Open Letter to DHS

Madam Secretary, Ms. Karen E. Timberlake
Department of Health Services
1 West Wilson Street
P.O. Box 7850
Madison, WI 53707

Re: Action Recommendation
July 23, 2010

Dear Ms. Timberlake:

I am a retired social worker who regularly advocates for campaign finance reform, state funding of stem research, and mental health treatment. I spent most of my professional life working in a large state-wide human service agency, and for many years, conducted both inpatient and outpatient mental health outcome evaluations. My work has been published and previously I have done extensive consultation and training throughout the United States.

My work began early in the 1970s and into the new century. Most of my work can best be described as clinical outcome studies versus using broader quality of life or post discharge social functioning outcome indicators such as employment status, education, family and close social relationships.

In spite of the many years spent on mental health program outcome evaluations, when I recently read Robert Whitaker’s expose’, “Anatomy of An Epidemic” I admittedly felt so disappointed with myself, with my profession, with Wisconsin’s Department of Health Services, Wisconsin Council on Mental Health, the National Institute of Mental Health, and especially, with the National Alliance on Mental Illness.

If any patient advocacy organization should have been informed and aware of what is really going on downstream, and in the trenches, with respect to long term drug-based patient treatment outcomes, it surely should have been NAMI-National. Particularly when their rhetoric for evidenced based treatment practices and outcome measures are touted so vociferously It’s hard for me to believe that even they too were duped.

Probably there is enough blame to go around. Robert Whitaker blames the American Medical Association, National Institute of Mental Health, the American Psychiatric Association and the national media. Whitaker brings to the table the cogent fact that over a dozen good scientific long-term outcome studies have been done over the past two decades. (A brief summary of these outcome studies are included further along in this letter.)

Whitaker reports that the findings from all of these scientific long term studies have been deliberately held back and out of the public media by NIMH and the APA, and I would have to add here by NAMI National as well. While these are published studies and appeared in professional journals for the most part they were never disseminated to the general public in any form and never in medical school curriculums.

Essentially what these studies have found was that those patients treated with drugs lag far behind those who were treated without medication on several broad key outcome indicators: employment, education/training, family and other close relationships, and most telling, the percent that maintained their community status without any further dependency on medication.

These very credible, scientific research findings showed that those similarly impaired and without drug treatment resided in their community for much longer periods. And many more no longer required any further medication and still remained in the community for the remainder of their lives.

As a patient advocate what really disturbs me the most is that our patients and their families were also kept uninformed of these long-term outcome findings. Even you and I, their service providers, who have spent long careers in mental health care were deprived of such outcome research knowledge until now. (Actually, about a decade ago, this same writer in an earlier book, “Mad In America” first attempted to raise serious questions about the state of our mental health system and about the motives of those who would become the most economically and professionally disadvantaged if there were unfavorable long term drug-based mental health outcomes: NIMH, APA, psychiatrists, and the pharmacology industry.)

Most regrettably for these very same reasons mental health consumers and the public-at-large typically now have much less confidence in your professionally trained social worker who does mental health family counseling. After all they have no claim to a magic bullet to “cure” you.

Actually Whitaker found much evidence that psychosocial and behaviorally treated patients, versus drug-based treated patients, had consistently higher long term outcome scores. This was so for both inpatient and outpatient services and for both adults and children.

Below is a brief summary of these, until now, very elusive long-term treatment outcome studies:

1992 - Schizophrenia outcomes are much better in poor countries like India and Nigeria, where only 16 percent of patients are regularly maintained on anti-psychotics, than in the United States and other rich countries where continual drug use is the standard of care.
World Health Organization

1995 - In a six-year study of 537 depressed patients those who were treated for the disorder were nearly seven times more likely to become incapacitated than those who weren’t, and three times more likely to suffer a “cessation” of their “principal social role.”
NIMH

1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania

1998 - In a World Health Organization study of the merits of screening for depression, those diagnosed and treated with psychiatric medications fared worse---in terms of their depressive symptoms and their general health---over a one-year period than those who weren’t exposed to the drugs.
WHO

1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania

2000 - Epidemiological studies show that long-term outcomes for bipolar patients today are dramatically worse than they were in the pre-drug era, with this deterioration in modern outcomes likely due to the harmful effects of antidepressants and antipsychotics.
Eli Lilly; Harvard Medical School

2001 - In a study of 1,281 Canadians who went on short-term disability for depression, 19 percent of those who took an antidepressant ended up on long-term disability, versus 9 percent of those who didn’t take the medication.
Canadian Investigation

2001 - In the pre-drug era, bipolar patients did not suffer cognitive decline over the long term, but today they end up almost as cognitively impaired as schizophrenia patients.
Sheppard Pratt Health System in Baltimore

2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude.
Australian scientists

2005 - Angel dust, amphetamines, and other drugs that induce psychosis all increase D2 HIGH receptors in the brain; antipsychotics cause this same change in the brain.
University of Toronto

2005 - In a five-year study of 9,508 depressed patients, those who took an antidepressant were, on average, symptomatic nineteen weeks a year, versus eleven weeks for those who didn’t take any medications.
University of Calgary

2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
University of Illinois

2007 - Long-term users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
French Scientists

2007 - In a large study of children diagnosed with ADHD, by the end of the third year “medication use was a significant marker not of beneficial outcome, but of deterioration.”
The medicated children were also more likely to engage in delinquent behavior; they ended up slightly shorter, too.
NIMH

2008 - In a national study of bipolar patients, the major predictor of a poor outcome was exposure to an antidepressant. Those who took an antidepressant were nearly four times as likely to become rapid cyclers, which is associated with poor long-term outcome.
NIMH

Inasmuch as the Department of Health Services’ goal is to make Wisconsin a national
Leader in reforming health care, and

Inasmuch as, The Wisconsin Council on Mental Health and its Adult Quality Mental Health Committee is legally mandated to evaluate and review Wisconsin’s mental health system’s progress towards achieving improved outcomes and the adequacy of mental health services in the State of Wisconsin under 51.02 Wisconsin Statutes and Public Law 102-321, and

Inasmuch as, “The purpose of the Council is to assist the State in the planning, development and implementation of a comprehensive mental health system, and

Inasmuch as, The Goal of the Council is “to facilitate (patient) recovery through independence, productivity, integration into the community as well as to advocate for and promote wellness, prevention, and early intervention, and

Inasmuch as, “the work of the Department of Health Services, Division of Mental Health and Substance Abuse Services is to improve life expectancy and health outcomes for individuals with these (mental health) conditions, and

Inasmuch as I am a citizen of the State of Wisconsin and laboring as a patient advocate on behalf of mental health reform, and

Inasmuch as, “We need to become better informed about the long-term outcomes literature briefly reviewed in this letter and most cogently laid out for all to read in Robert Whitaker’s new book, Anatomy of An Epidemic, and

Inasmuch as, we need to talk about what is truly known about the biology of mental disorders, about what the drugs actually do, and about how the drugs increase the risk that people will become chronically ill, and

Inasmuch as, if we in the State of Wisconsin could have that discussion, then change would surely follow.”

I, William R. Benedict, do formally request that the Wisconsin Council On Mental Health evaluate the above enclosed long term mental health outcome findings and evaluate their mental health policy implications for DHS and for suffering families throughout Wisconsin, and report back to the DHS Secretary, Governor and Wisconsin State Legislature its recommendation in a formal report not later than by July 30, 2011.

Most sincerely,

William R. Benedict, ACSW

cc: Governor Jim Doyle, Senator Mark Miller, Senator Scott Fitzgerald, Rep. Jeff Fitzgerald, Rep.Michael J. Sheridan, John Easterday, Jackie Baldwin, Mary Newbauer, Corrie Briggs, Geoff Greiveldinger, Lania Syren, Michael J. Fitzpatrick, Marc Herstand, Jan Greenberg, Diane Greenly