Mental Health Leaders to Discuss Use of Psychiatric Medication
Bob Whitaker calls mental illness a hidden epidemic and questions why the number of people diagnosed has tripled in the past 20 years
Whitaker will discuss his book with a panel of mental health advocates and providers, including Becki Child, director of Mental Health America of Oregon, Chris Gordon an assistant professor of psychiatry at Harvard Medical School, Will Hall, a Portland-based mental health therapist, and Gina Nikkel, director of the Oregon Association of Community Mental Health Programs.
Whitaker’s book calls into question why the number of people with mental illness has more than tripled in the past 20 years. “The epidemic has grown in size and scope over the past five decades, and now disables 850 adults and 250 children every day,” he writes, referring to mental illness as a “hidden epidemic.”
Doing a literature review of multiple studies investigating the effectiveness of psychiatric drugs, Whitaker finds that psychiatric drugs have little long-term benefit. The result, he writes, is that people are kept on psychiatric drugs for as long as the rest of their lives, are on disability because they are unable to work.
“That’s extraordinarily expensive,” Whitaker said in an interview with The Lund Report. “The truth of the matter is that we can't afford the current system. We need a system that really helps people achieve robust recovery. That will be cheaper in the long term.”
Whitaker’s book has already received a warm reception from people involved with mental healthcare in Oregon. “I can’t read a book like this, put it down, and not do anything,” said Nikkel.
Following the panel discussion will be a two-day conference to discuss how psychiatric medication is used, and how it can be improved.
There are alternatives. Child and Whitaker are proponents of “medication optimization,” which manages how medications are dispensed, when they are used, and for how long. Providing wrap-around services and services that consider all of a person’s needs can effectively treat mental illness, Nikkel said.
Whitaker advocates for an evidence-based model focused on long-term outcomes, “and looks at function outcomes,” he said, that include employment rates among people with mental illness, whether they are living at home, are socially engaged and in good physical health.
Child and Whitaker are supporters of the Open Dialog Project, a mental health treatment program in western Finland that de-emphasizes medication, helps people immediately after their first psychotic break, and develops a treatment plan within 24 hours. According a study evaluating effects of the program after five years, 83% of patients returned to their jobs and not on disability. Child called those outcomes “unbelievable.”
Whitaker is pessimistic the mental healthcare system will change rapidly any time soon because of the influence of drug companies as lobbying powers. “That’s a powerful force,” he said.
A medical-based model has been used to treat mental illness since the 1950s, when Thorazine, the first antipsychotic medication that noticeably resolved patients’ psychotic symptoms, was introduced.
The heavy use of medication have lead to a “broken brain” theory that mental illnesses are the result of chemical imbalances in a person’s brain, which can be properly treated by medication.
“That’s led to a lot of stigmatization,” Whitaker said, because it leads one to think that there’s something “wrong” with the mentally ill person.
“People don’t have hope,” said Child. “People are being told that they have to stop working, that they have to give up their hopes and dreams. It doesn’t help them get better. There’s a lot human capital that is being wasted.”
Nikkel said the current system is too expensive, doesn’t place people in the appropriate care settings to get the treatment they need, and makes them more susceptible to entering the criminal justice system. “The real tragedy is that a lot of this can be prevented.”
The panel discussion featuring Bob Whitaker takes place on Thursday, February 10, at the First Unitarian Church, 1011 SW 12th Ave. Portland, OR., 5-9pm, the panel discussion starts at 7pm.
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It concerns me that mental health education and training--especially in nursing and medical schools--is far less than it was in the past. Mental health seems to be integrated in other areas of education, but often that means that it gets left out, or at least its not treated as a primary educational need.
Your article quotes:
Whitaker’s book calls into question why the number of people with mental illness has more than tripled in the past 20 years. “The epidemic has grown in size and scope over the past five decades, and now disables 850 adults and 250 children every day,” he writes, referring to mental illness as a “hidden epidemic
Granted ONE adult or child is too many, but this quote doesn't seem possible; to which adults is he referring? 850 NEW adults and 250 NEW children per day? Or adults and children on any given day in Oregon? Iowa?
Certainly not "on any given day in the US" .esp not in light of epidemic proportions he references.
I believe Whitaker is referring to Social Security Administration records, for SSI and SSD.
One note. I never write in Anatomy of an Epidemic that people on government disability due to a mental disorder lead "meaningless" lives. I may quote studies that tell of people diagnosed with severe disorders becoming socially isolated over time, but I am simply reporting on what researchers have found. Personally, I know many people on SSI or SSDI due to a psychiatric disorder who lead quite meaningful lives. But clearly, we do need to rethink our current paradigm of care, given the explosion in the number of people receiving a government disability check due to mental illness. We need to have a system that helps people return to work and thrive in their lives.
Robert Whitaker
Real reform in the mental health industry will only come with a change in paradigm. Unfortunately, there are a lot of folks who are heavily invested, both emotionally and financially, in the current way of doing business. The evidence is clear (read Whitaker's book if you doubt that), but the political will to take on those who are profiting by the current system needs to be developed. We spend more on healthcare than any nation in the world per capita, and yet have some of the worst health outcomes in the industrialized world. This is one more example of why: we do what is convenient and profitable in the short run, rather than what science has proven to truly benefit people in the long term.
Steve McCrea, MS
Thank you for this article.
The public is heartily encouraged to come to the February 10 forum. Here are the details.
RETHINKING PSYCHIATRY: MOVING MENTAL HEALTH RECOVERY FORWARD --A community forum
Thursday, February 10, 2011
The First Unitarian Church of Portland
1011 SW 12th, Portland OR
Reception
5:00pm-6:45pm
Keynote speaker Robert Whitaker and panel
7:00pm-9:00pm
Robert Whitaker, author of "Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America" and a panel of mental health providers and peers will share their perspectives and plans to create a more compassionate mental health system in Oregon and across the nation.
$5-$20 donation requested. No one turned away for lack of funds. Two CEUs available. Child care available.
For more information call 503-665-3957 or www.realwealthpdx.org/rethinkingpsychiatry.
###
PANEL
Beckie Child, Director of the Mental Health America of Oregon
Cindi Fisher, Movement of Mothers Standing - Up -Together: Taking Back Our Children ( The M.O.M.S. Movement )
Chris Gordon, Assistant professor of Psychiatry at Harvard Medical School , Medical Director of Mental Health Advocacy.
Will Hall, Portland therapist and national leader in "peer recovery"
Gina Nikkel, Director of the Oregon Association of Community Mental Health Programs.For more information go to:
www.realwealthpdx.org/rethinkingpsychiatry
With the advent of mediation treatment came the 15 minute psychiatric assessment of the client prior to prescribing meds, which replaced hours of therapy. The most effective treatment involves a good "fit" between client and therapist which increases the effectiveness of therapy to reduce symptoms and allow the client to be more productive in society.
“That's led to a lot of stigmatization,” Whitaker said, because it leads one to think that there's something “wrong” with the mentally ill person.
First, of course, something is wrong with an ill person. Who could argue against that?
How does the first term apply? In an educated society, I can appreciate it as a 19th century reference, but not as a 21st century one. Especially after the women's movement: It refuted the association of that term with women who had survived assault, and World War II which showed us the extremes to which such a claim carried far too many minds.
So you argue I carry a stigma, not you cooperate in pretending one? It is a fun word to direct, behind it is truth: vile prejudice masked by a Greek (classic) rooted word. It is your cooperation I fear.
Harold A. Maio, retired Mental Health Editor
khmaio@earthlink.net
Here is a point where I wish I had read the book. From what I understand the book to be saying, I disagree with a lot of it. But I also disagree with you.
"First, of course, something is wrong with an ill person. Who could argue against that?"
I would argue against that. This idea that there is something fundamentally wrong with someone as a human being is the most belittling, derogatory, hateful, and harmful attitudes one could possibly take. Not to mention the fact that it is false. There is nothing wrong with the way people with mental illnesses see things, they are just drawing different conclusions based on different reference points. (See my article here: [http://open.salon.com/blog/nathan_foster/2009/02/15/how_the_schizophrenic_mind_works]). If we all had the same reference points as those with mental illnesses, we would all draw the same conclusions. Therefore, there is nothing "wrong" with someone who has a mental illness.
I find it troublesome that someone who takes this view could possibly rise to a position of prominence in the mental health arena. The view you're espousing is discrimination pure and simple, no better than Hitler's antisemitism. The view you hold is precisely the view we need to get rid of in the mental health system. There is nothing more anxiety- / paranoia-producing than trying to talk reason to somebody (e.g. a psychiatrist) who you know will never seriously consider what you have to say because they've already made the judgment that you're "insane" or "mentally ill" and obviously have a fundamentally lower status than everybody else.
People have the right to be insane, because insanity is nothing but the sane expression of a warped mental situation. Society needs to catch up to us. We don't need to cow tow to society.
Nathan Foster
Diagnosed Paranoid Schizophrenic
I heartily agree with Whitaker and Child. The question facing Oregon is what steps the new governor intend to take to address not just the acute care issues that have become more ineffective and more costly?