4 compelling reasons against Mental Health Parity
Fri, 12 Sep 2003
Compelling reasons NOT to approve insurance parity for mental health services come from the following recent reports suggesting that mental health services and treatments have often done more damage than good. Until psychiatry and mental health service providers develop services and treatments that help people–rather than the drug industry or any other “therapy dur jour.” Bad treatments are worse than no treatment. It makes no sense to divert scarce funds for damaging mental health services that those in distress don’t want.
1. A column by Sharon Begley in The Wall Street Journal (below) examines the evidence behind the “disaster industry” that has sprouted in the 1990’s without any credible evidence of debriefing of traumatized people has done any good. Indeed, evidence is accumulating demonstrating that “grief counseling” has in many cases done harm. Unlike other fields of medicine, when mental health services are available, they are often forced on people against their will. For example, NYC police and firemen were REQUIRED to undergo “debriefing” after 9/11, adding insult to injury.
2. A recent report published in the Archives of General Psychiatry confirms that the use of antidepressants (SSRIs) during pregnancy may cause neurological problems in newborns:
“We report increased risk for central nervous system serotonergic adverse effects during the first days of life in newborns of mothers taking the SSRIs citalopram or fluoxetine during the third trimester of pregnancy,” they write. “The clinical relevance of the present results is awareness of the psychiatrists who prescribe SSRIs during pregnancy and the pediatricians who treat the serotonin-related neurologic symptoms of the newborns during the first days of life. Although these effects seem to subside quickly, they may expose the infants to more serious neonatal complications such as convulsions.”
See: http://www.medscape.com/viewarticle/458559 MEDSCAPE: Use of SSRIs During Pregnancy May Cause Neurologic Symptoms in Newborns Reported August 18, 2003
This is not surprising inasmuch as SSRIs have come under fire this summer when previously concealed evidence of harm from severe withdrawal effects and drug-induced suicidal acts, was brought to the attention of drug regulating agencies in the U.K., Canada, and the U.S. In the U.K. and Canada, at least one SSRI (Paxil / Seroxat) has been banned from use in children under 18. In August, a second SSRI manufacturer (Wyeth) issued a similar warning about the suicidal risk of Effexor. FDA issued a warning and announced that it is reexamining ALL clinical trial data from all pediatric SSRI trials. Until now, drug manufacturers of SSRIs have concealed as much as 75% of their own clinical trial findings, making essentially false claims based on selected biased findings.
2. The nationwide misprescribing of psychotropic drugs America’s children. A report in today’s Palm Beach Post states that Florida’s foster care children are being abused with psychotropic drugs:
“In a review of the files of 1,180 children, most in therapeutic foster homes, the advocacy council found 652 were on at least one psychotropic medication. About 44 percent of those receiving medications had no record of a medical examination in the file. In many cases, there was no evidence that doctors had the consent of a parent or guardian to prescribe the drugs. Many of the drugs were prescribed by primary care physicians, not psychiatrists who specialize in emotional and mental disorders.
“And in two-thirds of the cases, there was no evidence anybody checked for the side effects that can range from irregular heartbeats, permanent shakes and tics and worsening of the very symptoms the same drugs are supposed to improve.”
“One foster teen in a psychiatric ward was so drugged that she acted more like a passive Alzheimer’s patient, said John Walsh, who represents foster children in Palm Beach County through the Legal Aid Society. Walsh said he has been increasingly concerned about the number of young children on antipsychotic medication in the past three or four years.”
Palm Beach Post Friday, September 12
Mind drugs given to hundreds in Fla. foster care
By Kathleen Chapman, Palm Beach Post Staff Writer
Friday, September 12, 2003
4. Researchers at UCLA are conveying the opposite message about antidepressants to pregnant women whom they are recruiting for an experiment in which the women are encouraged to take SSRIs while breastfeeding! The purpose of the experiment is to test the effect of the drug on their newborns babies.
It would appear from the UCLA promotional recruitment material that the investigators fail to inform the women about the foreseeable adverse neurological effects on newborns exposed to these drugs. Instead they claim that infants of “untreated depressed mothers” are slower to grow. It is puzzling why the only treatment for depression being recommended by the study investigator, is antidepressant drugs.
UCLA recruitment material neatly dodges the evidence of adverse effects for infants from antidepressants, stating disingenuously: “the drugs appeared to have no effect on their growth.”
Could it be that the researchers are more focused on recruiting human subjects for a trial whose unacknowledged purpose is to promote the interests of the sponsoring drug manufacturer, rather than meeting their responsibility to protect the health of newborn babies? These infants are non-consenting human subjects of a drug experiment. The newborns are being exposed to foreseeable risks of harm on the basis of a flimsy observation.
AHRP believes there ought to be a law to hold accountable those who conceal data of adverse drug effects, and make false claims about the safety and efficacy of drugs on the basis of partial data. There should be stiff penalties for those who betray the public trust.
For more information about the UCLA study, contact:
UCLA’s Mood Research Program
LOS ANGELES (Ivanhoe Newswire) — Many nursing mothers are understandably cautious about the drugs they take, but new research suggests they don’t need to refrain from taking certain anti-depressants. In fact, one researcher at UCLA says it may be much better for the baby than the alternative.
THE WALL STREET JOURNAL
September 12, 2003
By SHARON BEGLEY
Is Trauma Debriefing Worse Than Letting Victims Heal Naturally?
The executive was in a meeting in one of the Twin Towers when the first plane hit. Of the 30 people with him, he and only six others staggered out alive that morning. Crushed by the enormity of the tragedy, the man told his trauma counselor that it was all he could do to try to understand why he had lived while others died. Yet he had to cope with a great deal more.
Like thousands of other victims of Sept. 11, the executive underwent psychological debriefing, a catch-all term for sessions in which a counselor encourages a group of 10 to 20 trauma survivors or disaster workers to share, in a supportive environment, what they experienced, felt and thought. Debriefing, say proponents, can prevent long-term psychological problems such as post-traumatic stress disorder. The disaster industry that emerged in the 1990s has vigorously promoted psychological debriefing, training more than 40,000 people a year in it. Members of the U.S. military undergo stress debriefing before deploying home from Iraq.
For the executive who survived the 2001 terrorist attacks, though, hearing other victims describe what they saw and suffered that day was too much. When one described seeing a body part roll down a sidewalk, he had to flee the session.
For weeks afterward he suffered flashbacks and nightmares, finally seeking help from Crisis Management International, an Atlanta-based company that, at the behest of 204 corporate clients, had sent hundreds of counselors to New York within days of Sept. 11. “The group debriefing had led him right into what he couldn’t get rid of in the first place: the memories and images of 9/11,” says CEO Bruce Blythe.
WTC TENANTS: AFTER THE FALL
See a September 2002 special report1 from the Online Journal for a look at how former World Trade Center tenants — including some business owners mentioned in this article — worked to rebuild their businesses after the terrorist attacks.
In science, anecdotes are not data. But stories like this executive’s are igniting a firestorm of controversy in psychology. After scrutinizing dozens of studies of psychological debriefing, a panel of eminent researchers assembled by the American Psychological Society — Richard McNally of Harvard University in Cambridge, Mass.; Richard Bryant of the University of New South Wales in Sydney and Anke Ehlers of King’s College London — has reached a clear conclusion.
“Contrary to a widely held belief, pushing people to talk about their feelings and thoughts very soon after a trauma may not be beneficial,” they write in a paper to be published in November in the journal Psychological Science in the Public Interest (available at www.psychologicalscience.org/pspi2). “Although psychological debriefing is widely used throughout the world to prevent PTSD, there is no convincing evidence that it does so. … For scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed people.”
Most survivors who have undergone psychological debriefing call it helpful. But objectively comparing the outcomes of people who did and didn’t undergo debriefing — survivors of car accidents, police officers exposed to trauma and disaster workers — tells a different story. Debriefing has no effect on rates of PTSD.
A 2001 analysis, for example, examined peer-reviewed studies that randomly assigned trauma survivors to receive “critical-incident stress debriefing,” a commonly used protocol, or not. (Randomized controls let you separate the effects of debriefing from natural recovery.) The conclusion: There is no evidence that debriefing helps prevent PTSD in trauma survivors, partly because most recover naturally.
More worrisome, debriefing may impede natural recovery. When police officers who worked a plane crash underwent debriefing, they had significantly more PTSD symptoms 18 months later than officers who weren’t debriefed. By forcing survivors to relive horrific memories, says Prof. McNally, “debriefing may consolidate emotional memories more intensely, when what you need is to shut down for a while. As one earthquake survivor in Turkey said, ‘It was as if the debriefers opened me up as in surgery and didn’t stitch me back up.’ ”
Jeffrey Mitchell, an associate professor at the University of Maryland, Baltimore County, who devised critical-incident stress debriefing, dismisses the negative studies. Many include debriefings conducted by poorly trained or minimally experienced counselors, he says, or done too soon after the trauma. Moreover, “this was never designed as a stand-alone. Crisis intervention includes much more than debriefing.”
In fact, at least one debriefing study found a benefit. In 1999, scientists reported that 42 emergency medical personnel who underwent debriefing after working the 1992 Los Angeles riots reported significantly fewer PTSD symptoms than did 23 nondebriefed workers. Other pro-debriefing studies, however, are problematic. Some failed to include a no-treatment group to serve as a control. In others, the follow-up period for assessing “lasting” psychological damage was woefully short.
Businesses aren’t waiting for academics to resolve the debate. Concerned about the potential harm of debriefing, says Mr. Blythe, CMI has abandoned it. The company’s Web site now warns prospective clients that the science behind debriefing is so iffy, and the suggestions of harm so troubling, that requiring employees to undergo debriefing could invite lawsuits.
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