseph Glenmullen says that in psychiatry, “all of its diagnoses are merely syndromes [or disorders], clusters of symptoms presumed to be related, not diseases.” Dr. Thomas Szasz, professor of psychiatry emeritus from the State University, Syracuse, New York, observes, “There is no blood or other biological test to ascertain the presence or absence of a mental illness, as there is for most bodily diseases.” Bipolar (previously known as manic depression), schizophrenia, attention deficit hyperactivity, depression, etc., are disorders, not diseases or illnesses.

There are, however, medical tests for marijuana use; but how many psychiatrists give drug tests to their patients before prescribing mind-altering psychiatric drugs for symptoms of depression or other so-called mental disorders?

While medicine has established causes and cures, leading psychiatric agencies such as the World Psychiatric Association and the U.S. National Institute of Mental Health admit that psychiatrists do not know the causes of or cures for any mental disorder or what their treatments specifically do to the patient. They have theories and conflicting opinions about their diagnoses and methods, and lack a scientific basis for them.

What’s more, medical studies clearly show that psychiatric drugs not “mental disorders” cause violent, hostile and suicidal behavior, exacerbating the problems that may be caused by marijuana or other illicit drug use.

Any medical doctor who takes the time to conduct a thorough physical examination of a child or adult exhibiting signs of what psychiatrists say are “mental disorders,” can find un-diagnosed, untreated physical conditions, including drug use that may be causing those mental disorders.

Any person labeled with a so-called psychiatric disorder needs to receive a thorough physical examination by a competent medical – not psychiatric – doctor to determine what underlying physical condition is causing the manifestation, including, but not limited to testing for:

drug use
lead- or pesticide-poisoning
thyroid conditions
early-onset diabetes
heart disease
worms
viral or bacterial infections
malnutrition
injuries or tumors
allergies
vitamin and/or mineral deficiencies
mercury exposure

all of which can cause mental symptoms.

For more information, visit http://www.cchrstl.org/.

Reporter’s query

Sunday, June 1st, 2008

Have you or someone you know been wrongly diagnosed with a mental health disorder? Contact health reporter Blythe Bernhard at bbernhard@post-dispatch.com for a story she’s reporting.

New Web Site and Video Expose Psychiatric-Pharma Conflicts

Sunday, June 1st, 2008

A new video exposing the extensive conflicts of interest between the American Psychiatric Association (APA) and the pharmaceutical industry was released this week on a newly launched website, (http://www.psychconflicts.org/), to coincide with the 161st anniversary of the APA and its annual convention being held in Washington, D.C.

Widespread psychiatric drugging of children has become an increasingly contentious issue, with pharma-funded psychiatrists at the center of the controversy. The psychiatric drugging of foster children in particular is now the subject of a congressional hearing. A study in the May issue of the journal Pediatrics, now garnering international attention, found that American children take antipsychotics at about six times the rate of UK children, while a January New York Times (NYT) investigation revealed that “the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children.”

According to the psychiatric watchdog Citizens Commission on Human Rights (CCHR), which produced the new webpage and video, the soaring increase in psychotropic drugs to children is a result of the incestuous relationship between the APA and the pharmaceutical industry—totaling more than $10 million a year in conflicts of interest.

Today, about 30% of the APA’s income derives from pharmaceutical industry advertising and nearly 20 drug companies this year have invested an estimated $3 million into the APA’s convention alone. Of the nearly 30 pharmaceutical industry-supported symposiums, speakers’ fees could run as high as $250,000. The APA has also made an estimated $40 million from sales of its Diagnostic & Statistical Manual of Mental Disorders (DSM), an “insurance billing bible” that pharmaceutical interests potentially influence.

In 2006, a Psychotherapy and Psychosomatics study determined that 56% of psychiatrists on panels determining what “disorders” would be included in the DSM-IV had undisclosed financial interests in drug companies. Researchers also found that 100% of the psychiatrists on panels overseeing so-called “mood disorders” (which includes the lucrative “bipolar disorder”) and “schizophrenia/psychotic disorders” were financially involved with drug companies that manufacture the drugs prescribed for these conditions, the sales of which are around $40 billion a year worldwide.

Lisa Cosgrove, a clinical and research psychologist from the University of Massachusetts, Boston and co-researcher in the 2006 study reported that these disorders are not based on medical science: “No blood tests exist for the disorders in the DSM. It relies on judgments from practitioners who rely on the manual,” she stated.

Last December, U.S. News and World Report revealed that 19 out of the 27 task force members for DSM-V, due to be published in 2012, had financial ties to drug companies.

The January NYT investigation further found that psychiatrists earn more money from drug makers than doctors in any other specialty. In one state, Vermont, drug company payments to psychiatrists more than doubled from $20,835 in 2005 to an average of $45,692 in 2006. Antipsychotic drugs were among the largest expenses for the state’s Medicaid program. On September 4, 2007, the NYT reported, “Drug makers and company-sponsored psychiatrists have been encouraging doctors to look for [bipolar] disorder.” The expanded use of bipolar as a pediatric rather than adult disorder has made it the fastest-growing part of the $11.5 billion U.S. market for antipsychotics, reported Bloomberg News the next day.

Melissa Delbello, research psychiatrist with the University of Cincinnati who is speaking at the APA convention on May 7, was recently cited by Senator Charles Grassley for her failure to disclose to the university how much she had earned from pharmaceutical companies. In 2002, she was the lead author of a study that concluded that children responded well to the antipsychotic drug Seroquel, which is manufactured by AstraZeneca, one of the companies funding symposiums at the APA this year. She disclosed that she’d received $100,000 from the company between 2005 and 2007, but Senator Grassley discovered it was more than double that—$238,000.

A sample of speakers at the APA convention include:

+   David Kupfer, Professor and Chair, Department of Psychiatry, University of Pittsburgh School of Medicine, was a member of the DSM-IV Task Force and is Chair of the DSM-V Task Force. He has been a consultant to Eli Lilly & Co., Hoffman-LaRoche, Pfizer, Forest Labs and Servier and also sat on the advisory boards of Eli Lilly & Co., Forest Labs and Pfizer.

+   Kupfer’s wife, Ellen Frank, Ph.D., has received research support from Eli Lilly & Co. and Pfizer and was also a member of the DSM-IV Task Force.

+   Joseph Biederman, Chief of the Clinical & Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital is giving seminars on pediatric bipolar disorder and Attention Deficit Hyperactivity Disorder, the latter funded by Ortho-McNeil Janssen Scientific Affairs. He was a member of the DSM-IV committee overseeing what infant, childhood and adolescent disorders would be included. Biederman has received research funds from 10 pharmaceutical companies, including manufacturers of antipsychotic drugs prescribed for bipolar. Last year, his promotion of pediatric bipolar disorder was blamed, in part, for the death of 4-year-old Rebecca Riley from Massachusetts from a prescribed cocktail of psychiatric drugs which included antipsychotics for bipolar. Dr. Lawrence Diller, a California behavioral pediatrician, told the Boston Globe, “I find Biederman and his group to be morally responsible in part. He didn’t write the prescription, but he provided all the, quote, scientific justification to address a public health issue by drugging little kids.”

+   David Shaffer, Professor of Child Psychiatry at Columbia University and Director, Division of Child Psychiatry, New York State Psychiatric Institute, is part of a symposium discussing “disorders of childhood: A DSM-V research agenda.” Shaffer was a member of the DSM-IV Task Force and is responsible for inventing TeenScreen, a subjective survey conducted on teens in schools to determine if they are potentially suicidal. He admits there’s a potential 84% chance of wrongly identifying students using his survey.

+   S. Charles Schulz, Professor and head of the Department of Psychiatry, University of Minnesota Medical School Minneapolis, Minnesota, was a DSM-IV project participant. His industry-supported seminar about “medication treatment for youth” is funded by AstraZeneca, the manufacturer of the antipsychotic Seroquel. The company faces multiple suits alleging that it downplayed the risk of diabetes with the drug. Schulz has been a consultant for AstraZeneca and Eli Lilly & Co. and has received grants from them and Abbott Laboratories and Janssen Pharmaceutica.

+   Charles Nemeroff, Professor of Psychiatry and Behavioral Sciences and Chairman of Psychiatry and Behavioral Sciences, Emory University School of Medicine in Atlanta, is conducting a seminar on depression supported by Sanofi-Aventis. Dr. Nemeroff was one of the psychiatrists on an FDA Advisory Panel in 1991 that exonerated Prozac (the first SSRI antidepressant) from causing suicidal behavior—a fact established 13 years later when the FDA ordered drug companies to add a black box warning that all SSRIs induce suicidal behavior in children and teens. Nemeroff is a consultant for at least 20 pharmaceutical companies and has received research funds from at least 8 psychiatric drug manufacturers.

CCHR has released the new webpage and video on the APA and its conflicts of interest to raise awareness on the fact the DSM medicalizes all human troubles as “mental disorders” in order to sell psychiatric drugs.

In 1969, the Church of Scientology and Dr. Thomas Szasz, Professor of Psychiatry Emeritus from SUNY Health Science in Syracuse, New York, co-founded CCHR to investigate and expose psychiatric human rights violations. For more information on CCHR visit http://www.cchrstl.org/.

New Study on Depression Screening Fuels Controversy Over Bill

Sunday, June 1st, 2008

A recent study by UK researchers found that depression screening is both inaccurate and unhelpful—fueling controversy over a Senate bill called the “Mothers Act.” Critics say the bill, S.1375, is dangerous to mothers and newborns and a violation of informed consent, despite being promoted under the guise of ensuring that “new mothers and their families are educated about postpartum depression, screened for symptoms, and provided with essential services….”

Dr. Chris Manning, Chief Executive of Primary Care Mental Health Education, stated that he was not surprised by the results of the new depression screening study, published in the April issue of the Canadian Association Medical Journal. He warned that population screening was fraught with problems and would produce any number of false positives, resulting in inappropriate treatment and over-medicalization. Harvard Medical School psychiatrist Dr. Joseph Glenmullen also warns about the problem with depression questionnaires, stating that they “may look scientific,” but “when one examines the questions asked and the scales used, they are utterly subjective measures.”

According to the mental health watchdog Citizens Commission on Human Rights (CCHR), if passed the Mothers Act will increase the number of new mothers falsely diagnosed with postpartum depression and given powerful psychotropic drugs like antidepressants—potentially lethal to both the mother and child.  There is no language in the bill requiring full disclosure of the risks of these drugs and no language requiring mothers be given other non-harmful treatments and medical care besides drugs, violating their right to informed consent.

Antidepressants, the most common “treatment” for postpartum depression, are documented by the U.S. Food and Drug Administration to cause mania, psychosis, hallucinations, suicidal ideation and in some cases, homicidal ideation. Additionally, regulators worldwide have warned that antidepressants prescribed to pregnant women can cause miscarriage, premature birth, and in babies born to pregnant women taking these drugs, congenital heart defects, life-threatening lung disease, neurological symptoms and withdrawal symptoms. Research also shows such drugs could affect the developmental process of the embryo.

One mother, Amy Philo, posted a YouTube video telling the story of what happened to her when she was prescribed psychiatric drugs after the birth of her child: http://youtube.com/watch?v=LQW23XCmOCw

CCHR maintains that mothers have a fundamental right to be fully informed that there are non-harmful, non-drug medical alternatives to being diagnosed with a mental disorder and prescribed dangerous psychiatric drugs, and that mental health “screening” is subjective and could lead to improper diagnoses. The Mothers Act opens the door to the violation of informed consent procedures, and should be defeated.

CCHR is an international psychiatric watchdog group co-founded in 1969 by the Church of Scientology and Dr. Thomas Szasz, Professor of Psychiatry Emeritus, to investigate and expose psychiatric violations of human rights. For more information, visit www.cchrstl.org or write to cchrstl@cchrstl.org.