MEETING MINUTES
Meeting Place: Wisconsin Family Ties
Participants present: Jackie Baldwin, Paula Buege, Mike Bachhuber, Bill Benedict, Lori Krinki and Joann T.Stephens. Donna Wren, was unable to attend, but agreed to share her comments about: Robert Whitaker’s book, Part 3, Chapter 6 soon.
Bill began this meeting by thanking all those present for taking on this assignment and for their attendance. Special thanks were given to Paula for helping to arrange the best date for this meeting and to Lori for providing the meeting location and telephone hookup.
The first forty-five minutes of the meeting went by much too quickly as we each took turns talking about our reading assignment, but it was well worth it. Several points of concern and questions helped us considerably to better clarify this advocacy project’s much narrower mission: To help inform all Wisconsin Council on Mental Health members of the importance of long-term mental health patient outcome findings, and using this knowledge when reviewing policies/grants and best practice service standards. (For those interested, below I have also added a summary of this reading assignment.)
Following the discussion members gave attention to the project’s July 30, 2011 timetable which called for Council action on his request by July 30, 2011. While Bill expressed thanks and appreciation for Council cooperation thus far for what has already been accomplished to date, including both his two Council meeting visits and presentation to both the Adult Quality and Policy and Legislative Committees, however, he expressed concern with the progress made to date.
While the earlier discussion of Whitaker’s book was enthusiastic and compelling, efforts to identify what Council action might be most effective proved to be more challenging. The following member suggestions were considered: 1.) conduct more awareness- raising educational opportunities for Council members. Perhaps a panel discussion and Q&A meeting at a Council meeting; 2.) Ask Bill to present a concise summary of long-term study findings for each of the four major mental disorders and ADHD, 3) Establish a long-term patient outcome sub-committee composed of members from each of the Council Committees to be a resource and advisory group to the Council., 4) Prepare a Council letter supporting greater attention to long-term patient findings to the Department and funding sources.5. The Council would recommend to the Department IT Unit long-term patient functioning indicators to be including in the existing service information system; Finally, 6.) recommend that this project be referred outside the Council to a state-wide patient peer organization.
With respect to the latter suggestion, Bill noted that after again carefully reviewing the Council’s mission and membership make-up that he was more than ever convinced that this patient advocacy project belongs with the Wisconsin Council on Mental Health.
Group members agreed to report back to their respective Committees on this meeting and the suggestion presented: Meeting closed at 3 PM
The following is a summary review of the reading content discussed by group members:
(In order to share the nature of the reading content discussed, please note below the summary contained in Chapter 6, “The Case for Neuroleptics” and their effectiveness in the short-term and long-term. Whitaker states that “Once these anti-psychotic drugs were proven to be effective in the short-term, attention soon turned to determining, how long schizophrenia patients should stay on the medication?
To investigate this question, they ran studies that, for the most part, had this design: Patients who were good responders to the medication were either maintained on the drugs or abruptly withdrawn from them. Many such studies were done and showed good results with 53 percent of the drug-withdrawn patients, relapsed within ten months versus 16 percent of those maintained on the medication.
Based upon this research, an investigator summarized these findings this way: “The efficacy of these medications in reducing the risk of psychotic relapse has now been well documented.” Furthermore, as late as 2002 John Geddes, a prominent British researcher, wrote in the New England Journal of Medicine, “Anti-psychotic drugs are effective in treating acute psychotic symptoms and preventing relapse.”
Whitaker however claimed he saw “a hole in this evidence,” and cites another prominent investigator of the New York State Psychiatric Institute, Joseph Zubin who earlier in a 1956 conference warned that when it came to evaluating a therapy for a psychiatric disorder, a six-week study induced a kind of scientific myopia. It would be foolhardy to claim a definite advantage for a specified therapy without a two to five-year follow-up,” he said. (Please note the attachment which gives the differences between a clinical trials study versus a long-term study.)
Now with respect to the hole in the evidence, an investigator, Liza Dixon, at the University of Maryland School of Medicine in 1995, goes on to add that “Little can be said about the efficacy and effectiveness of conventional antipsychotics on non-clinical outcomes. Well-designed long-term studies are virtually nonexistent, so the longitudinal impact of treatment with conventional antipsychotics is unclear.”
As late as 2002 an editorial in European Psychiatry, a professor of psychiatry at the University de Montreal, Emmanuel Stip had this to say: “After fifty ears of neuroleptics, are we able to answer the following simple question: Are neuroleptics effective in treating schizophrenia/” There was, he said “no compelling evidence on the matter, when ‘long-term’ is considered.”
Out of the following context Whitaker, after reviewing medical and scientific journals going back over fifty years, then goes on to agree that there is no long-term data to be reviewed. Whitaker is not easily satisfied however, and goes on to say that “it is in fact possible to piece together a story of how antipsychotics alter the course of schizophrenia. He suggests that the story to answer this question begins, quite appropriately, with the NIMHs follow-up study of the 344 patients in its initial nine-hospital trial.
Most briefly, this NIMH study found that regardless of what treatment they had received in the hospital, they were not faring so badly. At the end of one year, 254 were living in the community, and 58 percent of those who according to their age and gender, could be expected to work were in fact employed. He then notes, that at this very first moment in the scientific literature, there is the hint of a paradox. “While the drugs were effective over the short term, perhaps they made people more vulnerable to psychosis over the long-term, and thus the higher re-hospitalization rates for drug-treated patients at the end of one year.
Partly as a result of these findings, soon the NIMH investigators were back with another surprising result. In two drug withdrawal trials, both of which included patients who weren’t’ on any drug at the start of the study. Relapse rates rose in correlation with drug dosage. Only 7 percent of those who had been on a placebo at the start of the study relapsed, compared to 65 percent of those taking more than five hundred milligrams of the chlorpromazine before the drug was withdrawn. “Relapse was found to be significantly related to the dose of the tranquilizing medication the patient was receiving before he was put on placebo---the higher the doses the greater the probability of relapse,”)
Out of the above summarized context Lori did however begin our group’s discussion with a question relating to the validity and usefulness of findings derived from a retroactive study by two psychiatrists at Boston Psychopathic Hospital---J. Sanbourne Bockover and Harry Solmon. In their study they found that 45 percent of the patients treated in 1947 at their hospital hadn’t relapsed in the next five years and 76 percent were successfully living in the community at the end of that follow-up period.
In contrast, only 31 percent of the patients treated at the hospital in 1967 with neuroleptics remained relapse-free for five years, and as a group they were much more “socially dependent” on welfare and needing other forms of support. They concluded, that their extended use (neuroleptics) in aftercare may prolong the social dependency of many discharged patients. Part of Lori’s concern had to do with the two comparison groups used and the appropriateness of the two very different follow-up dates.
(Why do we need more and better long-term mental health patient follow-up studies: They may help us to more objectively and better determine what forms of care are strongly associated with fewer relapses, or with higher global functioning scale results. Or they may provide us with more and better information about what is the optimum dosage and duration of care for different diagnostic mental health populations? How do long-term continuous medication regimens compare with more episodic or as-needed medication practices?
Finally, we may be able to better determine what kinds of mental health outcomes are correlated with economic independence, physical health, quality of life satisfaction, family and community engagement, and mortality rates.)
Respectively submitted,
William R. Benedict
Mental Health Patient Advocate
Wednesday, April 13, 2011
Monday, February 14, 2011
Reply From WI DHS
State of Wisconsin
Department of Health Services
February 14, 2011
Mr. William R. Benedict
Madison, WI 53704-5107
Dear Mr. Benedict:
Thanks you for your letter and your interest in informing the Wisconsin on Mental Health about Robert Whitaker’s book, “Anatomy of an Epidemic.” You noted that the book outlined the research regarding the long-term impact, cost and repercussion of reliance on prescription drugs to treat mental illness.
You note in your letter that you believe that the Council members, who include patients and family members, would be the best to review the findings of Mr. Whitaker’s book because they have the fewest conflicts of interest. At this point, the Council has not yet recommended to the Department further action or additional consideration of the book’s findings.
I agree with you that our Department should use every means possible to become more efficient and effective and use the latest data and research to promote the most cost-effective treatment approaches that will improve outcomes for people who have a mental illness. I appreciate the information that you have provided and thank you for binging this to my attention.
Sincerely,
Dennis G. Smith
Secretary
Department of Health Services
February 14, 2011
Mr. William R. Benedict
Madison, WI 53704-5107
Dear Mr. Benedict:
Thanks you for your letter and your interest in informing the Wisconsin on Mental Health about Robert Whitaker’s book, “Anatomy of an Epidemic.” You noted that the book outlined the research regarding the long-term impact, cost and repercussion of reliance on prescription drugs to treat mental illness.
You note in your letter that you believe that the Council members, who include patients and family members, would be the best to review the findings of Mr. Whitaker’s book because they have the fewest conflicts of interest. At this point, the Council has not yet recommended to the Department further action or additional consideration of the book’s findings.
I agree with you that our Department should use every means possible to become more efficient and effective and use the latest data and research to promote the most cost-effective treatment approaches that will improve outcomes for people who have a mental illness. I appreciate the information that you have provided and thank you for binging this to my attention.
Sincerely,
Dennis G. Smith
Secretary
Wednesday, February 2, 2011
Project Update - Letter to new Secretary of the Wisconsin Department of Health Services
Secretary Dennis Smith
Department of Health Services
1 West Wilson Street
P.O. Box 7850
Madison, WI 53707
February 2, 2011
Re: Wisconsin Council on Mental Health Action Recommendation
Dear Mr. Smith:
Congratulations and the best of luck in your new position. What follows is my effort to maintain the continuity and support for a modest project that is now in process. I hope it will accomplish much and at the lowest possible cost to Wisconsin taxpayers.
I am a retired social worker and worked for many years as the program evaluation specialist for Lutheran Social Services of Wisconsin and Upper Michigan.
In July of last year I wrote a letter to the then Sec. Karen Timberlake and alerted her to the recent book by Robert Whitaker called Anatomy of an Epidemic. I informed her that in spite of my many years in mental health research, only after reading Whitaker’s book did I become aware of the fifty or more evidenced-based long-term mental health outcome studies and their findings therein.
Most briefly, these long-term study findings ---several funded totally or in part by the NIMH ---consistently showed that mental health patients treated continuously on a strong drug regimen usually did less well than those treated primarily with fewer drugs and with a range of psychosocial therapies.
My recommendation to Ms. Timberlake simply called for members of Wisconsin’s Council on Mental Health to become as knowledgeable as possible of these latest evidenced-based long-term study findings, and in light of their own findings, consider there implications for the for the Division’s current mental health policies and practices. Presently my proposed recommendation to the Wisconsin Council on Mental Health has been assigned to the Council’s Legislative and Policy Committee.
Considering the challenges that all Wisconsin taxpayers now face along with a staggering deficit and an ever faltering economy I believe our health department should use every means possible to become more efficient and effective.
One way to do this is to simply take look at the latest scientific mental health long-term research study findings contained in Whitaker’s book but largely kept from the public’s eye until now.
My recommendation to the Wisconsin Council on Mental Health envisions a completion date by July of this year and a small volunteer committee of interested Council members to read and review at least a sample of the most significant long-term studies, and then weigh these findings in the context of one or more programs within the Division.
Who better than patients or family members of patients to compare these new long-term outcomes findings with Wisconsin’s existing mental health policy and practices? Who could serve with the fewest conflicts of interests or be any fairer than Council members whose primary mission and commitment is to monitor Wisconsin’s mental health program performance and make recommendations for improvements
To help contain both the members’ time and resources I hope the July deadline will be met. As an incentive for organizational representatives to purchase this book I have allocated $300.00 out of my own budgeted resources to help organizations defray their expenses for the cost of the book.
I hope this update will be useful. Your comments would be most welcome and appreciated. For more information about this advocacy project see my blog:
danecountyalmanac.blogspot.com.
Most respectfully yours,
William R. Benedict, MSW
See: Gov. Scott Walker, Sen. Scott Fitzgerald, Rep. Jeff Fitzgerald, Sen. Mark Miller, Rep. Joe Parisi, John Easterday, Jackie Baldwin, Judy Wilcox, Geoff Greiveldinger, Lania Syren, Marc Herstand, Jan Greenberg, Diane Greenly, Marc Herstand, Michael J. Fitzpatrick
Department of Health Services
1 West Wilson Street
P.O. Box 7850
Madison, WI 53707
February 2, 2011
Re: Wisconsin Council on Mental Health Action Recommendation
Dear Mr. Smith:
Congratulations and the best of luck in your new position. What follows is my effort to maintain the continuity and support for a modest project that is now in process. I hope it will accomplish much and at the lowest possible cost to Wisconsin taxpayers.
I am a retired social worker and worked for many years as the program evaluation specialist for Lutheran Social Services of Wisconsin and Upper Michigan.
In July of last year I wrote a letter to the then Sec. Karen Timberlake and alerted her to the recent book by Robert Whitaker called Anatomy of an Epidemic. I informed her that in spite of my many years in mental health research, only after reading Whitaker’s book did I become aware of the fifty or more evidenced-based long-term mental health outcome studies and their findings therein.
Most briefly, these long-term study findings ---several funded totally or in part by the NIMH ---consistently showed that mental health patients treated continuously on a strong drug regimen usually did less well than those treated primarily with fewer drugs and with a range of psychosocial therapies.
My recommendation to Ms. Timberlake simply called for members of Wisconsin’s Council on Mental Health to become as knowledgeable as possible of these latest evidenced-based long-term study findings, and in light of their own findings, consider there implications for the for the Division’s current mental health policies and practices. Presently my proposed recommendation to the Wisconsin Council on Mental Health has been assigned to the Council’s Legislative and Policy Committee.
Considering the challenges that all Wisconsin taxpayers now face along with a staggering deficit and an ever faltering economy I believe our health department should use every means possible to become more efficient and effective.
One way to do this is to simply take look at the latest scientific mental health long-term research study findings contained in Whitaker’s book but largely kept from the public’s eye until now.
My recommendation to the Wisconsin Council on Mental Health envisions a completion date by July of this year and a small volunteer committee of interested Council members to read and review at least a sample of the most significant long-term studies, and then weigh these findings in the context of one or more programs within the Division.
Who better than patients or family members of patients to compare these new long-term outcomes findings with Wisconsin’s existing mental health policy and practices? Who could serve with the fewest conflicts of interests or be any fairer than Council members whose primary mission and commitment is to monitor Wisconsin’s mental health program performance and make recommendations for improvements
To help contain both the members’ time and resources I hope the July deadline will be met. As an incentive for organizational representatives to purchase this book I have allocated $300.00 out of my own budgeted resources to help organizations defray their expenses for the cost of the book.
I hope this update will be useful. Your comments would be most welcome and appreciated. For more information about this advocacy project see my blog:
danecountyalmanac.blogspot.com.
Most respectfully yours,
William R. Benedict, MSW
See: Gov. Scott Walker, Sen. Scott Fitzgerald, Rep. Jeff Fitzgerald, Sen. Mark Miller, Rep. Joe Parisi, John Easterday, Jackie Baldwin, Judy Wilcox, Geoff Greiveldinger, Lania Syren, Marc Herstand, Jan Greenberg, Diane Greenly, Marc Herstand, Michael J. Fitzpatrick
Friday, January 28, 2011
Presentation to the Wisconsin Council Mental Health’s Legislative and Policy Committee
January 13, 2011
First, a brief update re my letter to the Secretary of the Department of Health
First, let me begin by saying how pleased I was to learn that your Committee was chosen to consider my recommendation and to report back your findings to the Council. I thank you and I am so pleased to be here this afternoon.
On July 23, 2010 I wrote a letter to the Secretary of the Wisconsin Department Health, Ms. Karen E. Timberlake. In this letter I briefly shared my professional qualifications and experience relating to evidenced-based, long-term mental health outcome studies. I noted that in spite of this professional training and some thirty years of experience, Robert Whitaker’s latest book, Anatomy of An Epidemic, shocked and surprised me (For the full text of the letter, including my recommendation for action, to the Secretary, please see my blog: Danecountyalmanac.blogspot.com).
In this book, for the first time, Whitaker brings into public view over fifty evidenced-based and scientific long-term mental health outcome studies about what actually occurs to those treated for mental illness in the United States. This story is quite different than what the public media has given us until now. This story is framed from dozens of archival scientific mental health research studies beginning in the 1950s to the present. They are cogently summarized and documented (See Chapter 6: A Paradox Revealed).
Because Whitaker tells his story through the prism of evidenced based scientific long-term mental health outcome results, this Legislative and Policy Committee can draw its own conclusions about these studies, including your recommendations regarding their implication for Wisconsin’s mental health program. Based upon these scientific studies Whitaker asked and chose to write about some of the following questions:
“During the past fifty years when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? And, are long-term recovery rates higher for medicated or un-medicated patients with serious mental health disorders?
I am convinced that Robert Whitaker’s book will be this century’s definitive
evidenced-based repository and source when people gather to discuss long-term outcome evaluation studies.
I believe that with your help, that hereafter mental health researchers and other stakeholders 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 study findings. 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. Certainly most of us are aware that Wisconsin has led the country in timely patient-centered mental health reform in the past.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this long-term evidenced-based information and reconcile them with existing practice and funding policies and with their future long-range planning for this state’s mental health system.
To continue as usual in the face of the overwhelming evidenced contained in these scientific long-term outcome studies would be ethically and professionally irresponsible. These evidenced-based outcome study 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 and recommendations in response to their own study of these study findings.
Most of all, each day that mental health stakeholders delay in informing themselves regarding these latest scientific findings is another day wasted before we reexamine our present care and treatment practices and funding policies against these latest research findings.
As a patient advocate what also concerns me most is that we can no longer continue to follow treatment practices as usual if we find this evidence to be compelling and actionable.
Finally what are we going to say to our youngest mentally ill patients, when and if, they discover down the road that this long-term information existed, and that we should have acted on it on their behalf but failed to do so, way back in year 2011?
What are we going to tell patients and suffering families with mental illness who depend on us and trust us to be aware, informed, honest, upfront and transparent about these latest scientific long-term research findings, if they later prove to be fundamentally true?
I am optimistic however that here in Wisconsin, we will not be too busy, too proud or complacent or too invested in the status quo to consider alternatives, if in deed, we find these long-term evidence-based findings should point in that direction.
Thank you again so much for allowing me to talk with you today. I hope we still have a few minutes for your questions or comments.
Respectfully, William R. Benedict
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81-104 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
To access all the documents to date regarding this mental health reform project,
see this writer’s blog: danecountyalmanac.blogspot.com
First, a brief update re my letter to the Secretary of the Department of Health
First, let me begin by saying how pleased I was to learn that your Committee was chosen to consider my recommendation and to report back your findings to the Council. I thank you and I am so pleased to be here this afternoon.
On July 23, 2010 I wrote a letter to the Secretary of the Wisconsin Department Health, Ms. Karen E. Timberlake. In this letter I briefly shared my professional qualifications and experience relating to evidenced-based, long-term mental health outcome studies. I noted that in spite of this professional training and some thirty years of experience, Robert Whitaker’s latest book, Anatomy of An Epidemic, shocked and surprised me (For the full text of the letter, including my recommendation for action, to the Secretary, please see my blog: Danecountyalmanac.blogspot.com).
In this book, for the first time, Whitaker brings into public view over fifty evidenced-based and scientific long-term mental health outcome studies about what actually occurs to those treated for mental illness in the United States. This story is quite different than what the public media has given us until now. This story is framed from dozens of archival scientific mental health research studies beginning in the 1950s to the present. They are cogently summarized and documented (See Chapter 6: A Paradox Revealed).
Because Whitaker tells his story through the prism of evidenced based scientific long-term mental health outcome results, this Legislative and Policy Committee can draw its own conclusions about these studies, including your recommendations regarding their implication for Wisconsin’s mental health program. Based upon these scientific studies Whitaker asked and chose to write about some of the following questions:
“During the past fifty years when investigators looked at how psychiatric drugs affected long-term outcomes, what did they find? Did they discover that the drugs help people stay well? Function better? Enjoy good physical health? And, are long-term recovery rates higher for medicated or un-medicated patients with serious mental health disorders?
I am convinced that Robert Whitaker’s book will be this century’s definitive
evidenced-based repository and source when people gather to discuss long-term outcome evaluation studies.
I believe that with your help, that hereafter mental health researchers and other stakeholders 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 study findings. 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. Certainly most of us are aware that Wisconsin has led the country in timely patient-centered mental health reform in the past.
Because I feel so strongly about this, I have requested that Wisconsin’s Council on Mental Health become informed of this long-term evidenced-based information and reconcile them with existing practice and funding policies and with their future long-range planning for this state’s mental health system.
To continue as usual in the face of the overwhelming evidenced contained in these scientific long-term outcome studies would be ethically and professionally irresponsible. These evidenced-based outcome study 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 and recommendations in response to their own study of these study findings.
Most of all, each day that mental health stakeholders delay in informing themselves regarding these latest scientific findings is another day wasted before we reexamine our present care and treatment practices and funding policies against these latest research findings.
As a patient advocate what also concerns me most is that we can no longer continue to follow treatment practices as usual if we find this evidence to be compelling and actionable.
Finally what are we going to say to our youngest mentally ill patients, when and if, they discover down the road that this long-term information existed, and that we should have acted on it on their behalf but failed to do so, way back in year 2011?
What are we going to tell patients and suffering families with mental illness who depend on us and trust us to be aware, informed, honest, upfront and transparent about these latest scientific long-term research findings, if they later prove to be fundamentally true?
I am optimistic however that here in Wisconsin, we will not be too busy, too proud or complacent or too invested in the status quo to consider alternatives, if in deed, we find these long-term evidence-based findings should point in that direction.
Thank you again so much for allowing me to talk with you today. I hope we still have a few minutes for your questions or comments.
Respectfully, William R. Benedict
(For more about this presenter’s evaluation work, see “Goal Attainment Scaling: Applications, Theory, and Measurement”, Mental Health and Social Service Applications, p. 81-104 which was edited by Thomas M. Kiresuk, Aaron Smith and Joseph E. Cardillo.)
To access all the documents to date regarding this mental health reform project,
see this writer’s blog: danecountyalmanac.blogspot.com
Handout at WC’s Leg & Policy Committee presentation
(January 13, 2011)
Some thoughts prior to my meeting with the Legislative and Policy Committee regarding their likely response to Robert Whitaker’s book and to my action recommendation to the Council.
1. To what extent are Council members already aware of evidenced-based
long-term scientific studies and the significance of their findings?
2. Are Council members aware that such long-term outcome studies exist
for all the major mental health maladies, including schizophrenia,
depression, bipolar, anxiety, ADHD?
3. How many Council members have read either both or perhaps one of
Whitaker’s books on these long-term studies – Anatomy of an Epidemic,
Mad in America? If, so how many were already aware of these findings?
4. What do Council members know about Robert Whitaker? His education,
training, work before becoming a journalist, etc, and his reputation
as a science investigator reporter or writer? Awards?
5. If a member has read the book what level of credibility, scholarship and
respect do they have for Whitaker’s investigative and research style?
Did they find the book easy to read and interesting and appropriate for
most lay people and informed citizens?
6. Who do Council members believe would be the most objective and fair
group to evaluate these long-term mental health findings if not the
Council members themselves?
7. What understanding do members already have about how psychiatric
drugs affect long-term patient community adjustment and health?
8. Are Council members aware that mental illness has tripled over the
past two decades 1990 – 2010?
9. How many Council members are aware that due to mental illness every
day 1,100 adults and children are added to the government
disability rolls?
10. Where on “the most important scale” for Council members should
information of this kind be treated?
Some thoughts prior to my meeting with the Legislative and Policy Committee regarding their likely response to Robert Whitaker’s book and to my action recommendation to the Council.
1. To what extent are Council members already aware of evidenced-based
long-term scientific studies and the significance of their findings?
2. Are Council members aware that such long-term outcome studies exist
for all the major mental health maladies, including schizophrenia,
depression, bipolar, anxiety, ADHD?
3. How many Council members have read either both or perhaps one of
Whitaker’s books on these long-term studies – Anatomy of an Epidemic,
Mad in America? If, so how many were already aware of these findings?
4. What do Council members know about Robert Whitaker? His education,
training, work before becoming a journalist, etc, and his reputation
as a science investigator reporter or writer? Awards?
5. If a member has read the book what level of credibility, scholarship and
respect do they have for Whitaker’s investigative and research style?
Did they find the book easy to read and interesting and appropriate for
most lay people and informed citizens?
6. Who do Council members believe would be the most objective and fair
group to evaluate these long-term mental health findings if not the
Council members themselves?
7. What understanding do members already have about how psychiatric
drugs affect long-term patient community adjustment and health?
8. Are Council members aware that mental illness has tripled over the
past two decades 1990 – 2010?
9. How many Council members are aware that due to mental illness every
day 1,100 adults and children are added to the government
disability rolls?
10. Where on “the most important scale” for Council members should
information of this kind be treated?
Robert Whitaker’s Anatomy of an Epidemic, and Mad in America
Chapter 16
Pages 331 - 359
Blueprints for Reform
Examples of some of the possible policy/practice implications found in Whitaker’s two books: (This list is not in any special order with respect to importance or presumed
significance.)
New practice policies/practice formulations relating to psychiatric medications.
Solutions – When and how should they be used for health and safety.
Acknowledge the possibility that the biological causes of mental disorders continue to remain unknown. Present certainty leaves no room for error and causes providers to have too little humility with patients.
Why not consider the real possibility that psychiatric drugs, rather than fixing chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways?
Acknowledge the possibility that current medications actually worsening long-term outcomes for a significant number of patients.
Prescribers still need to learn better ways to use the drugs more judiciously and wisely, and respect the need for some patients to be given alternative therapies, that don’t rely on medications or at least minimize their use.
To produce best results USE PSYCHIATRIC MEDICATIONS IN A SELECTIVE, limited and CAUTIOUS MANNER (OR NOT AT ALL) Dr. David Healy writes on the history of psychiatry.
Acknowledge the possibility that some patients can recover naturally.
Many patients will improve with low doses.
Focus on the patients past successes, 337
Patients are more interactive without medications 338
Long term use of drugs increase the likelihood of chronicity and a shorter life span.
Lower initial dosages
Consider practice policies that relate to the gradual medication withdrawal during the early medication phase of treatment. Establish best practice temporal standards to
Ensure that the long range medication regimens have regular patient-centered stop/go assessments specifically relating to the pro and cons of drug continuation.
Develop and require greater patient education about the pros and cons of medication versus other therapeutic alternatives
Consider doing a longitudinal budget analysis of the comparative proportionality of the cost of medication and other forms of therapy.
Longitudinally tract to percent of those on medications vs. social and more natural therapies.
Consider the implications of Whitaker’s study findings in the context greater consumer rights relative to their informed consent, safety and welfare.
Consider implications for existing long-term treatment and care for those who are placed an on-going drug regimen/
Evaluate and perhaps stop the ever expansion of psychiatric boundaries. Mental Health Advocacy Project
Pages 331 - 359
Blueprints for Reform
Examples of some of the possible policy/practice implications found in Whitaker’s two books: (This list is not in any special order with respect to importance or presumed
significance.)
New practice policies/practice formulations relating to psychiatric medications.
Solutions – When and how should they be used for health and safety.
Acknowledge the possibility that the biological causes of mental disorders continue to remain unknown. Present certainty leaves no room for error and causes providers to have too little humility with patients.
Why not consider the real possibility that psychiatric drugs, rather than fixing chemical imbalances in the brain, perturb the normal functioning of neurotransmitter pathways?
Acknowledge the possibility that current medications actually worsening long-term outcomes for a significant number of patients.
Prescribers still need to learn better ways to use the drugs more judiciously and wisely, and respect the need for some patients to be given alternative therapies, that don’t rely on medications or at least minimize their use.
To produce best results USE PSYCHIATRIC MEDICATIONS IN A SELECTIVE, limited and CAUTIOUS MANNER (OR NOT AT ALL) Dr. David Healy writes on the history of psychiatry.
Acknowledge the possibility that some patients can recover naturally.
Many patients will improve with low doses.
Focus on the patients past successes, 337
Patients are more interactive without medications 338
Long term use of drugs increase the likelihood of chronicity and a shorter life span.
Lower initial dosages
Consider practice policies that relate to the gradual medication withdrawal during the early medication phase of treatment. Establish best practice temporal standards to
Ensure that the long range medication regimens have regular patient-centered stop/go assessments specifically relating to the pro and cons of drug continuation.
Develop and require greater patient education about the pros and cons of medication versus other therapeutic alternatives
Consider doing a longitudinal budget analysis of the comparative proportionality of the cost of medication and other forms of therapy.
Longitudinally tract to percent of those on medications vs. social and more natural therapies.
Consider the implications of Whitaker’s study findings in the context greater consumer rights relative to their informed consent, safety and welfare.
Consider implications for existing long-term treatment and care for those who are placed an on-going drug regimen/
Evaluate and perhaps stop the ever expansion of psychiatric boundaries. Mental Health Advocacy Project
Brief Excerpts from Anatomy of an Epidemic
Sixteen outcome studies
November 12, 2010
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from
medical archives by Robert Whitaker:
A brief summary of the following 16 long-term mental health outcome studies
appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent) . NIMH Go to page 374; citation number 35.
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 Go to page 370, citation number 45.
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 Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
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 depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
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 Long-term bipolar outcomes. Page 379, citation number 53
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 bipolar depression study, See page 373, citation on page 167
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 bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude Australian scientists’ benzo study. Seepage 372, citation 43.
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.
Angel dust reference. See page 370, citation 53
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.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
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.
Study of ADHD. See page 381, citation 36 & 39.
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.
Bipolar study. See page 378, citation 46 &47
NIMH
November 12, 2010
Perhaps you have not yet had the opportunity to read Robert Whitaker’s latest book, Anatomy of an Epidemic which deals with the history of mental illness in the United States through the prism of long-term scientific follow-up study results.
Whitaker asks us to imagine what our beliefs would be today if, over the past twenty years, we had opened our newspapers and read about the following findings, which represent but a sampling of the long-term outcome studies recently retrieved from
medical archives by Robert Whitaker:
A brief summary of the following 16 long-term mental health outcome studies
appear below and were taken from pages 307-309 of Whitaker’s book. Each summary is then followed with that study’s page and specific citation number.
1990 - In a large, national depression study, the eighteen-month the eighteen month stay-well rate was highest for those treated with psychotherapy (30 percent) and lowest for those treated with an antidepressant (19 percent) . NIMH Go to page 374; citation number 35.
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 Go to page 370, citation number 45.
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 Depression study. Go to 375, citation 61.
1998 - Antipsychotic drugs cause morphological changes in the brain that are associated with worsening of schizophrenia symptoms.
University of Pennsylvania Go to page 370, citation number 52.
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 depression screening study. Got to page 375, citation number 59.
1999 - When long-term benzodiazepine users withdraw from the drugs, they become “more alert, more relaxed, and less anxious.”
University of Pennsylvania Benzo study. Go to page 372, citation number 37
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 Long-term bipolar outcomes. Page 379, citation number 53
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 bipolar depression study, See page 373, citation on page 167
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 bipolar cognitive study, Page 379, citation 60.
2004 - Long-term benzodiazepine users suffer cognitive deficits “moderate to large” in magnitude Australian scientists’ benzo study. Seepage 372, citation 43.
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.
Angel dust reference. See page 370, citation 53
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.
Depression patients, See page 375, page 58
University of Calgary
2007 - In a fifteen-year study, 40 percent of schizophrenia patients off antipsychotics recovered, versus 5 percent of the medicated patients.
See page 371, citation 58
University of Illinois
2007 - Long-tem users of benzodiazepines end up “markedly ill-to extremely ill” and regularly suffer from symptoms of depression and anxiety.
Study of benzo users. See page 372, citation 40
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.
Study of ADHD. See page 381, citation 36 & 39.
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.
Bipolar study. See page 378, citation 46 &47
NIMH
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