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The New Freedom Commission on Mental Health was established by U.S. President George W. Bush through Executive Order 13263 on April 29, 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings. [1] The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.
The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. [2] The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.[ citation needed ]
A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission's findings as a launching point for recommending widespread reform of the nation's mental health system.[ citation needed ]
A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed 'atypical antipsychotic drugs', such as Seroquel, Zyprexa, and others, [3] for a wide variety of non-psychotic behavior issues. These drugs were later found to cause increased rates of sudden death in patients.
In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. [4] Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. [5] In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people. [6]
Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative's wider objectives are to foster chemical behavior control of American citizens, contrary to civil liberties and to basic human rights.
The commission issued an interim report on November 1, 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care. [7]
On July 22, 2003, the President's commission returned a report containing nineteen formal recommendations, organized under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centered care, and recommendations that states develop a more comprehensive approach to mental health.[ citation needed ]
The commission reported that "despite their prevalence, mental disorders often go undiagnosed," so it recommended comprehensive mental health screening for "consumers of all ages," including preschool children, because "each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders." [8]
In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening program for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.[ citation needed ]
Noting the country's services for people with mental illness and disabilities were "fragmented," the commission's final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:
Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry's use of front organizations [10] and the compromise of scientific integrity under color of authority, [11] look askance at the irony of the commission's 'freedom' descriptor, contending the commission is yet another example of the excesses of drug industry marketing, [12] [13] and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.
Mad in America author Robert Whitaker criticized the commission's screening recommendations as "fishing for customers." [14] A coalition of over 100 advocacy organizations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of longtime member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. "He needs a lot of help. I'll see him for free," said Adams. [15]
Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission's suggestion to use schools as a site for screening. [16] Paul's concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on January 4, 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. [17] Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); [18] those, likewise, died in committee. [19] [20] [21]
Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.
TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public's attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.
Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the "political/pharmaceutical alliance." [22] It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab."
Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis, principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder.
Anti-psychiatry, sometimes spelled antipsychiatry without the hyphen, is a movement based on the view that psychiatric treatment is often more damaging than helpful to patients, highlighting controversies about psychiatry. Objections include the reliability of psychiatric diagnosis, the questionable effectiveness and harm associated with psychiatric medications, the failure of psychiatry to demonstrate any disease treatment mechanism for psychiatric medication effects, and legal concerns about equal human rights and civil freedom being nullified by the presence of diagnosis. Historical critiques of psychiatry came to light after focus on the extreme harms associated with electroconvulsive therapy or insulin shock therapy. The term "anti-psychiatry" is in dispute and often used to dismiss all critics of psychiatry, many of whom agree that a specialized role of helper for people in emotional distress may at times be appropriate, and allow for individual choice around treatment decisions.
The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 38,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders.
Fluphenazine, sold under the brand name Prolixin among others, is a high-potency typical antipsychotic medication. It is used in the treatment of chronic psychoses such as schizophrenia, and appears to be about equal in effectiveness to low-potency antipsychotics like chlorpromazine. It is given by mouth, injection into a muscle, or just under the skin. There is also a long acting injectable version that may last for up to four weeks. Fluphenazine decanoate, the depot injection form of fluphenazine, should not be used by people with severe depression.
Edwin Fuller Torrey, is an American psychiatrist and schizophrenia researcher. He is associate director of research at the Stanley Medical Research Institute (SMRI) and founder of the Treatment Advocacy Center (TAC), a nonprofit organization whose principal activity is promoting the passage and implementation of outpatient commitment laws and civil commitment laws and standards in individual states that allow people diagnosed with severe mental illness to be involuntarily hospitalized and treated throughout the United States.
Encephalopathy means any disorder or disease of the brain, especially chronic degenerative conditions. In modern usage, encephalopathy does not refer to a single disease, but rather to a syndrome of overall brain dysfunction; this syndrome has many possible organic and inorganic causes.
The Texas Medication Algorithm Project (TMAP) is a decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of psychiatric management guidelines for doctors treating certain mental disorders within Texas' publicly funded mental health care system, along with manuals relating to each of them. The algorithms commence after diagnosis and cover pharmacological treatment.
The TeenScreen National Center for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents. On November 15, 2012, according to its website, the program was terminated. The organization operated as a center in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City. The program was developed at Columbia University in 1999, and launched nationally in 2003. Screening was voluntary and offered through doctors' offices, schools, clinics, juvenile justice facilities, and other youth-serving organizations and settings. As of August 2011, the program had more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.
The Mental Health Act 1983 is an Act of the Parliament of the United Kingdom. It covers the reception, care and treatment of mentally disordered people, the management of their property and other related matters, forming part of the mental health law for the people in England and Wales. In particular, it provides the legislation by which people diagnosed with a mental disorder can be detained in a hospital or police custody and have their disorder assessed or treated against their wishes, informally known as "sectioning". Its use is reviewed and regulated by the Care Quality Commission. The Act was significantly amended by the Mental Health Act 2007. A white paper proposing changes to the act was published in 2021 following an independent review of the act by Simon Wessely.
A growing body of research has begun to highlight differences in the way racial and ethnic groups respond to psychiatric medication.
In applied psychology, interventions are actions performed to bring about change in people. A wide range of intervention strategies exist and they are directed towards various types of issues. Most generally, it means any activities used to modify behavior, emotional state, or feelings. Psychological interventions have many different applications and the most common use is for the treatment of mental disorders, most commonly using psychotherapy. The ultimate goal behind these interventions is not only to alleviate symptoms but also to target the root cause of mental disorders.
People with schizophrenia are at a higher than average risk of physical ill health, and earlier death than the general population. The fatal conditions include cardiovascular, respiratory and metabolic disorders.
A chemical restraint is a form of medical restraint in which a drug is used to restrict the freedom or movement of a patient or in some cases to sedate the patient. Chemical restraint is used in emergency, acute, and psychiatric settings to perform surgery or to reduce agitation, aggression or violent behaviours; it may also be used to control or punish unruly behaviours. Chemical restraint is also referred to as a "Psychopharmacologic Agent", "Psychotropic Drug" or "Therapeutic Restraints" in certain legal writing.
Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America is a book by Robert Whitaker published in 2010 by Crown. Whitaker asks why the number of Americans who receive government disability for mental illness approximately doubled since 1987.
Psychiatric pharmacy, also known as mental health pharmacy, is the area of clinical pharmacy specializing in the treatment of people with psychiatric illnesses through the use of psychotropic medications. It is a branch of neuropsychiatric pharmacy, which includes neurologic pharmacy. Areas where psychiatric pharmacists are found most abundantly are in chemical dependency, developmental disabilities, long-term care facilities, adherence clinics, mental health clinics, and within the prison system. However, psychiatry and neurology are not the only areas where psychiatric pharmacists require comprehensive knowledge. They must also be proficient in clinical problem solving, interprofessionalism, and communication with understanding and empathy for the patient population they serve, as they are a sensitive group.
Doctoring the Mind: Why psychiatric treatments fail is a 2009 book by Richard Bentall, his thesis is critical of contemporary Western psychiatry. Bentall, a professor of clinical psychology, argues that recent scientific research shows that the medical approach to mental illness is fatally flawed. According to Bentall, it seems there is no "evidence that psychiatry has made a positive impact on human welfare" and "patients are doing no better today than they did a hundred years ago".
Covert medication, the covert administration of medicines is when medicines are administered in a disguised form, usually in food or drink, without the knowledge or consent of the individual receiving the drug. The decision-making processes surrounding covert medication should be in the best interests of the patient, transparent and inclusive.
Psychiatry is, and has historically been, viewed as controversial by those under its care, as well as sociologists and psychiatrists themselves. There are a variety of reasons cited for this controversy, including the subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.
A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).
Shubulade Smith is a British academic and consultant psychiatrist at the South London and Maudsley NHS Foundation Trust (SLaM). She is a senior lecturer at King's College, London and Clinical Director at the NCCMH and forensic services at SLaM, and is currently serving as the first black President of the Royal College of Psychiatrists.