Long Term Outcome Studies On Long Term Mental Health Care

Introduction -

Today, most mental health professionals rely on medications to meet treatment objectives. Probably this results from two factors.

First, the medical model has a long history of medication usage to meet treatment goals. Second, budgetary considerations reduce reliance on worker-intensive patient services. Workers include social workers, psychiatrist, psychologist and other related mental health practitioners.

As we have noted in the field of health services in general, much attention is placed on the fiscal costs of treatment services rather than salutary effects on patients.

Medication certainly has is place; however, studies of treatment effectiveness indicate that questions may be raised as to effects of extensive medications on patients being treated for mental illness.

Robert Whitaker in his book Anatomy of an Epidemic strongly questions what is happening today and suggests re-evaluation of the current treatment paradigm and probable changes in practice policy.

It’s just off the press this year. Some of you may have read his first book called Mad in American which also dealt with psychiatric policy issues.

Why has the number of disabled mentally ill in the US tripled over the last two decades in spite of all the new miracle medications now in the market place?

In 1955 there were 355,000 adults in state and county mental hospitals with a psychiatric diagnosis. During the next three decades (the era of the first generation of psychiatric drugs) this number rose to 1.25 million. As all of you know, Prozac arrived on the market in 1988, (along with the dawn of the second new generation of drugs) and during the next 20 years, the number of disabled mentally ill grew to more than four million adults (4 million) in 2007)

Every day over 850 adults and 250 children are added to the government’s disability list - Supplemental Security Income or Social Security Disability Insurance. That is, over eleven hundred American citizens become newly disable each day.

During this latter period the prescribing of psychiatric medications to children and adolescents took off (1987 to 2007), and as this new medical practice took hold, the number of youth in America receiving a government disability check due to mental illness leapt from 16,200 in 1987 to 561,569 in 2007 (a 35–fold increase.)

Whitaker asks, What is going on? He challenges his readers to think through the question themselves. In the first part of Whitaker’s investigation he discusses what is known today about the biological causes of mental illness. He asks, “Do psychiatric medications fix “chemical imbalances” in the brain or do they in fact create them?”

He provides Magnetic Resonance Imaging (MRI) evidence that the brain after extensive drug treatment physiologically adapts and soon morphs or changes as a response to the guest chemicals.

He provides official court testimony which shows that in an effort to market Prozac the marketers intentionally tried to say that certain negative drug reactions were simply symptoms of the disease.

As you all know researchers have spent decades studying this question and by the late 1980s they had the answer. If you read this book, and if you are anything like me you will be as startled and dismayed as I was about what Whitaker actually found in the scientific journals as opposed to what you and I, and all American citizens, have received from our public media.

I believe you will be both astonished and outraged at how the drug industry, including the American Psychiatric Association, have made a science of false marketing.

While Whitaker’s description of the development and marketing of drugs in the 21st century will be fascinating and in some ways remarkably ingenious, don’t let it distract you from his core message.

Mainly, what the scientific researchers have learned over the last 60 years about how psychiatric drugs have affected long-term mental health outcomes, and especially what these outcome findings have to say about people with serious and persistent mental illness.

In his meticulous investigation into the long-term antipsychotic treatment research literature Whitaker asks, “Did they discover that the drugs helped people stay well?” Function in the community better? Enjoy good physical health? Or, did these medications actually increase the likelihood that people will become chemically ill, less able to function and more prone to physical illness?

To each of the above questions, drug-based treatment, in these long-term studies, was proven by robust evidence to be either less effective or actually potentially contribute to increased recovery time, and more prone to physical illness.

Whitaker also asks, are antipsychotics effective when schizophrenia patients are in crisis? His answer, psychiatric medication has been proven to be effective when patients are in crisis and for reducing target symptoms for short-term treatment. Are long-term recovery rates significantly higher for non-medicated schizophrenia patients? Time and time again the research from these long-term studies answered this question in the affirmative.

Does taking antidepressants decrease or increase the risk that a depressed person will become disabled by the disorder? The preponderance of the evidence shows that antidepressants increase the risk that they will become disabled.

Conclusion:

Now, before closing, I would like say a few words about my recommendation to the Council to conduct an examination into these long-term outcome studies and prepare a report regarding the implications that these findings have for reforming the Wisconsin mental health system.

I am convinced that Robert Whitaker’s book will be this century’s definitive
source when people gather to discuss long-term outcome evaluation studies. I believe that hereafter mental health researchers will use and refer to this text whenever they turn their attention to the latest scientific findings having to do with long-term mental health outcome studies.

Hereafter when ever questions of long-term treatment efficacy are raised in mental health care, researchers and administrators, and all stakeholders, the world over, will turn to Whitaker’s book.

Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this scientific information and reconcile it with their future long-range planning for this state’s mental health system.

One implication is clear and that is that existing assumptions about what best constitutes the most effective treatment paradigm needs to be reexamined.

To continue as usual in the face of this overwhelming evidence would be ethically and professionally irresponsible. Whitaker’s findings demand that all mental health stakeholders, but especially this citizen council, our Governor’s oversight body, carefully consider these findings and document their own findings in response to their own study of this work.

Thanks you again so much for allowing me to talk with you today. I hope we still have a few minutes for questions or comments.

Warning/Disclaimer – This presentation and the content and scope therein is not intended to be applicable to any individual and his/her doctor or prescriber. I strongly recommend that any questions that might arise from this presentation relating to your particular medical situation, be discussed between you and your doctor.

(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)

For more information on this subject see my blogs by clicking on mental health reform in the left column.