Psychiatrists Deliver the Lowest-Quality Healthcare of Any Medical Specialty

In response, the authors suggest that a solution is to stop measuring psychiatrists’ performance.

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In a new study, psychiatrists were found to deliver the worst healthcare performance of any medical specialty. They were over three times more likely than other doctors to receive a penalty in Medicare’s Merit-Based Incentive Payment System (MIPS).

The authors write:

“In this national cross-sectional study of Medicare psychiatrists and other outpatient physicians participating in the 2020 MIPS, psychiatrists received significantly lower performance scores, were penalized more frequently, and received fewer bonus payments than other outpatient physicians.”

So now that we know that psychiatrists deliver the lowest-quality healthcare performance of any medical specialty, what should we do about it?

The authors of this study conclude that psychiatrists should not be judged on the same metrics as other doctors.

 “Policymakers should evaluate whether current MIPS performance measures appropriately assess the performance of psychiatrists,” they write.

The study’s lead author was Kenton J. Johnston, PhD, at St. Louis University. It was published in JAMA Health Forum.

MIPS was rolled out in the past few years to measure the quality of care provided by doctors and incentivize doctors to provide high-quality care by ensuring that the best doctors receive bonuses while the worst doctors receive penalties. It is a mandatory system for almost all outpatient doctors whose patients use Medicare. There are 210 quality measures in the system, and doctors must report at least 6 to MIPS. There are 25 mental/behavioral health specialty measures for psychiatrists to choose from.

The performance metric includes four domains: quality, cost of care, interoperability (they give the example of using a certified electronic medical record), and practice improvement (they give the example of participating in clinical registries).

The average overall score for psychiatrists was 84, versus 89.7 for other doctors. The specific measure of the quality of care was even lower: 79.6 in psychiatry versus 86.7 in other specialties. Psychiatry was also worse at documenting patients’ medication use, scoring an 80.8 versus 89.5 in other specialties. Psychiatry also performed poorly in terms of technology use and preventive care.

In terms of penalties, 6.1% of psychiatrists were penalized in MIPS, compared with 2.9% of other doctors.

But, the authors argue that psychiatrists shouldn’t be judged by this system. They write:

“Concerns have been raised that there are relatively few well-defined and widely accepted behavioral health quality measures compared with other medical fields.”

The authors suggest that there is no way to measure the quality of psychiatric care—and, therefore, that psychiatrists should not be judged for failing to provide good care to their patients.

In fact, they suggest that having to worry about the quality of care they provide will “disincentivize psychiatrists from treating Medicare patients.”

In an associated editorial about the study, other researchers also noted that incentivizing high-quality care will disincentivize psychiatrists because they perform poorly on these metrics. But they add that psychiatrists are already less likely than other doctors to take Medicare patients and that, in fact, their participation in Medicare has been dropping even before MIPS:

“Psychiatrists’ participation in Medicare networks has decreased over time, and psychiatrists are significantly more likely to opt-out of Medicare than other specialties,” they write.

Their proposed solutions include allowing psychiatrists to opt-out of quality assessment; no longer assessing cost, interoperability, and improvement for psychiatrists; and removing the penalties for psychiatrists who provide low-quality care.

 

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Qi, A. C., Joynt Maddox, K. E., Bierut, L. J., & Johnston, K. J. (2022). Comparison of performance of psychiatrists vs. other outpatient physicians in the 2020 US Medicare merit-based incentive payment system. JAMA Health Forum, 3(3), e220212. doi:10.1001/JAMA-healthforum.2022.0212 (Link)

50 COMMENTS

  1. Just wow. So let me get this straight. ‘They’ say ‘mental illness’ is a biologically based disease just like any other–say, diabetes. But they don’t give those patients the same quality of care as other ‘medical’ illnesses, and now it’s said they shouldn’t even be held to the same standards. Some next-level gaslighting goin’ on here.

  2. Quality post, Miranda Spencer. 🙂

    I agree. And I think…as usual…that I hear Szasz (or at least a good enough paraphrase) in my ear: the industry/guild is -not- a valid branch of medicine. This is social control. If the state did not need (and want!) the psych guild, other “professionals” would not be attempting regulatory acrobatics to make psychiatry “fit” into a medical profession that is increasingly expected to perform to some rather basic standards to justify ongoing government funding through Medicare, etc.

    If Medicare-funded primary care doctors performed as poorly as psychiatrists, my semi-educated guess is that at least some “heads would roll,” and some attempts at “shaping up,” or at least…giving the appearance of providing adequate care…would be fairly automatic. I’m picturing committees, perhaps some (over)hyped new regulations, on and on. actual…change? -shrug- no idea. but I do think some professionals would at least attempt -the appearance- of “accountability” (” ” because…buzz word…) and such. and then…

    psychiatry. Following Szasz…what is it anyone expects, anyway? drugs into people. labels onto people. people into some sort of confinement, and social invisibility and medicalized slavery. done, done, done. I think the -big- reason other “experts” are doing their very, very best to accommodate (obviously, fraudulent, dangerous, sub-standard, often lethal) “psychiatric care” on the government coffers is because…

    they -are- doing their jobs. And that’s what scares the living hell out of me, personally. 🙁

  3. Psychiatry is not medicine. It is political uzurpation of the psyche (mythical imagination) by stupid intelectualists with pretensions to medicine. Psyche and psychological identity never was a branch of medicine, till the industrial era of psychopats. The fault is one – normal obedient people. Normal human being is only enough to be a capitalist worker. Psyche is somethong too sophisticated for normal empty materialists with marxists roots. And so they built a trap for the psyche, using the wrong language inside a wrong ideologies. Still, they think that they know psyche.Marxists medicine know nothing about the psyche. Wrong laguage, wrong ideology. Wrong mind.

    • I am confused. Are you faulting capitalism or marxism or both for the proliferation of psychiatry and its horrible effect on society, government, culture, etc.? In my personal opinion, psychiatry, because of its inherent evil, is subject to being exploited by any and all government and economic systems. Oh no, I just see/hear another news tv report trying to make the world feel guilt and shame because they allegedly don’t pay attention to “mental health/illness/suicide?” like so many think they should i.e., do-gooders, mass media, government, etc. So much, many have not yet figured out, understood, or even realized that they are being conned? If they did realize that psychiatry would essentially be out of business and people would be happier, healthier and live longer! Thank you.

      • Marxism and capitalism are generally – materialism, without the spirit and psyche. Without spiritual and psychological influence on materialism.When materialism is only a materialism, it is low culture of barbarians. Marxists hate religion. Monism hate psyche. Since the enlightement era, people don’t know what is psyche. And what is the nature of the psyche. They think that spirit is psyche, they confuse spirit with the psyche. This is robbery. Psychological man is a hostage to both monism and Marxism. Death depression psychosis are the essence of the psyche. Form naive spirituality and barbaric materialism, these core traits of the psyche are the intruders in utopian reality they create. And this mistake and usurpation is getting worse.

  4. 1) How can these psychiatrists deliver quality health care when they do is as far from health as say, Neptune is to the Sun—-no farther and Neptune is a very cold place and unlivable to Earthlings. 2) Yes, at present, psychiatrists do receive compensation from Medicare and Medicaid like traditional medical doctors (the ones you go see when you get a ‘hangnail.’) 3.) Miranda Spencer has an excellent post on this matter, as we seem to all agree. and 4.) Why do we waste our time worrying how beset the psychiatrists are with self-esteem and other issues now called “personality disorders” that used to be neuroses. Come to think of it, who really has the personality disorder or actually any alleged diagnoses as described in the DSM? Could it be the psychiatrist after all? I shudder to think. Thank you.

  5. WAIT! This is STOOPID! YOU MORANS! LOL!….
    Psychiatry doesn’t deliver healthcare AT ALL! Psychiatry is a quack pseudoscience and pill pushing racket, along with being a social control mechanism for folks the moneyed-people find inconvenient and annoying, bothersome. Psychiatry is “healthcare” like Phrenology is neurosurgery!….

  6. There’s NO medical, chemical, physical, mental, objective *TEST* of ANY kind, for ANY so-called “mental illness”. It’s all IMAGINARY, arbitrary, invented and created and curated, but NEVER cured because it is conceptualized as making a lifetime money faucet to PhRMA out of traumatized abused persons. How can anybody measure the pain and suffering psychiatry inflicts on people? What measure of psychiatry-induced pain and suffering was I forced to endure, starting as an innocent, trusting, drunken, out-of-control 15yr old? How can such medical demonism be “measured”?….Psychiatry is FRAUD. Damn them all to Hell, by God….

  7. Nailed it Ms. Spencer.
    Psychiatry is relentless regarding proof of their ‘legitimacy’, especially to other medical professionals. Their use of ‘evidence- based’ a minimum of 3 times in every sentence tells us so….like Fredo in the boathouse declaring “Im smart!…not dumb like everybody says!”.

    Cringe-y …..& desperate to prove something at client’s expense.
    Step away from the prescription pad & the DSM & we’ll talk about the rest.

  8. There is no death penalty in the Republic of Ireland. So if somebody were to be successfully injected to death (as I nearly was) – then this could be seen as an advantage.

    When I moved to the UK many years ago I wrote to Galway, Ireland, asking them to ‘warn’ doctors in the UK about my Near Fatal Experience.

    Some time after ‘the doctor’ contacted me with a warm and friendly letter promising me that I had been looked after.

    I was to discover at a much later date that I had been ‘badmouthed’ on records sent to the UK, and that ‘warning’ – was conspicuously absent.

  9. I remember when I had postpartum depression that was complicated by abuse from the midwife, and I sought care for it, and was routed to the psychiatrist. It was the worst care I ever received. The doctor was misogynistic and was gaslighting me on the details of my own birth experience. I was put on the wrong medication which amplified my symptoms rather than alleviate them. Fortunately, a lactation consultant from the Le Leche League knew of a local support group, and offered me a community care option, which helped significantly more.

    Mutual aid and community-centered care is already replacing psychiatry, which is heartening, because the profession does more harm than good.

    • You know that if you had continued to “treat” with those quack psychiatrists, then they would have slapped you with a BPD*(“Borderline Personality Disorder”), or “Major Depression”, or even “treatment resistant depression”, and subjected you to ECT-Electro-Cution Torture….You would be thoroughly discredited & invalidated a priori, if you had complained further about the midwife….that’s how the fraud of psychiatry rolls. They are the MUSCLE, and ENFORCERS of medicine…. “Misogynistic Medical Fascism”, – that’s psychiatry…..

  10. “The authors suggest that there is no way to measure the quality of psychiatric care—and, therefore, that psychiatrists should not be judged for failing to provide good care to their patients.”

    Oh, that ol’ “mysterious mental illness,” “it’s all too complicated for non-psychiatrists” cliche. But this is just untrue.

    Did you make your client “manic” with an antidepressant and/or ADHD drug? Then you’ve provided “quality psychiatric care.” Did you make your client “psychotic” or apathetic – via anticholinergic toxidrome or neuroleptic induced deficit syndrome – with an antipsychotic? Yeah for you, that’s “quality psychiatric care.” Did you cover up child abuse, rape, or easily recognized iatrogenesis with psych drugs? Yeah for you, that’s “quality psychiatric care.”

    It’s just not that difficult to understand what the psychiatrists believe is “quality psychiatric care.” Psychiatry is harming people for profit, and for nefarious reasons.

    “In fact, they suggest that having to worry about the quality of care they provide will ‘disincentivize psychiatrists from treating Medicare patients.'”

    Well, since all the psychiatry does is make people “mentally ill” with their psych drugs, ‘disincentiviz[ing] psychiatrists from treating Medicare patients’ would be a good thing.

    And out of curiosity, what “penalties for psychiatrists who provide low-quality care” exist, since most lawyers won’t take cases against the psychiatrists? I know of no “penalties for psychiatrists who provide low-quality care.”

    Including a nut job of a psychiatrist – who was the psychiatric “snowing” partner-in-crime – of this now FBI convicted criminal doctor.

    https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

    • For just over 30 years, I have been both a MediCaid, & MediCare beneficiary. State & Federal “healthcare” SCAMS, really. The local hospital, “CheshireMedicalCntr/DartmouthHitchcock-Keene, (“CMC/DHK”), who has a government-sponsored pure, protected MONOPOLY of any healthcare here in Keene, is REFUSING ME ANY MEDICAL CARE. Really. But anyway, I don’t care. I’m independently healthy. 25+years psychiatry & psych-drug FREE!…. If there were any way that I could CEASE & DESIST any $$taxpayer fund$ going to the FRAUD of psychiatry, I would. Why doesn’t Medicaid & MediCare reimburse Phrenology treatments? Or Astrologers? Or palm-readers & fortune-tellers? All the SAME as psychiatry. Subsidizing the Kissing Booth at the County Fair would be a better use of tax money spent on healthcare than psychiatry ever can be….

  11. “The authors suggest that there is no way to measure the quality of psychiatric care—and, therefore, that psychiatrists should not be judged for failing to provide good care to their patients.”

    But its ok to judge humans sometimes for mere minutes or sometimes not all and nevertheless ejudicate biased DSM labels and force Big Pharma drugs.

    Pscyhiatry is the worst religion of all.

    • Isn’t the fact that there is no way to measure the quality of psychiatric care kind of proof that we’re not dealing with medical issues? What if heart surgeons said that there was no way to tell if they did a good job or not, so that everyone should just let them do whatever they want to? I don’t get why they get away with that kind of nonsense.

      • “Isn’t the fact that there is no way to measure the quality of psychiatric care kind of proof that we’re not dealing with medical issues?”

        No, and I’d urge you not to promote false equivalencies and provide fodder for psychiatric apologists to smear antipsychiatry principles. I’d argue that the vast majority of Americans at least are sick, judging by the obesity rates and subscription drug use. The likelihood (if you keep abreast of the research) is that chronic inflammation plays a major role in mental distress of all kinds. You’re never going to heal a broken mind while ignoring the vessel that cradles it.

        The problem as I see it is that like the rest of western medicine, psychiatry targets symptoms and not causes. If we were to target obesity’s causes for example, Our government would stop subsidizing cheap crops of low nutritive value which end up being ubiquitous sources of calories absent nutrition in processed foods. We’d have a shorter work day and work weeks. People would get paid a living wage and valued for their contribution to society, not to corporate bottom lines. We’d regulate chemicals that pollute our water, food, air and nearly every product we purchase. We’d promote community stability and pro-family values and structures. We’d ensure that all who want it have access to safe housing and meaningful work that gives a sense of purpose to their lives.

        But in such a toxic environment that is our actual reality, it’s hardly surprising that so many people are distressed. And suggesting that real medicine does a better job of healing is farcical in light of the facts. The real problem is one nobody wants to admit, much less address. (It is admittedly gargantuan.) Medicine alone cannot fix what’s wrong with our broken culture and polluted, toxic, and increasingly uninhabitable world. And our collective distress will unfortunately increasingly reflect that reality as the air warms, the seas rise, our bodies are increasingly filled with PFAS and micro plastics and pro-inflammatory “foods”, and ever more divisive social milieu.

        Psychiatry may not be medicine. But medicine is no hero here, either.

        • All of what you wrote is mostly right. Traditional Medicine is now as bad as psychiatry in most cases. In a way, traditional medicine has been taking lessons from psychiatry and even exploiting those lessons to the detriment of so many. I am not quite sure about the other things you write, but they do deserve some consideration. Actually, the problem really is that we have lost our way. We have relied on things like psychiatry to cure our ills. MISTAKE! We need to return to the truth. That we are SPIRIT “housed” in “human” bodies or for most on this planet “animal” or “plant” bodies. This is not necessarily to change our eating habits or other habits right this instant. It is to allow ourselves to rely not on the falsehoods propagated by much of false science, especially including psychiatry, which, in my personal opinion has become the “dominant science”. I use the word “science” because I lack a better word. Psychiatry is not science at all, so that immediately explains the state of all which we would traditionally call science in the twenty-first century. SPIRIT will allow us to access the truth about ourselves, both individually and as a community. So, in my opinion, I think the answer is THINK SPIRIT, rather than science, medicine, psychiatry, or even business, government, education, etc. PLEASE REMEMBER: THINK SPIRIT! Thank you.

  12. I don’t understand how these “Mad Scientists” ever gained any Medical Credibility. Surely those real M.D.‘s have noticed the harm by now?. I assume they make money treating the physical problems caused by Psychiatric medication?? How do you measure quality of absolute LIES?
    Meanwhile in reality people are faced with real problems and drugging them out of their minds does not help. Could it be that the entire Medical/Institutional/Educational Goliath suffers from Mass formation Psychosis or is it Greed? When will the Medical Doctors do the ethically correct thing? How can I get paid to do a totally irrelevant study of absolute bullshit? I believe there is no Scientific proof needed for anything anymore. If I say I am Man *poof***magical imaginary sound*** I am a Man. This could be the end of Psychiatry.

    • Worst case scenario for a G.P.-general practitioner/”PCP”-primary-care-physician/NP-Nurse Practitioner, is the VERY DIFFICULT PATIENT!…Nightmare! Problem! Solution? Turn them over to the psychs. Drug ’em into submission, compliance, & agree-ance, if usually morose & diffident presentation….the money is essentially the same either way, and equal paperwork administration load….The general dysfunction level of society acts as a lid beneath which live all the undesirables. The drunks, druggies, crazies, elderly, the alone, the gimps & cripples, the different & strange. The ones who give legitimacy to the pampered, sheltered lives of the well-to-do, & well off, well-heeled rich scumbags. The Elite. The 1%. That’s who psychiatry serves, and PROFITS. Genocide for profit, – that’s the pseudoscience of psychiatry. So it goes…..

    • Re “Could it be that the entire Medical/Institutional/Educational Goliath suffers from Mass formation Psychosis or is it Greed? When will the Medical Doctors do the ethically correct thing?”

      No, it’s worse because mass formation psychosis (falsely) implies something temporary, and it’s way above and beyond greed….

      The most vital urgent and DEEP understanding everyone needs to gain is that a mafia network of manipulating PSYCHOPATHS are governing big businesses (eg official medicine), nations and the world — the evidence is overwhelming and irrefutable (study the scholarly article “The 2 Married Pink Elephants In The Historical Room”… https://www.rolf-hefti.com/covid-19-coronavirus.html

      And psychopaths are typically NOT how Hollywood propaganda movies have showcased them. And therefore one better RE-learns what a psychopath REALLY is (see cited source above).

      But rulership by psychopaths is only ONE part of the equation that makes up the destructive human condition as that article explains.

      That correct understanding of how things are answers your last question, “When will the Medical Doctors do the ethically correct thing?” It will ONLY ever happen IF these psychopaths and their institutions and business are abolished and they’re put in prison for life. Now guess how likely that will ever happen? The answer becomes very clear once you understand BOTH pink elephants in the room….

    • The cancer that is biological psychiatry has spread into general medicine by corrupting its less than skillful and ethical practitioners. Most toxic “mental illness medications” are prescribed by medical doctors. If an incompetent MD cannot determine the cause behind the cause of a patient’s symptoms, the temptation to buy into the myth that it’s all in the patient’s mind can be irresistible. If the bogus diagnosis is confirmed by a psychiatrist, even better, now the difficult case is somebody else’s problem, and the psychiatrist is happy for the referral.

      • Bingo.
        It’s perfect for making money off a patient.
        And it ends up in the worst or non care for the patient
        because now the patient cannot even get his pain or suffering addressed.
        It’s a game because no one can say the honest truth.

        It is time psychiatrist also become specialists in heart, lung, cancer, arthritis, etc etc, because how could they possibly determine it’s in the patient’s “head”, if they have no scientific knowledge about the specialities? Not to mention an intuition to see that a patient is not well, “physically”.
        No one should EVER go to a shrink after an MD mumbles “mental”. Because the MD knows squat about what is going on in your head, and the shrink knows nothing about your physical stuff OR your “head”.

        • Actually, psychiatrists know less about the brain than even traditional doctors do; however, which in most cases could be considered nil to nothing. Ironically and tragically, psychiatrists have achieved the title of “shrink” in slang terms. I think of “shrink-wrapped” like they do some food and packages. But in reality, the psych drugs they prescribe, profit from and promote assisted by “psychotherapists” and the therapizing they do; actually, shrinks the brain and damages it—usually for life; whether you continue on the drugs or withdraw from them in some manner. I have never seen a more apt slang word for a group of people than “shrinks” for “psychiatrists.” It’s a shame. I do not like to use slang words for any one or any particular group of people as they are usually very wrong, do not consider the individual, prejudicial, etc. But in the case of psychiatrists and the word “shrinks.” it is not so. In fact, it is the largest case of “self-fulfilling prophecy” ever noted in the history of the planet. Thank you.

  13. Psychiatrists have been able to get away with delivering substandard health care because of obfuscation. The use the distress and confusion of either the patient or loved ones (family members, etc.) and then basically gaslight them to “obedience.” They also take words and terms and turn them inside out against the patient in question. This is not new nor is it confined to psychiatry. I remember a dermatologist at a government hospital doing this to my parents about a skin issue I had at time. I was about 13 years old or so. My parents, who were very concerned, tried to press the doctor on whether it was malignant or not. He was so vague that my parents got irritated and stopped taking me to this doctor. That issue, in question, disappeared as I grew into adulthood and magically, it must not have been malignant because I am still here. I have seen this type of technique even used in what was said job interviews and then taken against after the individual after being hired. Psychiatrists may have just taken it to a new level. And right now, they are harnessing mass media and recruiting soldiers even amongst their victims, who are tragically unaware. Thank you.

  14. It would strengthen this article to look at the metrics to determine if one agrees that they are actually indices of good vs poor care. One might also question the extent to which these metrics have improved care in other specialities. Going to a physician these days often involves spending time looking at the physician entering data into a computer. This to a large extent is how that physician is achieving the quality care that Medicare requires. Is this what MIA is suggesting would improve psychiatry?
    This is a complex issue that is not served well by this summary.

  15. Yes Sandra, those questions are intrusive, and perhaps some caregivers actually believe that they are well intentioned but after a few years in “medicine”, one would think that even the least aware clinician would get it. They would understand that to hint at or label someone does not result in stigma, but what looks much more like persecution.

    It is a terrific way to get no validation as a human being. That is all.

    I wonder if any clinicians would like to see their child or parent being treated like a lesser or non human BUT, that is EXACTLY what happens.

    The stigma word was invented to pretend that it’s someone else and not the medical people who hate the mentals.

    Yet really, the only places that actually matter to a person’s welfare is the only place they receive the so called “stigma”.

    Nope, if “MI” is a science, and it resides in the brain, I prefer to go to a neurologist, he would have a bit more knowledge, than mere name calling.

    And it’s a bit backwards to develop drugs for “diseases” where the mechanisms are not even known a tiny bit.

    Don’t ask me “well what do I do with all “these” people.

    Not knowing, is not an excuse to just throw garbage at “those people”, And labels are garbage.

    • One of the strangest comments I have heard, especially from psychiatrists, but now increasingly from “traditional doctors” is about the drugs/medications they prescribe: “We don’t know how it works, but it works.” In my opinion, this is usually “code” for “we’re giving you a drug for a non-existent illness, and it assuages our guilt and pacifies you,” and, if you do take this “drug” it may not work or even “damage” you somewhat and that lets them “off the hook.” Or in the case of traditional doctors, they feel that they don’t know what else to do. Sadly, they have shut off their intuition and imagination and all they see as the answers to “your problems/issues. etc.” is drugs, drugs, more drugs, and tests, and more tests and maybe a procedure or two or worse. So, does the patient get any better? Usually, no, they just get more frustrated and even more resigned to their “pain.” And, sometimes, they even lose their will to fight. Therefore, in many cases, they just get worse and so much of the time, it is the “patient” that gets the blame. Thank you.

      • “We don’t know how it works” is quite an admission. I’d challenge the “but it works” part with, “Works for whom?” or “Who gets to decide what ‘works'” means?

        I was an advocate for nursing home residents at one time in my career. I visited one facility because a family member said her dad was overdrugged on Abilify or some other “antipsychotic”. I went to talk to the guy, and he could barely keep his eyes open, couldn’t even stand up without assistance. He had bruises on his forehead from running into the door jamb on the way to dinner. I talked to the activities director, who said a week ago, she’d been hitting a volleyball back and forth in the courtyard with this same guy.

        Did the Abilify “work?” Well, if your intent was to induce a near coma so the guy was incapable of doing anything at all, I’d say it worked great. If the goal was to enhance his quality of life, I’d say it did the opposite. Those who claim it “worked” clearly consider his quality of life to be a secondary concern, or of no particular relevance. So it “works” for them, even though it destroys the client’s life.

        Beware of anyone claiming something “works” on someone else!

        • Yes, I completely agree. Abilify didn’t work on me as it caused my throat to close up, so I could not swallow. However, all the psychiatrists and even their enabler LCSW Therapists at the clinic touted it as a wonder drug. All I can say is another wonder drug that seriously debilitated my life and almost killed me. Thank you.

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