Presentation to the British Columbia Legislature’s
Select Standing Committee on Children and Youth
by Rev. Dr. Steven Epperson on June 24, 2015
I appreciate the opportunity to speak to the committee. I share your concerns about the mental health challenges facing children and youth in BC and our duty to respond thoughtfully and effectively.
I am here in two capacities: first, I am a parent. I am also here as a front-line professional. In my capacity as a member of the clergy and minister to a large Vancouver congregation, I’m called to respond to individuals and families suffering emotional and mental distress. I have made scores of visits to emergency rooms, psychiatric assessment units and in-patient wards at UBC, VGH, St Paul’s, St Joseph’s, Surrey Memorial, and Riverview, as well as to community mental health offices and half-way houses. I have preached about our mental health crisis, held numerous private office consultations with individuals and families dealing with mental health crises, and helped to organize support groups and public education presentations and seminars on mental health issues.
From years of personal and professional experience, I must tell you my biggest fear is that we’re massively misunderstanding the emotional and mental suffering of children and teens. We’ve taken their feelings, thoughts and suffering and transformed them into symptoms, diagnoses, reductive theories and then prescribing them an array of psychiatric drugs with dire short- and long-term consequences. We’re drugging their emotions, their thinking and their quest for meaning into disabling silence. When a child or teen is sad, we say that they’re depressed. When they’re elated or in a rage, we say they’re manic. When a child has a lot of energy and can’t sit still in a regimented classroom setting, we say he’s got ADHD. When they’re frightened, we say they’re anxious. When a young person is distressed about the world and their future in it and they may come up with unusual beliefs and behaviors, we say they’re psychotic. We’ve stopped listening to the powerful communications that children and youth are offering us and say instead, she’s bipolar, depressed, anxious, or psychotic, and in a panic we say they’ve got to be fixed with drugs.
When a child’s or teen’s emotions are very intense there’s usually a compelling reason for it: abuse, or bullying, or a struggle to cope in a developmentally difficult or inappropriate environment; or maybe it’s just the normal, the difficult human task of trying to forge a viable path into the future of the project we call life. I fear we’re not looking enough at the root causes of suffering that can arise from the loss of extended family support, or of divorce, poverty, the pressure of constant assessment and testing in schools, and parents’ confusion about the question of discipline. We’re not looking enough at the hyperactivity of family life, children’s diets, their consumption of media, and the titanic pressures of a highly competitive, monetized culture placed upon them by adults and peers. And we’re not sufficiently taking into account the reduction of unsupervised play and contact with nature.
Dr Allen Frances, the past President of the American Psychiatric Association, stated recently: “The healthcare industry, from psychiatrists to family doctors, has gone down the wrong path turning childhood itself into a disease.” Tamara Pringsheim, a neurologist at the University of Calgary, recently completed the only Canada-wide study on the prescription of anti-psychotic drugs to children which reported that there was a 114% increase in prescriptions between 2005-9. She said this about the findings of her report: “Pills can be seen as a quick and easy solution in a crisis…but in the end they merely mask the underlying problem. I’m always telling parents not to pathologize their children’s behaviour; that a lot of this is normal development…[but, she said, it’s] our tolerance for problem behaviour that has dropped dramatically.” (Geoff, Leo, “Have we turned childhood into a disease?” CBC News, June 10, 2014)
Here, I have the first of two personal stories to share:
Every year, the second grade teacher in our local public school sent notes home the first week of school to parents of the more rambunctious boys in her class telling them that their boys had ADHD and to please take them to their pediatricians for a prescription of Ritalin. Our eldest son received one of these notes and we took him to his doctor. That pediatrician then gave us a piece of his mind: “If you’re looking for someone to drug a perfectly healthy little boy into sitting still behind a desk for his second grade teacher, you go find yourselves another pediatrician.”
That energetic son turned into a dynamic young man who grew to full height and managed to channel his energy into a successful legal career; and he is a wonderful father. The other little boys who received the same note were not so lucky. They had outcomes described in the literature about the long-term effects of years of stimulants on developing children’s bodies and minds: stunted growth, mood disregulation, and behavioural problems. One of those boys started selling his Ritalin on the playground by sixth grade and later went on to sell street drugs.
This may be the only time I have the opportunity to speak directly to policy makers on this issue, and I especially feel a sense of deep urgency to speak with you about the psychiatric drugging of children and youth. For the past thirty years, the overwhelming, first-line response by GPs and mental health professionals to children and youth experiencing emotional and mental distress is a diagnosis that they are suffering from an underlying brain disorder. In spite of the fact that there are still no biological tests, no brain scans, and no genetic markers that substantiate this claim, children and teens are being prescribed stimulants, SSRIs, neuroleptic drugs and major tranquilizers at an alarming rate.
For example, there was a ten-fold increase in prescribing psychiatric drugs to children and adolescents in BC between 1997-2007. This continues unabated in spite of data showing adverse long-term effects of these drugs such as stunted growth, elevated blood pressure, mood swings, sexual dysfunction, involuntary muscle spasms, extreme agitation, massive weight gain, incontinence, sedation and cognitive impairment. Not coincidentally, disability claims attributable to mental illness—for adults, youth and children—are the fastest-growing category of disability costs in Canada. (see http://www.ti.ubc.ca/PDF/74.pdf, http://www.madinamerica.com/mia-manual/psychotropic-drugspediatric-adolescent-disorders/, http://www.madinamerica.com/wp-content/uploads/2011/11/Medicating-Children-.pdf. Also see “Economic Impact of Mental Illness in the Workplace,” in Out of the Shadows at Last…report of the Senate Standing Committee on Social Affairs, Science and Technology.)
A few words about these drugs:
Stimulants and ADHD
In comprehensive clinical trial for children diagnosed and treated for ADHD, NIMH researchers found that while attention deficit drugs did increase concentration in the short term, at the end of three years of treatment: “medication use was a significant marker…of deterioration.” At the end of six years, “medication was associated with worse hyperactivity-impulsivity and oppositional defiance…greater overall functional impairment” and stunted growth. Dr William Pelham, the lead investigator of the study concluded: “We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There were no beneficial effects, none…..And that information should be made very clear to parents.” (see Whitaker and Cosgrove, Psychiatry Under the Influence….2015, p. 162)
Antidepressants for Children:
According to the Journal of Child and Adolescent Psychology: “There is no escaping the fact that research studies certainly have not supported the efficacy of …antidepressants in… adolescents.” Articles on “Pediatric Onset Bipolar Disorder,” published in the Harvard Review of Psychiatry and American Journal of Psychiatry reported that the long-term risks of antidepressants in children are that the drug treatment converts depressive symptoms to bipolar disorder, increases apathy, cognitive impairment and sexual dysfunction in adulthood. A 2004 editorial in the British medical journal The Lancet summed up these and other studies by declaring that “these drugs [antidepressants] are both ineffective and harmful in children.” (Journal of Child and Adolescent Psychology, 1992); Paul Andrews, et al, “Primum non nocere: an evolutionary analysis of whether antidepressants do more harm than good,” Frontiers in Psychiatry, 24 April 2012; Editorial, “Depressing Research,” The Lancet, V.363, n. 9418, p1335, 24 April 2004)
Prescribing Antipsychotics for Children and Youth
According to studies published in European Neuropsychopharmacology and the Journal of Canadian Academy of Child and Adolescent Psychiatry these drugs are being increasingly used by GPs and psychiatrists for non-psychotic, off label conditions including ADHD, impulsivity, insomnia, aggression, PTSD, obsessive-compulsive symptoms, eating disorders and poor tolerance of “frustration.
“What exactly do [antipsychotics] do?” asked Dr Nancy Andreasen, former editor of the American Journal of Psychiatry? “They block basal ganglia activity (situated at the base of the forebrain that controls voluntary motor movements, procedural learning, eye movements, cognition and emotion). The prefrontal cortex doesn’t get the input it needs and is being shut down by the drugs. That may reduce psychotic symptoms [in the short term]. It also causes the prefrontal cortex to slowly atrophy.” Brain shrinkage is related to the use of antipsychotic drugs. Other adverse effects of antipsychotics include: weight gain, diabetes, involuntary muscle tics, sedation, extreme agitation, incontinence, impotence, heart arrhythmia, cognitive impairment, etc.
A year ago in Vancouver, in a seminar presentation on clinical drug testing, Dr Jim Wright, chair of the Department of Pharmacology at UBC, stated that “truly scientific, evidence based drug trials for any medication should meet seven criteria.” (e.g. randomized, double blind, large data base, long-term, independent of drug companies, negative and positive results published, etc.) And then he said the following:
“There have been no trials for psychiatric drugs that meet any of these criteria. We are harming a huge number of people. It’s shocking. It’s unethical. There are no evidence based, scientific diagnoses in psychiatry because we don’t even know what we’re talking about.”
And in a presentation to UBC Pharmacology staff and students last November, Dr. Peter Goetzsche, one of the world’s leading experts on clinical drug trials, concluded without a doubt that the use of psychiatric drugs causes far more harm than good.
Second personal story. Over a dozen years ago, we entered the mental health world here with one of our sons, trusting in the expertise of psychiatrists and other mental health professionals. What followed has been a living nightmare: our son’s physical and mental health has been destroyed by the long-term effects of an array of psychiatric drugs, the trauma of hospitalizations and the treatment he received. The empirical, daily observations by his parents on the effects of certain drugs and dosages, as well as the scientific literature we shared with his health care teams were dismissed. Condescension, defensiveness and contempt are common responses I’ve heard from parents in similar situations. We’re expected to monitor and enforce the psychiatric medications—a double bind, I can tell you, that can do harm to family relationships. In sum, the trust and hope we had in the BC mental health system diminished as our son has incurred irreparable physical and neurological damage.
If the drugs worked, you would think that mental and physical health and recovery outcomes would improve and that people, especially our children and youth, would be getting better. The opposite is the case. Over the long-term, these drugs induce changes in the brain opposite of what was intended and increase the risk that a person will become chronically ill, and I have sadly seen this to be the case first-hand. Epidemiologists are now reporting brain mass loss, catastrophic organ failure and premature deaths of twenty-five years and more in those taking psychiatric drugs after years of prescribed use. Disability data are coming in from around the world, and what they show is an astonishing rise in disability claims due to mental disorders. This enormous increase has risen in lock step with the astronomical rise in the use of psychiatric drugs in the past 40 years. If only the drugs worked, people would be recovering and disability rates due to mental disorders would be decreasing. But they’re not; and increasingly, rising disability rates will become financially and socially unsustainable, and health professionals and policy makers will be held to account by effected individuals and families and by taxpayers. (on comparative international disability rates, see Whitaker and Cosgrove, pp. 159-61)
A lot of my work in the past four years has been with adults who’ve been on psychiatric drugs, many of whom were started on them as teenagers. And I have to tell you they are desperate. Most of them are on permanent disability. Their kidneys are shot; their ability to think and act has been irreparably damaged; they struggle with drug induced obesity, diabetes and fibromyalgia, and sexual dysfunction. Many of them have been deeply traumatized by forced medication and their treatment in hospital.
And here I need to underline something: When a person is in emotional and mental distress as a result of traumatic experiences in their lives, the worst thing that can happen to them are behaviours by police, EMTs, security guards, Emergency Room and psychiatric unit staff—nurses and doctors—that additionally traumatize them. Handcuffs, manhandling and roughing people up, the use of restraints and seclusion, aggressive language, threats, mocking people for their confusion and behaviour, withholding information about their care, denying them water, a toilet, and due process rights and forced psychiatric drugging—all of these things can and do deeply traumatize people and make their suffering even more acute. I have seen these things happen with my own eyes. They’ve happened to my son and to many others on the streets, in their homes, and in our hospitals; and I have heard numerous and similar first-hand accounts from reliable witnesses. (on due process rights, see Recommendation #11)
Canada is a signatory to the UN Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment, as well as the UN’s Convention on the Rights of Persons with Disabilities (UN CRPD). Juan Mendez, the UN’s Special Rapporteur on the UN Convention against Torture, has called for an absolute ban on forced psychiatric interventions including nonconsensual drugging and electroshock, as well as restraint and solitary confinement, and has called for repeal of legal provisions allowing confinement and compulsory treatment in mental health facilities—something that goes on every day in this Province! (see http://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf)
If only all these the psychiatric drugs worked for kids, youth and adults, we’d be living in a brave new world. But they don’t and we’re not. Three years ago, Dr. Christian Fibiger of the Department of Psychiatry at UBC, one of the strongest advocates of the bio-chemical explanation for mental disorders, said this: “Psychopharmacology is in crisis. The drug data are in, and it is clear that a massive …30 year…experiment has failed.” “We have hunted,” wrote Dr Kenneth Kendler, “for…neurochemical explanations for psychiatric disorders and have not found them.” And in 2011, Dr Ronald Pies said “in truth, the chemical imbalance notion was always [an] urban legend, never a theory seriously propounded by well-informed psychiatrists.” That is, the chemical imbalance theory is false; it’s not true and doesn’t have a leg to stand on. (Fibiger, “Psychiatry, The Pharmaceutical Industry, and the Road to Better Therapeutics,” Schizophrenia Bulletin, vol. 38, no 4, 2012; Kendler, Psychological Medicine, issue 12, 2006; Pies, http://www.psychiatrictimes.com/blogs/couch-crisis/psychiatry-new-brain-mind-and-legend-chemical-imbalance)
And yet, just last month, I read a preview of a Mental Health and High School Curriculum written by Dr Stan Kutcher of Dalhousie University, a curriculum he’s marketing (with the partnership of the education faculty at UBC) for use in BC schools. In the curriculum, I discovered that Dr. Kutcher is still advocating the now widely discredited “broken brain,” chemical imbalance explanation for psychiatric disorders. As well, he claims that, like other biological illnesses, they can be effectively treated with drugs; and the sooner young people are labelled with a “mental illness” and enter into the psychiatric medication regime, the better.
(The assumption that conventional early psychosis intervention helps deter the development of more serious mental health disorders has recently been critically examined and seriously undermined. See Mortimer, Ann, and Timothy Brown. “Early Intervention in Psychosis: Another Triumph of Hope over Experience?” Progress in Neurology and Psychiatry 19, no. 3 (May 1, 2015): 10–14. doi:10.1002/pnp.379.)
The curriculum also states that mental illnesses are not caused by poverty, though the Canadian Association for Mental Health and Mood Disorders Canada state: that “Canadians in the lowest income group are 3-4 times more likely than those in the highest income group to report…poor mental health,” and that “social and economic status” [is] the factor that has more to do with Canadians’ health status than medical care or individual behaviours.” (see www.camh.net.media-key-CAMH-statistics-for-media; www/mooddisorderscanada.ca/documents/Media%20Room/Quick%20Facts%203rd%20Edition%20Referenced%Plain%20Text.pdf)
This curriculum, along with some lobby groups, also claims that “mental illness” is not a consequence of parenting or stressful circumstances, and that family crises and relations have little to do with mental disorders. This assertion is at odds with the findings and advice of family counselors and of the NIMH where it states, in its Treatment of Children with Mental Illness:
“Children…need guidance and understanding from their parents…Parents and children may need special help to undo …unhealthy interaction patterns….Parents can help by taking part in parenting skills training…and stress management techniques….Sometimes the whole family may need counseling… Psychosocial therapies can be very effective [though] they often take time, effort and patience. However, children [and parents] learn new skills that may have positive long-term benefits.” (www.nimh.nimh.gov/health/publications/treatment-of-children-with-mental-illness-fact-sheet/index.shtml)
Effective alternatives to the psychiatric drugging of children and youth in emotional and mental distress exist, but “they often take time, effort and patience.” But that’s the crux of the problem isn’t it? In our need for a quick-fix, magic bullet in the form of a myth, a pill, or an array of meds that have been marketed with billions of dollars by pharmaceutical companies, we’re arresting the physical, emotional, cognitive and spiritual development of our children and youth. Drugging them ushers all of us into a blighted landscape that can lead to long-term helplessness, trauma, declining health and disability.
It seems, all-too-often, that we tend to be more concerned about responding to and assuaging adult guilt; to assuring parents and policy makers that children’s distress has little to do with relations and stressors in the family and other systemic social and economic factors. I hear this mantra intoned over and over in Big Pharma advertizing, advocacy publications, the media, and in community health and in-patient hospital settings. (see Sami Timimi, “The medicalisation of childhood,” Healthcare Counseling and Psychotherapy, 7, 2007, pp 7-9; Richard Wilkinson and Kate Pickett, The Spirit Level: Why Greater Equality Makes Society Stronger,2009, pp. 62-73, 176-7, 181, 237)
One thing I do know about professionally is the social psychology of religions; I know something about fundamentalism and doctrinaire religious organizations. And I have to tell you from first-hand experience during the past dozen years, I have never seen or experienced such defensive, dogmatic and condescending belief and behaviour than what my family and other families are going through in dealing with psychiatrists and others working in this city’s mental health system.
However, the tide is turning. Psychiatry and psychology are currently undergoing a self-critical paradigm change as research data, studies and a host of stories are being published about the adverse, long-term effects of psychiatric drugs, and about the trauma many, many people are experiencing in the mental health system. A number of programs around the world are demonstrating remarkable recovery rates from “mental illnesses.” I fear that if we don’t take this changing landscape into account, British Columbia is going to be a backwater consigned to discredited mental health theories, out-of-date curricula, intrusive surveillance, and dangerous treatment regimes. And as we do that, the numbers of disabled, sedated, traumatized and emotionally and cognitively devastated young people and adults will continue to grow. We can do better than that, and must, for the sake of our children and youth.
(Addendum: a social worker from Kenya, a proud professional who worked for Vancouver Coastal Health, told me that refugee families who’ve fled from the trauma of war and violence in Somalia and Ethiopia have become alarmed at the negative effects of psychiatric drugs on parents, children, and grandparents who have come under treatment in our mental health system. These refugee families are so distressed by the grotesque physical and cognitive changes in their loved ones as a result of the drugs and their treatment in hospital, that fundraising has been taking place in refugee communities to buy plane tickets in order to send their effected family member back to Somalia and Ethiopia in the belief that they will be safer and healthier there than in our city and Province.)
- We need a nuanced, humanistic, non-pharmaceutical industry influenced, truly well-informed curriculum for schools, community centres and religious organizations that provides education to children, youth and their parents about the spectrum of human experience, life transitions, and ways in which boyhood (!), distress, unusual experiences and stress can be resiliently handled.
Such an approach would help young people and parents become more comfortable with a broader range of emotions, thoughts and experiences than are typically “normal,” and, if necessary, become more confident and knowledgeable in navigating the mental health system. (I am currently working with a curriculum team to prepare a workshop series for youth aged 11-14 (and separately with parents) in order to develop “confidence with their own inner uniqueness as well as deeper appreciation for the value of interpersonal understanding and community support.” Workshop modules would include:
- Seeing through the lenses we wear
- What is suffering?
- The vast spectrum of human experience and expression
- What are “mental health,” mental illness,” and mental health treatment”?
- Understanding the mental health system
- Strategies for mutual support
- Strategies for you: what you can do to help yourself
- Strategies for navigating the mental health system
(Please speak with me about this project. We are looking for support to mount trial runs with youth groups.)
A further recommendation is rather pointed: ensure that Dr. Stan Kutcher’s proposed high school curriculum is not used in BC schools before more damage is done.
- The BC Ministry of Health should issue a moratorium on issuing new prescriptions of psychiatric drugs to children and youth until there have been scientifically credible clinical drugs trials that can conclusively prove that these drugs demonstrably do more good than harm.
Please remember: Dr Jim Wright of UBC’s Department of Pharmacology has stated: There have been no trials for psychiatric drugs that meet any [empirical, credible] criteria. Talk to UBC’s Dr Jim Wright about how to run a scientific clinical drug trial. Talk to him as well about training doctors how to carefully and effectively taper patients down or off psychiatric drugs—something very few of them know how to do.
- Investigate the disproportionately high use of psychiatric drugs in the BC foster care system.
Talk with Dr Tony Stanton, formerly of the Seneca Center in California, about how he successfully tapered hundreds of “worst case” foster care kids off psychiatric drugs and saw them “come back to life” and successfully reengage with society. (for this story see Robert Whitaker, Anatomy of an Epidemic…, pp.347-53)
- Look into numerous, successful programs with demonstrably high mental health recovery rates such as Open Dialogue in Western Finland, Healing Homes in Gothenburg Sweden, and Parachute NYC. These programs are already in place and have shown excellent therapeutic and recovery results in the treatment of emotional and mental distress in children, youth and adults. We don’t have to re-invent the wheel; just find out what’s working and adapt it to the needs and resources of this Province.
- The hospital-based Open Dialogue program in Western Finland. For the past thirty years, psychiatrists and mental health teams working out of the Keropudas hospital have developed a family and social network approach to first episode psychosis care that has resulted in a dramatically less hospitalizations, the initial use of neuroleptics in only three per cent of patients, in contrast to 100% in a comparison groups, a 33% drop in psychiatric spending in the region, a 90% reduction in new cases of schizophrenia since the 1980s, and a recovery rate of 84% of those treated for psychosis—that is, they’re back in school, working and not receiving government disability. (These positive rates are the opposite of those in BC.) They have the best documented outcomes and recovery rates in the Western World. And I encourage you to discover why. (Jaakko Seikkula, Birgitta Alakare, Jukka Aaltonen; A Two Year Follow-Up on Open Dialogue Treatment in First Episode Psychosis: Need for Hospitaliztion and Neuroleptic Medication decreases, Social and Clinical Psychiatry, 2000, 10(2), 20-9); Jaakko Seikkula et al, “Five-year experience of first-episode non-affective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies,” Psychotherapy Research, March 2006; 16 (2), 214-28; Robert Whitaker, Anatomy of an Epidemic…, 2010, 339-41, 361-2)
- Parachute New York City. This program provides mobile response teams (without police intervention) and alternatives to hospitalization for people experiencing emotional crises. Parachute NYC offers free, community-based options that focus on overall wellness, recovery, and hope. It is largely driven by peers – who themselves have had their own experiences with the mental health system. In addition to home-based treatment, Parachute NYC offers crisis respite centers where people can stay overnight in a calm, open, and supportive environment. A support Line (646-741-HOPE) is also available for those experiencing emotional distress. (http://www.nyc.gov/html/doh/html/mental/parachute.shtml)
- “Healing Homes” of the Family Care Foundation in Gothenburg, Sweden. This program helps people recover from trauma and mental health crises by placing them to live with working farming families. Host families are chosen not for any psychiatric expertise, rather, for their compassion, stability, and desire to give back. People live with these families for upwards of a year or two and become an integral part of a functioning family system. Staff members offer clients intensive psychotherapy and provide host families with intensive supervision. The Family Care Foundation eschews the use of diagnosis, works within a framework of striving to help people come safely off psychiatric medication, and provides their services within the context of Swedish national health plan. http://www.madinamerica.com/2012/02/in-gothenburg-ordinary-homes-serve-as-havens-for-healing/; http://www.familjevardsstiftelsen.se/
- Mandate Provincial health care services, as well as police and emergency response, to incorporate trauma-informed practices and an awareness of the effects of trauma in their interaction with residents as recommended in the Vancouver Coastal Health’s “DTES-VCH Second Generation Health Strategy Report.”
This recommendation arises from the Report’s key observation that “emotional and physical trauma contributes to the vulnerability of local residents.” The Report further recommends the creation of: “a trauma taskforce that de-stigmatises the behavioural consequences of trauma and encourages services and frontline providers to adjust their practices accordingly.” I would encourage this Committee to see whether VCH and other parties have followed through on this recommendation. (See: http://dtes.vch.ca/secondgenerationstrategy/ also see Trauma Informed Care in Behavioral Health Services: Treatment Improvement Protocol, http://store.samhsa.gov/shin/content//SMA14-4816/SMA14-4816.pdf, http://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/)
For information and training in a crucial aspect of trauma informed services see http://www.mandtsystem.com/ an organization that “maintains and continues to promote a commitment toward Restraint Reduction and Restraint Elimination as our ultimate goal.” See also Jennifer Wisdom, et al, “New York State Project Shows Progress in Reducing Seclusion, Restraint for Children with Mental Illness,” http://alert.psychnews.org/2015/05/new-york-state-project-shows-progress.html
- Trauma-informed policies and practices should also be based in the findings of The Adverse Childhood Experiences (ACE) Study as reported by the Centers for Disease Control and Prevention.
ACE is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness and death as well as poor quality of life. The study shows how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery. (see http://www.cdc.gov/violenceprevention/acestudy/index.html)
- Convoke a meeting with editors of major media to ask why reports on people dealing with “mental illness” stigmatize, sensationalize and are full of factual inaccuracies.
The Vancouver police Department’s report: “Vancouver’s Mental Health Crisis,” September 2013, states that “VPD data show that persons dealing with ‘mental illnesses’ are 23 times more likely to be victims of violent crimes that the general public.” 75% of stories dealing with “mental illness” focus on violence, and most appear on the front page of newspapers. Only 4% of stories on mental health are about recovery, and 5% of stories include first person accounts, or report the perspective of the people who have been labeled as “mentally ill.” (See Patrick Corrigan, et al “Newspaper Stories as Measures of Structural Stigma,” Psychiatric Services, May 2005, Vol. 56, No. 5, pp. 551 – 556; and Rob Wipond, “Pitching Mad,” in Brenda A. LeFrancois, et al, Mad Matters: A Critical Reader in Canadian Mad Studies, 2014.)
- Regarding the “Interim Report: Youth Mental Health in British Columbia,” November 2014—focus and follow through on youth recommendations!, non-prescriptive treatments, youth worker/advocate in hospital emergency rooms and beyond, parenting skills and “family preservation and support services,” and impacts of trauma as presented by Jules Wilson, Julia Staub-French, Judith Wright, Kathleen Huxley, Sasha Soden and Samantha Smith of Youth LAB, Paul Lacerte, etc.
- Enforce Section 9(1) of the Food and Drug Act which prohibits advertising and oral information by drug companies and their representatives when they emphasize only product benefits without including safety information and discussing off-label use of a product. Regulations governing prescription drug promotion require harm as well as benefit to be mentioned—but this rarely happens in BC medical settings.
A published report by the UBC based Therapeutics Initiative revealed that fewer than 2% of the 1692 drug promotions included “minimally adequate safety information” by drug reps. “Serious adverse events were mentioned only 5% of the time.” For more information about the findings of this international study, which included Vancouver, see “Is prescribing information from sales representatives balanced?”, Therapeutics Letter, Issue 91/Aug-Sep 2014; and B Mintzes, et al, “Pharmaceutical sales representatives and patient safety: a comparative prospective study of information quality in Canada, France and the United States, J Gen Intern Med, 2013; 28 (10):1368-75.
Dr Tom Perry, who teaches clinical pharmacology at UBC Hospital, said that “doctors learn relatively little about drugs in medical schools, and much of their exposure to pharmacology” comes in the form of advertizing from drug reps. They are “unaware of the potential harms from drugs they prescribe and patients inevitably suffer the consequences” and yet the massive drugging of our children and youth is steadily increasing. (Vancouver Sun, April 13, 2013)
- The BC Ministry of Health should issue a moratorium on mental health screening of children and youth in primary care and school settings.
Separate Canadian and US Task Forces on Preventive Health Care have both recommended against mental health screening of children and youth. And yet, last year the BC Ministry of Health paid 600 doctors $2600 a piece to attend a training session in how to conduct mental health screening tests to identify “at risk” children and youth, and then refer them to specialists for treatment. Again, Dr Kutcher is leading this program and is a principal author of the screening tests. According to an administrator of the program, this effort is scheduled to expand with training of school staff to be more proactive “gatekeepers,” funnelling more kids toward screening tests and drug treatment. Alan Cassels, a University of Victoria pharmaceutical policy researcher, recently stated: “we know that the screening tools will increase the use of psychotropic drugs; that’s the outcome we’ve actually been able to measure.” Dr Elia Abi-Jaoude, a neuro-psychiatrist at the University of Toronto has stated that “the evidence doesn’t support screening and opens the risk of unwanted and potentially harmful interventions especially at a vulnerable stage of the lives of these young, developing brains.” (Rob Wipond, “The Proactive Search for Mental Illnesses in Children, www.madinamerica.com/2014/07/proactive-pursuit/)
- Ensure specific due process rights (currently denied under the Mental Health Act) to psychiatric patients as guaranteed under three BC Acts (Representation Agreement Act 1996, the Health Care (Consent) and Care Facility (Admission) Act 1996, and the Patient Care Quality Review Board Act 2008
Involuntarily admitted patients or those whose voluntary status has been changed to involuntary are excluded from three BC Acts, each related to due process rights.
Representation Act 1996: No right for a representative, previously designated legally by the individual when competent, to serve as a Representative/Substitute Decision Maker (SDM) should the individual become incompetent.
Health Care (Consent) and Care Facility (Admission) Act, 1996: no right to a) a presumption of competency unless otherwise assessed, b) a capacity assessment with an ongoing competency process with appeals provisions and c) the individual, once becoming capable, to have his/her wishes followed. No right to the provision of information for informed consent to the individual or SDM not recognized re: treatment options, including the least intrusive effective treatment, and risks and benefits of each.
Patient Care Quality Review Board Act, 2008: no right for an individual, SDM or family member to have complaints accepted and dealt with by the Complaint Office situated in every licensed hospital.
Each exclusion/denial of due process rights is contrary to the Canadian Charter of Rights and Freedoms and the UN Convention on the Rights of People with Disabilities ratified by Canada in 2010. Regarding the CRPD and “mental illness,” the UN High Commissioner stated that “the legal grounds upon which restriction of liberty is determined must be de-linked from the disability and neutrally defined as to apply to all persons on an equal basis.” (See Summary Position Paper “ Suggested Changes to BC’s Mental Health System Regarding Involuna=tary treatment in Non-Criminal Cases, adopted by the BC Civil Liberties Association, 2010.) (Last Spring, in its Eleventh Session, the UN Committee on the Rights of Persons with Disabilities issued an official Comment and Interpretation of Article 12 of the UN CRPD regarding “respect for personal integrity and freedom from torture, violence, exploitation and abuse:”
As has been stated by this Committee…forced treatment by psychiatric and other health and medical professionals is a violation of the right to equal recognition before the law and an infringement of the rights to personal integrity (Art.17); freedom from torture (Art.15); and freedom from violence, exploitation and abuse (Art.16). This practice denies the legal capacity of a person to choose medical treatment and is therefore a violation of article 12 of the Convention. States parties must…respect the legal capacity…to make decisions at all times, including in crisis situations; must ensure accurate and accessible information is provided about service options…and must provide access to support for decisions regarding psychiatric and other medical treatment. Forced treatment is a particular problem for persons with psychosocial, intellectual and other cognitive disabilities. States parties must abolish policies and legislative provisions that allow forced treatment, as it is an ongoing violation found in mental health laws across the globe, despite empirical evidence indicating its lack of effectiveness and the views of people using the mental health system who have experienced deep pain and trauma as a result of forced treatment. The Committee recommends that States parties ensure that decisions relating to a person’s physical or mental integrity can only be taken with the free and informed consent of the person concerned. (http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G14/031/20/PDF/G1403120.pdf?OpenElement)]
In 1975, the psychiatrist Samuel Bockoven observed that most “mental illnesses, especially the most severe, are largely self-limiting in nature if the patient is not subjected to a demeaning experience or loss of rights and liberties.”
- I am formally submitting two books and a recent report to the Committee, and want this to be part of the public record. As policy makers charged with political, ethical and fiduciary responsibilities to the residents of British Columbia, I appeal to Committee members and Staff to read these books and consider their implications for our mental health system.
Robert Whitaker, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness in America, 2010; Whitaker and Lisa Cosgrove, Psychiatry Under the Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform, 2015, and Understanding Psychosis and Schizophrenia, 2015, published by the Division of Clinical Psychology of the British Psychological Society. Whitaker is an award winning science/medicine journalist, and former Fellow at the Edmond L. Safra Center for Ethics, Harvard University. Anatomy of an Epidemic was given the 2010 Investigative Journalist and Editors Best Book Award. Cosgrove is Professor of Counseling and School Psychology, University of Massachusetts, and a Fellow at the Edmond L. Safra Center for Ethics, Harvard University.
Anatomy investigates why the number of disabled mentally ill in the US tripled over the past two decades. Psychiatry Under the Influence examines how the influence of pharmaceutical money and professional guild interests have impacted the expansion of medical diagnoses, biased clinical drug trials and guidelines, and pathologized normal behaviours in children, youth and adults. Understanding Psychosis and Schizophrenia explores: “why people sometimes hear voices, believe things that others find strange, or appear out of touch with reality, and what can help.”