Nebraska state shrinks still double-dipping, a decade after vow to end the practice

From a report from the Nebraska Watchdog. Another case of getting paid for more than what they do.

Nearly a decade ago, the new head of the state psychiatric hospital promised change to the Lincoln Regional Center after lawmakers discovered most of the psychiatrists had other jobs. Some were double-dipping — working at the state psychiatric hospital and county mental health center — while others were triple- and quadruple-dipping. But, 10 years later, Nebraska Watchdog has found little has changed.

Take Dr. Sanat Roy: He’s a psychiatrist at the Mental Health Crisis Center of Lancaster County, contract psychiatrist at the Lincoln Regional Center and has a private practice at Plaza West Psychiatrists. He’s also listed as the medical director for Blue Valley Behavioral Health, a Beatrice nonprofit that serves 16 counties in southeast Nebraska.

Scott Etherton, program director for the county’s mental health center, said Roy works part-time and is on call 24/7. He gets $160,000 annually plus nearly $30,000 in benefits. Roy is on a contract with the state, earning more than $125 per hour for up to 1,664 hours per year (32 hours per week) or $210,266 per year.

[...]

Another psychiatrist, Dr. Klaus Hartmann, works full-time for the Regional Center, earning $243,884 annually — the highest state salary. He’s also listed as a psychiatrist for Bryan LGH and fills in for Roy when he’s on leave, according to Etherton.

A third psychiatrist working a second job is Dr. Rafael Tatay, a full-time psychiatrist at the Regional Center who makes $237,597 annually. He also is listed as a psychiatrist at Plaza West Psychiatrists.

After getting complaints for years that Regional Center psychiatrists weren’t putting in 40 hours a week, a 2005 performance audit by the Legislature found most Regional Center psychiatrists had other jobs that had them putting in upwards of 80 hours per week. The audit report didn’t say whether the psychiatrists were still able to properly do their jobs, despite holding down multiple positions. After the report came out, the new head of the Regional Center at the time, Bill Gibson, said he would work to end the double-dipping.

Back then, Roy and Hartmann were making about $330,000 annually working for the state and county, with jobs that required them to put in more than 65 hours per week, plus private practices. They’d been doing it for two decades [...] “It has been standard practice. I don’t think it has been detrimental to patient care. But it is not what I envision for the future,” he said in 2005.

Psychiatrists are among the highest paid state employees — with eight of them cracking the top 15 highest paid state employees

[...]

GAO Finds Major Overuse of Antipsychotic Drugs by the Elderly

From the Illinois Nursing Home Abuse Blog

In late 2014 we blogged about the accusations levied against Dr. Michael J. Reinstein about his improper use of antipsychotic drugs prescribed to patients in abundance, as well as taking kickbacks from the drug maker to prescribe it, and making 140,000 or more false billing claims submitted to Medicare and Medicaid for those treatments. This activity landed him in both civil and criminal hot water, and in more recent news he pled guilty to criminal charges as well as settled civil claims with the Illinois and federal governments.

The companies accused of providing those kickbacks and receiving Medicare and Medicaid dollars from the business Reinstein generated by prescribing their antipsychotic drugs. Reinstein exemplifies a holdover of a slowly diminishing practice of using antipsychotic medications, which now is viewed more as the easy way out and a method of chemical restraint when there are other methods that could more humanely calm and care for a patient, particularly dementia and Alzheimer’s patients who have historically been the recipients of antipsychotic medications. Nursing homes historically used these especially when they kept low staffing levels and did not have the manpower to aid patients. Yet antipsychotic drugs can create a cycle of drug dependency, and can even lead to death.

Changing Tides?

While the movement to eliminate the use of antipsychotic medications has gained steam in recent years, the federal government reports that elderly Americans have been overusing psychiatric drugs such as clozapine (Dr. Reinstein’s apparent drug of choice), Abilify, and others. Such drugs are meant to calm down and sedate patients that are prone to violence or outbursts, which those suffering from dementia or psychosis may be particularly prone to exhibiting. The Government Accountability Office (GAO) has released a report stating that elderly adults who live outside of nursing homes and long-term care facilities overuse antipsychotic drugs which are prescribed to them by doctors, though residents in nursing homes also fell into such dependency and overuse, and efforts to curb over-prescription and overuse must continue there as well.

Notably, according to the report, about 86% of Medicare enrollees who suffer from dementia and live outside of nursing homes are prescribed antipsychotic medications, which is a staggering statistic. It is even more remarkable when considering that only approximately 6% of total Medicare enrollees living outside of nursing homes suffer from dementia. Thus the choice of treatment has predominantly been geared toward chemical intervention. For those in nursing homes, of the elderly dementia patients living in nursing homes for over 100 days in the year 2012, approximately a third of those patients were prescribed antipsychotic drugs (and 14% of those outside of nursing homes during 2012).

Part of the problem, according to the GAO report, is the lack of oversight by the government. Medicare and Medicaid specifically take responsibility for such oversight on behalf of the federal government, and states typically have Medicaid fraud units that look into not only financial fraud related to health care, but also investigate when issues include abuse or misuse of medications (which can result in unnecessary and excessive, and thus fraudulent, payments to providers and pharmaceuticals with federal dollars). Those agencies and offices, as well as the U.S. Department of Health and Human Services as the report notes, should be vital in promoting awareness of the dangers of antipsychotic drugs and reducing that use far more than the government has in the past.

East House Receives Grants To Help Former Rochester Psych Patients

From this short report on WXXI of Rochester NY.

East House, a local organization that provides services for adults in recovery from substance abuse and mental health disorders, has been awarded more than $500,000 in two state grants. The money will help people who are no longer being served by the Rochester Psychiatric Center and other inpatient psychiatric units.

The grants, administered through the Monroe County Office of Mental Health, will provide services to 116 people in a six-county area including Monroe, Wayne, Livingston, Genesee, Orleans and Wyoming Counties.

Of note is prospect that the Rochester Psychiatric Center is offloading these clientele because they will be accepting more patients

Some neighbors in the Upper Mount Hope area are expressing concern over the recently announced proposed changes to the Rochester Psychiatric Center. A spokesperson for the New York State Office of Mental Health confirmed to 13WHAM News that it plans to add 29 forensic beds to the building on Elmwood Avenue.

The facility was recently in the news because of the murder of a patient

State deal pledges better care at Bridgewater Hospital after three deaths, and threats of lawsuits

From a report in the Boston Globe

Many more details at the link

An independent monitoring group will open an office inside troubled Bridgewater State Hospital for the next two years to make sure that prison guards and clinicians continue reducing their use of isolation and physical restraints on mentally ill patients, under a deal with the state that averts a lawsuit.

“The agreement guarantees that over the next couple of years, someone will be in there watching, looking at the data, talking to the patients and staff, and really trying to make sure that people are treated appropriately as patients and not as prisoners,” Christine M. Griffin, the executive director of the federally funded Disability Law Center, which reached the agreement with the Patrick administration, said Tuesday.

The center had threatened to sue Massachusetts for what it said were widespread human rights abuses at Bridgewater, where the Globe has identified three deaths in recent years related to the use of restraints to control patients.

Under the agreement worked out over the last five months with Governor Deval Patrick, the center will not sue as long as the state follows through on a host of promises of better care, including a plan to move most of the patients to a proposed facility at an undetermined location to be run by the Department of Mental Health.

[...]

The Disability Law Center launched a six-week, on-site investigation into practices at Bridgewater after a series of stories in the Globe, including a detailed account of the death of Joshua K. Messier, a 23-year-old mental health patient sent to Bridgewater for a psychiatric evaluation who died as guards wrestled him into four-point restraints, cuffing his wrists and ankles to a small bed.

[...]

A more recent Globe story recounted the deaths of two more mental health patients — Bradley Burns and Paul Correia — whose deaths were attributed by the state medical examiner’s office to the use of restraints. Burns was held in five-point restraints for 16 months, 23 hours a day, before he died of a heart arrhythmia.

Under the agreement with the Disability Law Center, the administration has pledged to discontinue the use of five-point restraints — strapping a patient down by chest, wrists, and ankles — altogether and to revise its official policy on the use of seclusion and restraints by mid-January.

Meanwhile, Bridgewater State Hospital officials have replaced existing restraint beds with larger, more comfortable beds, and cut the overall use of restraints by 86 percent and the use of seclusion by 68 percent, since January, according to the Department of Correction.

Drug Shills Dispensing Pills A psychiatrist questions Big Pharma’s influence on her profession.

A recent article by Jean Kim in the magazine IN THESE TIMES

Jean Kim is a psychiatrist and writer in Washington, D.C., who is finishing her M.A. in nonfiction writing at Johns Hopkins University

In 2009, as an eager young psychiatry professor at New York-Presbyterian Hospital, I presented to faculty on the need for a moral dimension to psychiatric diagnoses. I was laughed out of the room.

One psychiatrist, a schizophrenia specialist, said he didn’t see the point. The acting medical director said he felt I’d called him immoral. A top research psychiatrist said, incredibly, “Morality and psychiatry should be kept separate.”

So a few years later, when ProPublica launched its Dollars for Docs database to track the drug company money doctors were taking, I typed in their names. The acting medical director received $12,550 in 2010 and 2011 for speaking gigs. The researcher received more than $212,489 between 2009 and 2012 for speaking gigs and consultations. The schizophrenia specialist made more than $323,300. And the database only includes disclosures from 17 of the more than 70 drug companies in the world. According to Dollars for Docs, hundreds of thousands of doctors have raked in a total of more than $4 billion since 2009, with the top earner, psychiatrist Dr. Jon Draud, netting at least $1.2 million.

As a psychiatrist who “grew up” in the last decade, I was not surprised.

I started my residency training in New York City in 2000. Lunches and dinners provided by drug company reps were astaple of my diet. For a hungry, harried resident on a paltry salary, a free pit stop at a steaming Chinese buffet was heaven. All around me in Manhattan, investment bankers and freshly minted lawyers were living it up, and I admit that I wanted a piece of the pie as well. By mid-decade, academic psychiatry had become glamorous. A resident might schmooze with a drug rep and get invited to a trendy spot—Nobu, Olives, Tao—where we could imbibe Sex and the City-style cocktails and sample the freshest sushi. Drug reps, selected for their looks and charm, were the popular, beautiful best friends we geeky docs never had.

In 2003, I won a free ride to the American Psychiatric Association annual meeting in San Francisco as part of an Aventis-sponsored fellowship for women in psychiatry. An industry-sponsored gala featured an open bar and a Brobdingnagian spread: tables loaded with huge flower displays, chocolate fountains, petit fours and gourmet hors d’oeuvres. The conference also hosted a Disney-esque exhibit hall full of brightly colored drug company displays with touchscreen computer stations. I filled my free tote bag with gifts—pens, laser pointers, candy, textbooks. My favorite was the Xanax XR clock, whose hands rested on a bed of clear turquoise fluid, to simulate the feeling of floating on a summer pool.

I graduated from residency training and became an attending psychiatrist myself. Back then, it was viewed as a symbol of academic prowess to be on a drug company’s speaker’s bureau. So when an enthusiastic new drug rep from my alma mater invited me, a lowly junior attending, to a speaker training session, I was flattered and accepted. On an all-expenses-paid two-day training trip to Chicago, I stayed at a posh hotel on Michigan Avenue and sat through lectures about the then-new antipsychotic drug Geodon. I was paid $2,500 for going, and another $1,000 for giving a “talk” for about seven minutes a few weeks later at a dinner with a handful of colleagues. Persuaded that I needed to gain experience with Geodon so that I could be a better presenter, I began prescribing it more often. Then I began to see that it was less reliable than other medications. I quit the speaker’s bureau, realizing I had been manipulated into writing more Geodon prescriptions. In fact, the drug rep’s salary depended on such performance increases. Drug companies can track all physicians’ prescriptions—a 2011 Supreme Court decision upheld their right to do so, citing data as “free commercial speech.”

In November 2007, as the economy imploded, a prominent psychiatrist, Dr. Daniel Carlat, wrote a famous essay in the New York Times Magazine about a stint as a pharma shill. He concluded, “The money was affecting my critical judgment. I was willing to dance around the truth in order to make the drug reps happy. Receiving $750 checks for chatting with some doctors during a lunch break was such easy money that it left me giddy. Like an addiction, it was very hard to give up.” I read it and realized that I had been going along with the tide—that a colossal, profit-driven advertising engine was using our own psychological tactics to manipulate us.

The next year, heads began to roll. In October 2008, Dr. Charles Nemeroff, then head of psychiatry at Emory University, made the front page of the New York Times for failing to report more than $1.2 million dollars in drug company-related income to Emory, which had strict guidelines for non-academic money. He resigned and now works for the University of Miami.

Dr. Joseph Biederman of Harvard Medical School went one step farther than Nemeroff. As the Times reported in November 2008, he not only hid from Harvard that he’d taken more than $1.4 million from drug companies; he publicly advocated for diagnosing more children with bipolar disorder and prescribing them more antipsychotic medications. The rate of prescriptions for these medications skyrocketed. Antipsychotics should only be used when absolutely necessary, given their potential for serious side effects, especially in children.

Since then, FDA regulations have gotten tighter, and in 2009, the Pharmaceutical Researchers and Manufacturers of America self-imposed a code on interactions with healthcare professions. Drug company speakers can no longer ad-lib invented uses for their medications and have to include mention of “negative studies” if available. Comped dinners must be modest by local standards and include presentations. Pens and trinkets are banned. The once-charming reps can speak to you only if spoken to, not unlike vampires who cannot enter your home unless invited.

The reforms have cut down on blatant pharma influence, but prominent psychiatrists still shill shamelessly, and much research is pharma-funded. Take the October 2014 issue of the American Journal of Psychiatry, the elite scientific publication in our field. Five of the six research articles contain disclosures that one or more of the authors worked or consulted for pharma. It remains to be seen whether more data releases from ProPublica—and now from Open Payments, a federal database mandated by the Affordable Care Act and unveiled in late September—will create enough public backlash to convince these doctors that this type of income does harm. Conflicts of interest weaken the credibility of research and hurt patients by encouraging poor prescribing practices. They also undermine the crucial trust between doctor and patient by fueling the paranoiac skepticism that all psychotropic medications are mind-altering, toxic tools of profit.

The right medications, alongside psychotherapy, can save and improve lives. I have seen people frozen in psychosis or melancholia awaken, as though from a nightmare, after getting the right treatment. I have seen soldiers back from war, riddled with flashbacks, become able to do simple things again, like go to a shopping mall. I have seen people once stuck in hospitals able to work again, to finish school, to have loving relationships. Those moments fulfill me as a doctor and as a human being. But I wish my profession would recognize that our ethics are worth more than a quick buck.

Quote: A top research psychiatrist said, incredibly, “Morality and psychiatry should be kept separate.”

Sums it up nicely, no?

Big Pharma Plays Hide-the-Ball With Data

NewsWeek has a Story featured on their front cover about how "Big Pharma Plays Hide-the-Ball With Data"

The story is focused on the general and universal problem of publication bias.

Naturally the problem is also a major issue for psych drug manufacturers.

It is much too long to quote in full but we can feature some highlights here.

On the morning of March 2, 2005, a 14-year-old Japanese girl woke up scared. At first she thought someone was outside the house watching her, but then she decided the stranger must be inside. She wandered restlessly and, despite the cold weather, threw open all the windows. Later, over a meal, she declared, “The salad is poisoned.” Two days later, she said she wanted to kill herself.

This teenager with no history of mental illness was diagnosed with delirium. The night before the hallucinations started, she began taking an anti-influenza drug called Tamiflu (generic name: oseltamivir), which governments around the world have spent billions stockpiling for the next major flu outbreak.

But evidence released earlier this year by Cochrane Collaboration, a London-based nonprofit, shows that a significant amount of negative data from the drug’s clinical trials were hidden from the public. The Food and Drug Administration (FDA) knew about it, but the medical community did not; the U.S. Centers for Disease Control and Prevention (CDC), which doesn’t have the same access to unpublished data as regulators, had recommended the drug without being able to see the full picture. When results from those unpublished trials finally did emerge, they cast doubt over whether Tamiflu is as effective as the manufacturer says.

---

Knowing about negative results is not just useful; it is essential to good science. Randomized clinical trials are considered the best way to test a drug: Get two groups of patients with the same problem, give one group an experimental treatment and see if it works better than no treatment. Even better, amass the results of dozens of similar clinical trials, level the differences and draw better conclusions from a larger amount of data. That’s called a systematic review.

Problem is, a systematic review only works if the reviewers have all the information—good, bad and inconclusive.

“In baseball, it is easy to find out just how well Cal Ripken has hit against various pitchers in the past, at home or away games, in recent weeks or during his career,” Dickersin and Rennie wrote. “Yet in medicine, there is no comprehensive source for finding out similar, accurate statistics for medical interventions. How can baseball be better organized and keep better records than medical science?”

One reason is that drug companies have so much to lose. “The potential economic implications of publishing an unfavorable study are really significant for pharmaceutical companies,” says Christopher W. Jones, who studies publication bias at Cooper Medical School of Rowan University. “And clearly those incentives have an effect on the way they choose to present their data to the public.”

---

Publication bias in clinical trials was, for a long time, something only scientists cared about. But lately the issue has raised a crop of lobbyists and gone mainstream. In 2005, John P.A. Ioannidis, a researcher at the Stanford School of Medicine, published a scientific paper under the provocative heading “Why Most Published Research Findings Are False” and mentioned publication bias. And British doctor Ben Goldacre leads a movement called AllTrials. His TED talk on publication bias has been seen 1.8 million times.

QUESTION: Where in the world could you go to find a place where half of all women are raped? ANSWER: Australia’s psychiatric hospitals.

Came across this news item from last year.

Still worth posting about

That’s the shocking conclusion of a new report from the Victorian Mental Illness Awareness Council (VIMIAC).

Their survey of women who have been in psychiatric wards in Victorian hospitals paints a shocking picture.

A terrifying 85 per cent said they had felt unsafe, with most saying they reported it to doctors and nurses and felt nothing was done. About 45 per cent had been sexually assaulted in hospital.

Just imagine the terror. You are alone, in a foreign place, completely under the control of medical staff, many of whom you have only just met, and surrounded by very disturbed people.

Even worse, you are disturbed: so depressed you unable to defend yourself, or perhaps already being tortured by fears, feelings or voices. There is a good chance you have a previous history of being assaulted, as such attacks vastly increase your chance of developing a mental illness.

It’s sickening. It’s happening now. And we are standing by and doing nothing.

“We expect people with mental illness to tolerate what no-one else would tolerate,” says Isabell Collins from VIMIAC. “It would only need to happen once in a general hospital ward and it would be fixed immediately.”

Yet, says Collins, she has been working in mental health for 25 years, “and sexual assault has been a problem for 25 years”.

Her survey included about 50 women from Victoria, but Collins says it does not overestimate the problem.

“If anything it underestimates it,” she says. “If you did the exact same survey in any state you would expect the same results”.

How could this be? How can we allow our most vulnerable people to be treated in this way? It’s hard not to agree with Collins that the answer is that society would rather just ignore mental illness, scared off by stigma and misinformation and a desire to sweep difficult problems under the carpet.

The incoming head of the Royal Australian and New Zealand College of Psychiatrists, Mal Hopwood, says that while he can’t be sure on the exact proportion of women raped in care, there is clearly a problem that exists around the country.

“Certainly the numbers in that report suggest it’s not an insignificant problem,” he says.

He wants hospitals to be properly funded to enforce female-only areas and support women who are assaulted.

But he says fixing buildings and allocating spaces won’t be enough: an attitude change is needed as well.

You also have to wonder if our over-reliance on medication and biological psychiatry have helped downplay the importance of creating positive environments in psych hospitals.

After all, if mental illness is just a brain disease that needs the right medication, then surely a stark, busy, hospital environment will make no difference?

But mental illness is closely linked to both our personal experiences and the culture we are living in, and putting people in scary, loud and under-resourced hospitals cannot be helping.

I couldn’t have more admiration for many of the hard-working doctors and nurses working in public hospital psychiatric units, yet the truth is that most of these places are awful to be in.

Rape is the terrible tip of a huge problem that we have been ignoring for far too long.

Maine's Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients

As reported in the Portland Press Herald

Further details at the link.

Riverview Psychiatric Center has failed to abide by the terms of a decades-old consent decree by not adequately reducing the risk of injury to clients and staff and by arbitrarily limiting treatment options for patients, according to a report issued by a former court-appointed receiver and consultant.

Elizabeth Jones was asked to report on observations she made during a three-day visit to Riverview, where the state treats its most severe mental illness cases, including patients sent there through the criminal court system.

Jones listed failures in treatment strategies, failure to provide proper interventions following aggressive acts by two patients and continued risk to patients and staff, a “serious misunderstanding of recovery model” that the hospital ascribes to, and lack of treatment and of outdoor time for Lower Saco unit patients, those who have been found not responsible for criminal conduct because of mental illness.

“Treatment options have been arbitrarily limited and, therefore, the provisions of the consent decree have been violated,” she wrote.

She said the use of seclusion and restraint need to follow consent decree requirements.

“At this time, it appeared that the requisite pro-active alternatives to seclusion and restraint have not been explored or provided consistently to the extent needed,” she wrote. “The lack of individualized treatment interventions and the lack of sufficient training and personnel support place both staff and class members at the risk of harm.”

Jones had a number of observations, including concerns that the state is no longer in compliance with the consent decree that requires individualized treatment plans and adequate staffing. The consent decree settled a lawsuit brought two decades ago by mental health advocates that holds the state mental health system to agreed-upon standards of care.

Daniel Wathen, the court master who oversees the consent decree, requested the visit following a series of problems at the hospital in Augusta, including serious attacks by patients on mental health workers and nurses, the use of a stun gun and pepper spray on patients, and a loss of federal funding estimated at $20 million annually because the Centers for Medicare and Medicaid Services had withdrawn the hospital’s certification.

Jones’ report was made public on Wednesday, though Wathen said he and Jones met immediately after the hospital visit with the commissioner of the state Department of Health & Human Services, and the hospital received a copy of the report on Monday.

Local Doctors Accused of Abusing Drugs, Alcohol and Over-Prescribing in Some Cases Killing Patients. California Prop 46 calls for Drug Testing for Doctors

As seen in this report

Local Doctors Accused of Abusing Drugs, Alcohol and Over-Prescribing in Some Cases Killing Patients

Of particular intere is California's propostion 46

Proposition 46 calls for random drug and alcohol testing of California doctors who work at hospitals or have hospital admitting privileges. It would also require doctors to submit to substance abuse testing if a patient under their care suffers medical harm.

Click here to see the complete voters guide on Proposition 46 from California’s Secretary of State Office.

Of course doctors are opposed to this.

there is a video report as well


What do you think?

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

As seen on ParentingPlan.net We have not quoted the entire paper, but only the introductory section with a few of the smaller examples.

The original post has many fine examples, plenty of detailed references, and is oriented to situations where parents are separated. Unfortunately, given other news reports of recent years, this paper is still quite relevant

Misuse of Psychological Tests in Forensic Settings: Some Horrible Examples

Ralph Underwager and Hollida Wakefield

American Journal of Forensic Psychology, Volume 11, Issue 1

Psychological tests are often used inappropriately and are misinterpreted and overinterpreted in the forensic setting. This harms the person being evaluated and interferes with the cause of justice. It also does a disservice to the reputation of psychologists and the science of psychology. Actual examples of misuse of particular techniques and tests and misinterpretation illustrate what has been done in forensic settings.

A forensic evaluation is different from a clinical evaluation. When an evaluation is done in the clinical setting, the conclusions are used to develop a treatment plan. These conclusions form working hypotheses which can be confirmed or rejected during treatment. However, in the forensic setting, a one-time decision is made about the individual — a decision which can markedly affect the person's life.

If tests are misinterpreted in the clinical setting, the treatment plan developed from the evaluation may not be the most effective for the client. However, since treatment plans are generally modified and revised throughout the course of treatment, the mistaken conclusions can be corrected. But, an erroneous decision in the forensic setting can result in immediate and severe consequences, such as losing custody of a child or being jailed. If decisions and recommendations by the psychologist are not based on adequate data, the psychologist is acting both incompetently and unethically.

In addition, conclusions drawn by the psychologist are subject to cross-examination in the adversarial setting. If the conclusions are not based upon adequate data, the psychologist's testimony will be discredited or impeached by a skillful opposing attorney. Therefore, the psychologist should only present conclusions in reports and testimony which can be defended when challenged in cross-examination.

In the course of examining hundreds of reports, we have seen many examples of tests that are misadministered, misinterpreted, overinterpreted, or should never have been given in the particular setting. We are presenting a sample of these to illustrate what should be avoided by any psychologist who does forensic evaluations.

DRAWINGS

Tests such as the House-Tree-Person (HTP) and Kinetic Family Drawings are often overinterpreted and misinterpreted. There is a lack of validity and reliability in the use of drawings as projective assessment devices. In a review of the Draw-A-Person test in the Seventh Mental Measurements Yearbook, Harris (1) notes that there is very little evidence for the use of "signs" as valid indicators of personality characteristics. With children's drawings there is so much variability from drawing to drawing that particular features of any one drawing are too unreliable to say anything about them. The Tenth Mental Measurements Yearbook (2), in reviews by Cundick and Weinberg (p.422-425) continues the consistent finding since the first edition, 1938, that interpretations of drawings (as are often done in forensic evaluations) are unsupported by empirical evidence. Both reviewers note that there are no normative data establishing reliability and validity of the Kinetic Drawing System.

Here are some of the examples as given:

Example 2

A four-year-old girl was asked to draw a picture of herself and the family doing something. She instead, according to the school psychologist who was evaluating her, "seemed to be preoccupied with drawing circles within circles which she called 'caves.' Her second representation bore a significant resemblance to male genitalia (when asked what it represented, she reported that it was a ball rolling into a lion's cave)." This was interpreted as being suggestive of sexual abuse and the fact that the child has been subjected to some type of traumatic experience.

When we saw the child, now age five, we tested her and found borderline to low-average intelligence and no ability to draw anything other than scribbled circles. The child clearly had difficulties with visual motor perception and indeed, could not draw, a fact which was ignored by the other evaluator. This example, therefore, illustrates the importance of recognizing the child's developmental level.

Example 5

A four-year-old girl's drawing of a tree in the HTP was considered significant because the child, when asked to draw a tree, also drew a cactus. This was interpreted in terms of "unconscious expression of danger and fearfulness." However, the child was not asked if she had a cactus in her yard (this was in Texas).

The child also brought a drawing of a clown's face to the therapist which she had ostensibly drawn while in the waiting room with her parents. The clown was interpreted as being significant because "there is an element of sadness in the clown's eyes." This clown is of much greater sophistication and detail than the child's other drawings. When pressed about this in his deposition, the psychologist acknowledged that the parents probably drew it and she colored it. This example illustrates both problems in administration and in interpretation.

Example 20

A baby was returned to the foster mother following a visit with the parents and was described as having the "smell of sex." An emergency hearing was held in which social services attempted to cut off visits because this "smell of sex" triggered the suspicion that the parents were having sex with their baby. A psychologist agreed that the sex smell was significant and indicated probable abuse on the part of the parents. Fortunately, the parents had been at a church potluck dinner during the entire visit so they were able to disprove, the accusations.

We can just imagine the horror that happens when this gets involved with separation and divorce proceedings.

Getting the Massachusetts Rx Drug Marketing Reforms Bill Signed

MASSPIRG is an advocate for the public interest in the state of Massachusetts.

When consumers are cheated or the voices of ordinary citizens are drowned out by special interest lobbyists, MASSPIRG speaks up and takes action. They use the time-tested tools of investigative research, media exposés, grassroots organizing, advocacy and litigation.

Last week on August 1st, they released this press regarding the regulation of Drug Company Marketing Practices, etc in the state of Massachusetts.

Legislature Passes Rx Drug Marketing Reforms And Other Measures To Control Health Care Costs

The legislature enacted and sent to the Governor last night a Health Care Cost Control Bill that will begin to reign in aggressive and inappropriate marketing tactics by drug companies and medical device companies. Those excessive marketing tactics have resulted in excessive prescription drug costs and compromised care. Direct-to-physician industry marketing promotes the prescribing of expensive drugs in place of equally safe and effective lower-cost drugs and the prescribing of newer brand name drugs that have the least safety and efficacy information. The excessive marketing of Vioxx, for example, led to the prescribing of a new drug that ended up causing unforeseen heart problems that killed 40,000 people.

“While the bill does not include a complete ban on industry gifts to prescribers it does make a giant step forward in shining the light on this marketing practice through the disclosure of anything of more than $50 value, giving the DPH authority to ban some gifts, and including significant fines for violations of the new regulations,” said Deirdre Cummings, Legislative Director of MASSPIRG.

The final bill also included the following cost control reforms:

RX Drug Marketing Regulations: Requires pharmaceutical and medical device companies to disclose payments to health care providers of $50 or above to DPH which will make the disclosures publicly available. Directs DPH to establish regulations on pharmaceutical and medical device marketing, using the industry’s own Code as a minimum standard, and establishes a $5000 penalty for violation, enforceable by the Attorney General.

Creation of an Academic Detailing Program: A much needed counterweight to the industry’s commercial detailing and gift-giving marketing efforts. Academic detailing programs are cost-effective ways to improve physician prescribing behavior and so reduce health care costs: Based on other states’ experiences with academic detailing programs, Massachusetts can expect to save two to three dollars for every dollar we spend on academic detailing.

Use of Uniform Claim Codes: Currently, nearly one-third of all dollars spent on health care go toward administrative costs – and much of that is wasted on managing the tangle of bureaucratic claim codes created by different insurance plans. Conservative estimates project that the adoption of uniform claim codes will save Massachusetts hospitals over $50 million annually in administrative costs.

Public Reporting of Healthcare-Associated Infections and Serious Reportable Events: Requires facility-specific public reporting of infections, as already required in twenty-two other states and the reporting of, and allows for the nonpayment for, serious reportable events.

Taken together, these provisions will begin to contain the cost of health care in the commonwealth helping Massachusetts citizens continue to have access to affordable health care.

They also have this online petition encouraging Governor Patrick to sign the Bill

Tell Gov.Patrick to stand up to Big Pharma

Big Pharma is a big spender.

They spent $8.2 billion marketing their drugs last year.

And they don't exactly scrimp when it comes to hiring lobbyists to represent their interests on Beacon Hill, either.

Maybe that's why they're so upset that things didn't go their way last week, when the Legislature voted for the Health Care Cost Control Bill, which included reforms to curb drug companies' over-the-top marketing gimmicks.

But Big Pharma isn’t about to back down. They've already set their sights on the one person they think might overturn the decision: Gov. Deval Patrick.

Tell Gov. Patrick to stand up to the pressure and sign the Legislature's Health Care Cost Control Bill into law:

Follow these 3 easy steps to help out.
1. Look over the message below, and feel free to add your own comments. Using your own words makes the message more meaningful.
2. Sign the letter by filling in the form below. We will not share your information with anyone else.
3. Click the button to send your message.

We encourage citizens from the Sate of Massachusetts to sign the petition

A red flag about medicating young children

A column from the Monadnock Ledger-Transcript by Bonnie Harris

World-renowned Harvard child psychiatrist and director of the research team at Mass General Hospital Dr. Joseph Biederman has been found by Sen. Chuck Grassley of Iowa to have failed to report millions of dollars he has received over the years from the drug companies that make the drugs he prescribes for ADHD and bipolar disorder. Biederman and his research team are responsible for putting the diagnosis of bipolar disorder, previously thought to start in young adulthood, on children as young as three.

The reported diagnosis of bipolar disorder grew 40-fold between 1994 and 2003. And that data is five years old. Biederman is the number-one influence on doctors nationwide who diagnose and medicate children with bipolar and attention-deficit disorder. Antipsychotic drugs previously prescribed for adults are now being given to children as young as three -- one of whom died at age 4 from an overdose her mother gave her desperately trying to control her behavior.

According to Medco, a pharmacy benefits manager, 500,000 children and teenagers were given at least one prescription for an antipsychotic in 2007, including 20,500 who were younger than 6 years old. Biederman claims, "The average age of onset is about four .... It's solidly in the preschool years."

Another 3-year-old was reported by his mother to have violent and explosive outbursts. After a year of treatment, his mother says a psychiatrist told her he thought her son was bipolar. As the boy's mother reported, "He would tell us, you know, 'You donlove me.' ''You don't like me.' 'I don't like myself.' 'I hate myself.' 'I'm stupid.' 'Nobody likes me.' 'I wanna die.' Four-year-olds don't talk like that." After the boy was put on a fourth medication, the family decided that was enough and took their son to Seattle Children's Hospital, where they were told he was not bipolar. He now takes medication for hyperactivity and a sleep disorder. And he's learning to deal with his explosive moods through a behavioral program. The family claims there is no comparison to the child they are parenting today compared to the one diagnosed as bipolar.

Dr. John McClellan, familiar with this boy's case, says the children's psychiatric hospital he runs in the state of Washington is filled with kids who have been misdiagnosed as bipolar. He says it has become a catchall for aggressive and troubled children.

Please, let this report be a red flag to all who have children too quickly diagnosed with ADHD, bipolar disorder, oppositional defiant disorder and others.

A young child claiming that no one loves him, that he's stupid, hates himself, or wishes he could die is often a child who is crying out for acceptance and attention from the influential adults in his life who have yet to understand him and his problems. With that understanding, adjusted expectations, removal of damaging behavior modification techniques such as punishment, many children, even those with chemical imbalances and disorders, can have appropriate behavior without medication. So many children in today's world react strongly to being told what to do and how to do it, to feeling disrespected with regular criticism and punishment, to not fitting in to a schoolroom full of other children who seem to be able to "get it" more easily, to being easily overstimulated or misunderstood for the reasons beneath their behavior.

Children who feel misunderstood are capable of highly inappropriate behavior that is trying to signal their need. They don't know how to say "Hey, this isn't working. My needs are not getting met." So they act it out -- louder and more dramatically the longer the misunderstanding. One of the children diagnosed with bipolar disorder had a father who had been accused of abuse. This factor was not part of the equation of the diagnosis.

We must look to the reasons -- the root causes -- of why our children don't, won't or can't do what we ask. Diagnoses often feel validating and relieving when our attempts at control don't work to get our children to comply. We can shift the blame onto to "problem" and we don't have to change how we parent.

Let me be absolutely clear that I do not consider the parent to blame. It is the culture in which we live that does not support parents to support their children. We are still in a children-must-do-as-we-say mentality and if they don't -- well now we can medicate them and we don't have to deal with it. Let me also say that are many cases in which medication is helpful and necessary.

But please lets start to put more effort into understanding children, their temperaments, the reasons for their behavior, their need for acceptance and compassion, their desire to get it right and their frustrations when they can't.

Let's not medicate those frustrations before thorough evaluations can be conducted by several professionals looking at the behavior from different perspectives.

And please let's take some responsibility for what we, their parents and teachers, are presenting to our children that become triggers for disruptive behavior.

---

Bonnie Harris, M.S.Ed,. is the director of Connective Parenting. Past columns can be found on her Web site, http://www.connectiveparenting.com. E-mail questions or topic requests to bh@bonnieharris.com.

Mentally retarded child beaten up by an angry caregiver at Denton State School in Texas

From a much longer article in the Houston Press

Every day she comes here to be with him — to wash his wiry hair and clip his yellowed nails and rub his calloused feet. The boy has no control over his body. His head rolls from side to side, his eyes dart from one thing to another and drool pools out of his mouth. His name is Haseeb, and he is 34.

He wasn't always like this. For most of his life, he has been profoundly mentally retarded, but there was a time when he could sing and dance and communicate with his mother, in broken English and Urdu. There was a time when he ate cheeseburgers with his family and bopped his head to his brother's hip-hop.

And then something happened.

Six years ago, not far from where Chishty sits, a nurse's aide found Haseeb in bed, soaking in his own blood and urine. No one at the school could explain what happened. For six months he lay in intensive care, suffering from massive internal injuries that triggered toxic shock and then paralysis. His mother insisted someone at the school was to blame — she had seen a bruise in the shape of a footprint near his groin on the morning they found him. But no one had reported any abuse, so her claims went ignored.

For two and a half years, she told this story to anyone who would listen, and then the unexpected happened. Kevin Miller, a former caregiver at the school, admitted he had abused Haseeb in a drug-induced rage, punching and kicking him more than a dozen times. He said his supervisors knew about the attack and helped him cover it up. Even more alarming, he said abuse at the school was rampant. He knew his confession, which he first offered at a drug rehab clinic in Houston, might send him to prison, but he felt it was worth the risk if it sparked reforms.

More than three years have passed since then, and none of the changes Miller envisioned have taken place. Yet largely thanks to Chishty's efforts, her son has become the face of a movement. For the first time in nearly a decade, advocacy groups for the mentally retarded are pushing for the closure of the 13 state schools in Texas. These facilities, which house nearly 5,000 people, represent the largest institutionalization of mentally retarded in the nation. The alternatives — smaller, community-based group homes — are cheaper, safer and more humane, mental health rights advocates say. The trend across the country is toward this model of care, and other states, including California and New York, have either shuttered their institutions or are in the process of doing so.

Jeff Garrison-Tate, who heads Community Now, an Austin-based advocacy group, cites the Chishty tragedy as a defining example of why Texas should close all its state schools. "Haseeb is the tip of the iceberg," he says. "By their very nature, these are places where abuse is rife to occur."

Psychiatrist Regrets Becoming A Whistle-Blower

A report from the Sunday Mercury; Birmingham (UK)

A doctor turned NHS whistleblower has revealed her regret at going public with claims of patient abuse at Midland hospitals.

Psychiatrist Rita Pal, from Sutton Coldfield, says her career was 'assassinated' after she made allegations that seriously ill elderly patients were being helped to die by NHS staff.

Dr Pal, 36, presented a dossier of evidence to the General Medical Council but it questioned her sanity - and discussed launching an inquiry into whether she was Wt to practise.

She was later awarded a lucrative settlement against the regulatory body and is still pursuing legal action against it.

Yet Dr Pal has now been banned from practising medicine after the GMC ruled she is no longer registered as a medical practitioner 'for administrative reasons'.

The psychiatrist says she regrets ever speaking out.

"Whistleblowing doesn't work," she told the Sunday Mercury.

"It has cost me an awful lot, my career is assassinated but that's the price I paid.

"It is a long and lonely road, and in the end, I'm left wondering if it was worth it."

Dr Pal said she was first branded a troublemaker soon after beginning her career.

"Fresh out of medical school in 1998, I started work at North Staffordshire Hospital as a house officer continuing my training," Dr Pal recalled.

"It was very intense, with 120-hour weeks, but I had no problems for the first three months.

"Then I was moved to a ward for elderly and emergency patients. I faced an emergency with a patient and there wasn't the basic equipment there.

"I was able to stabilise the patient but phoned the nursing director to say more staff and more equipment was needed as basic care wasn't been met.

"This didn't go down well.

"Other doctors had suffered with poor facilities but no-one ever raised concerns. Patients kept dying and no-one was doing anything."

Dr Pal's outspoken concerns brought her further anxiety.

"I then found myself in a complete nightmare," she said.

"Two weeks later I was accused of disposing of a needle on a day when I wasn't even on the ward. It's a criminal offence under health and safety to dispose of a needle.

"I faced a hearing where I represented myself, and the chargeswere dropped. But I'd already got a name for myself as a 'trouble-maker'.

"The pressure on me to leave was awful and I was advised to move into general practice.

"I moved to Birmingham to do surgery but I had no references and 'whistleblowing' follows you around.

"In 2000, I contacted a newspaper about the elderly patients who were being neglected and worse, being given drugs that hasten death.

"I thought if I raised concerns about healthcare, conditions would at least improve.

"I've had 10 years of fighting for accountability - I feel let down by the NHS.

12 Babies die during GlaxoSmithKline vaccine trials in Argentina

GlaxoSmithKline has long gotten into trouble for drugs (including psych drugs) that have had achieved notoriety for a variety of destructive side effects. Thus this most recent report does not come as a surprise, and is sadly revealing of the broader morals of the company

At least 12 babies who were part of a clinical study to test the effectiveness of a vaccine against pneumonia have died over the past year in Argentina, the local press reported Thursday.

The study was sponsored by global drug giant GlaxoSmithKline and uses children from poor families, who are "pressured and forced into signing consent forms," the Argentine Federation of Health Professionals, or Fesprosa, said.

"This occurs without any type of state control" and "does not comply with minimum ethical requirements," Fesprosa said.

The vaccine trial is still ongoing despite the denunciations, and those in charge of the study were cited by the Critica newspaper as saying that the procedures are being carried out in a lawful manner.

Colombian and Panama were also chosen by GSK as staging grounds for trials of the vaccine against the pneumococcal bacteria.

Since 2007, 15,000 children under the age of one from the Argentine provinces of Mendoza, San Juan and Santiago del Estero have been included in the research protocol, a statement of what the study is trying to achieve.

"Only 12 have died throughout the country, which is a very low figure if we compare it with the deaths produced by respiratory illnesses caused by the pneumococcal bacteria," pediatrician Enrique Smith, one of the lead investigators, said.

In Santiago del Estero, one of the country's poorest provinces, the trials were authorized when Enrique's brother, Juan Carlos Smith, was provincial health minister.

According to pediatrician Ana Maria Marchese, who works at the children's hospital in the provincial capital where the studies are being conducted, "because they can't experiment in Europe or the United States, they come to do it in third-world countries."

"A lot of people want to leave the protocol but aren't allowed; they force them to continue under the threat that if they leave they won't receive any other vaccine," said Julieta Ovejero, great aunt of one of the six babies who died in Santiago del Estero.

Fesprosa's Juan Carlos Palomares said that "in most cases these are underprivileged individuals, many of them unable to read or write, who are pressured into including their children" in the trials.

According to Fesprosa, "the laboratory pays $8,000 for each child included in the study, but none (of that money) remains in the province that lends the public facilities and the health personnel for the private research."

Prozac Nation No More?

Newsweek has a feel good interview with a psychiatrist who is against the use of Prozac.

In a new book, psychiatrist James Gordon explains why he believes there's a more effective and drug-free way to treat depression and anxiety. James Gordon, founder of the Center for Mind-Body Medicine in Washington, D.C., says there's a better way to treat depression—through diet, exercise and meditation. Roll your eyes all you like. He's used the approach for 35 years with a wide range of patients, from runaway children and middle-class adults in Washington, D.C., to victims of war in Bosnia, Kosovo, Israel and the Gaza Strip.

We remain skeptical about psychiatry in general. But we are pleased that someone did not fall for the marketing madness

Teaching kids to study works better than Ritalin

As seen in the Mercury News. Here's the essential tidbit:

"12-year-old Ryan was having trouble paying attention to the home-school tasks his mother, Cindy Withers of San Jose, set for him. Determined to avoid drugs such as Ritalin, Withers opted for brain-training instead.

At his psychologist's office, Ryan's treatment included specialized video games that responded to his brain waves. By remaining focused, the boy was able to propel digital spaceships or race cars. His mother says the therapy gave him a "can-do" attitude and improved his school work."

As noted elsewhere:

So here's the AMAZING CONCLUSION: Turns out that teaching your kids to pay attention works better than drugging them into submission. Amazing!

What's Wrong With Research In Psychiatry?

The Last Psychiatrist weblog has a decent article on what's wrong with research in psychiatry. Here are some choice bits, with more at the link:

Apart from the high fives, bravado, and binge alcoholism.

Dynastic:

There are no independent psychiatric researchers. Young academics are mentored by older academics; this isn't optional, for either person. In virtually no circumstance do they study something entirely of their own choosing, it is either an outgrowth of the mentors' research, or is the mentors' research.

Groupthink:

Academic psychiatrists are nearly all on the same page, and refer to one another as if they have a relationship, even when they've never met. ("Chuck Nemeroff is doing some good work on...") It's pointless to list the other characteristics of groupthink here, except to highlight one:

the purpose of groupthink is not to promote an ideology, but self-preservation, and this is unconscious. They don't realize that their lives are devoted to preserving the group, yet young researchers are brought on who connect with the group; peer reviewers-- and journal editors-- come from the group; grant reviewers, and NIMH people themselves came from, and support the group.

An example of groupthink preservation is the referencing of studies. Academics support their propositions with previous studies; however, no one checks the accuracy of these studies. No one has the time, and the group necessarily must trust the work of others in the group. Even if an error were to be found, it would be described as an isolated error. A cursory stroll through this site alone suggests just how "isolated" such errors really are.

Outcomes Research Is Purposefully Avoided, or Ignored:

You might think in a field with nothing but outcome studies (e.g. Prozac vs. placebo) I might not be able to make this claim, but I do.

Most studies are short term. The few long term studies that exist (e.g. Depakote for maintenance) are either equivocal (e.g. Depakote for maintenance) or show no efficacy (e.g. Depakote for maintenance.) And they are ignored.

But these outcomes are distractions. The question isn't is Depakote good for maintenance bipolar. The question is, is there any value to the diagnosis of bipolar? In other words, if you called it anxiety, or personality disorder, or anything else, and then treated them ad lib, would the outcome be different? Is there value to the DSM?

You might argue the diagnosis leads us to the treatment, but in most cases, meds are used across all diagnoses, and more often than not a diagnosis is created to justify the medication.

Are hospitals valuable? You would think that by now we'd have a clear answer to this, the most expensive of maneuvers. I can say, however, that reducing the length of stay from several months to 5-7 days has not affected the suicide rate. I'm not saying they are or are not valuable, I am saying that I don't know-- and that's the problem.

It is 2008 and there are more studies on restless leg syndrome then there are on hospital vs. placebo. You know why? See above.

A damning, valuable article

Psychiatric Drugs are the New Opiate of the Masses.

We stumbled across an interesting post on the Intellectual Conservative political blog, entitled The Hard Truth about a Soft Science: Why Psychology Does More Harm Than Good, starting off with this sentence

If you convince people they’re not responsible for their actions, you’ve set the stage for great evil to occur, as they will be able to justify anything suiting their fancy.

It makes a number of interesting points. While we are not taking sides in terms of politics here, a lot of the observations are spot on, especially as they get to the conclusion of the article.

Yet the implications of this collective sense that we aren’t responsible for our actions and that they can’t be “wrong” anyway go far beyond the resulting social breakdown. They even go beyond the governmental response, which is to step in and control from without people who do not control themselves from within. For the truly scary implication under such a scenario is not just that people will not govern their impulses, but that they cannot do so.

After all, if we are merely organic robots, at the mercy of our genes (hardware), chemistry and upbringing (software), we have no free will. It then follows that we cannot choose among, well, call them what you will, God’s morals or man’s values, as we are directed by things beyond our control. This reduces us to animals. While Christianity teaches that the two things making us like God and separating us from the animal kingdom are intellect and free will – two qualities necessary to be fully human – this idea tells us that, bereft of the second quality, we are mere automatons.

Of course, if Freud et al. are correct, that is all we are, chemicals and water arranged in a most interesting fashion – with a good helping of illusion thrown in for good measure. Thus, insofar as psychology succeeds in convincing us that there is no accountability because there is no free will – no ability to choose sin because there is no sin, only disease – it dehumanizes us.

Perhaps this dehumanization is why psychiatry has quite a history of using humans as guinea pigs. There was Benjamin Rush (the father of American psychiatry) and his bloodletting; Nazi experiments; electric shock and lobotomies; our MK ULTRA mind-control program; and Canadian psychiatrist Heinz Lehmann, who illegally used Thorazine on subjects in the 1950s.

Etc.

Yet another in a number of articles showing the decline of psychiatry.

One last quote:

As to this, I recently read about psychiatrists who are labeling the desire to engage in excessive text messaging a mental disorder. Then there is “Muscle Dysmorphia,” or the obsessive belief that one isn’t muscular enough; “celebriphilia,” the strong desire for amorous relations with a celebrity; “Intermittent Explosive Disorder,” or road rage; “Sibling Rivalry Disorder;” “Mathematics Disorder;” “Caffeine Related Disorder;” and “Expressive Writing disorder,” to cite just a handful of the hundreds of made-up conditions in the DSM. And every time a new variety is conjured up, psychology’s market and earning potential increases. I have to wonder, though, what do they call the obsession with labeling behaviors mental disorders? Some might call it greed.

Yet, as ridiculous as this seems, it’s also very consistent and understandable. Whether a religionist or atheist, one can’t help but notice that these organic robots don’t operate the way most of us would like. The Christian explanation for this is that we’re all sinners, but this is religious terminology and quite inappropriate for a machine. So psychology says we’re all mentally ill; it’s just a malfunction in the CPU, you see. Then, because a machine cannot commit sins but can be “out of order,” it calls them disorders. Thus, a defiant child or employee isn’t ruled by pride but has “Oppositional Disorder,” a person with a lack of gratitude isn’t just that but one who suffers from “Chronic Complaint Disorder,” and a man who is shallow and vain isn’t just that but one plagued by “Muscle Dysmorphia.” So there is a limit to the number of disorders that can be “invented,” and it’s roughly equivalent to the numbers of ways in which people can sin.

This brings us to an irony. In a strange way, this “study of the soul” is aptly named, as in a great measure psychology has usurped the role of religion. It co-opts sins, renames them, and then takes credit for their discovery; you could call it spiritual plagiarism.

I also might say that mental health professionals have become the new priesthood. After all, whereas years ago people might have gone to a man of the cloth for guidance, now they are likely to lie on a therapist’s couch. The prescriptions they get are far different, too. A priest, minister or rabbi would usually render advice steeped in tradition and God-centered, but the psychologist is most likely to offer relativistic counsel, where the focus is on feelings and is thus self-centered.

And what happens when the matter of religion is raised? If you’re like many, including someone I know of, you may be told you’re taking your faith too seriously, that such devotion is akin to a mental illness. This isn’t surprising, I suppose. What future could a person have with an “illusion,” even the very attractive one that Freud seemed to believe was the opiate of the masses?

Yet, with over 20 million Americans, 40 percent of college students and 1 out of 9 schoolchildren on psychiatrist-prescribed psychoactive drugs, one is left to wonder what realm is truly most deserving of that title.

Ahhh yes, Psychiatric Drugs are the New Opiate of the Masses.

The Decline of Psychiatry, Part 4

While people are in shock and horror at the decline of psychiatric services, this is all part of a larger picture where

• the psychs that do exist are moving to big cities where they can charge more and make more money
• Battered over the years, there are less people going into psychiatry as a profession.
• As soon as the organic disease process is identified, the claim of psychiatry is largely undermined and it passes instead to neurology or another specialty.

Of course, there have also been problems of compassion within the mental health industry as well, as evidenced by profiteering, etc.

From the Nanaimo Daily News

There may some logic, based on crunching numbers and bureaucratic mumbo jumbo, in the decision by the Vancouver Island Health Authority to close the psychiatric unit at West Coast General Hospital in Port Alberni, but the closure makes no sense.

VIHA said they had to shut the unit for as long as a year because they cannot find a replacement for a departing psychiatrist. It's hard to believe that VIHA has allowed itself to end up in this position.

In fact, Alberni-Qualicum MLA Scott Fraser is right when he says, "It's not acceptable . . . . It's not an option. You cannot shut down essential services."

To add to Fraser's incredulity, closing a mental health ward approaches irresponsible if not outright negligent.

VIHA might argue they have no control over the comings and goings of doctors, but it's pretty hard to believe that they did not or could not foresee this long enough ago to take appropriate action.

Either way, the fact that they could not negotiate to have the current psychiatrist remain until a replacement could be found, or that they were caught by surprise, indicates something is wrong within VIHA.

What this also seems to indicate is that the health authority has little regard for those in need of mental health care.

Imagine if VIHA allowed the same state of affairs to happen at an emergency ward. The province would have to step in, replacing the VIHA board of directors -- who may also be personally liable for any tragedy -- and take steps to make sure that mandated level of emergency care is in place.

It is pretty shocking when one considers how the VIHA brass in Victoria seem to think about the mentally ill. The need for a psychiatrist in any community has to be seen as crucial as an emergency ward.

What the health authority seems to be saying is that someone in Port Alberni, or anywhere in the VIHA jurisdiction for that matter, who arrives at a hospital with a psychiatric crisis counts less than someone with a broken arm.

Sure, an untreated broken arm can lead to gangrene and death. But untreated mental distress can lead to suicide. And just as time is crucial in treating a medical emergency, so it is with a person in crisis from a mental disorder. Leaving such a person without necessary help will lead to escalating behaviour which can be violent or self destructive.

One agency that will not be very happy with state of affairs will be the RCMP. They are the ones who will have to cope with violent or suicidal people until appropriate help can be found. What do the RCMP do? Drive them to Nanaimo Regional General Hospital? Keep them in jail and let the courts sort it out?

VIHA's plan is that mental health and addictions community office in Port Alberni will handle psychiatric patients. The folks in that office must be just thrilled that their bosses in Victoria, who appear to have no insight into the needs of a person in mental distress, have delegated them as the ad hoc psych unit for the city.

The other plan is that a community response team will also intervene for people in need of psychiatric care. One problem though is that the team has not been established.

It's rather puzzling that VIHA appears to be able to put together this idea of a community response team, but can't seem to hire a psychiatrist.

Since its inception in 2002 VIHA has failed to serve any community on the Island adequately. Hospitals have become dirtier and less efficient, staff are overworked like never before, health facilities are increasingly crowded and this episode in Port Alberni is evidence of gross mismanagement.

The one place to start for a solution is for the VIHA board to censure Howard Waldner and his management team. And given that the board is ultimately liable, it seems they need to send a message that this state of affairs cannot go on.