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While I was in charge of the public systems for both mental health and addictions in Oregon, I found it a challenge to maintain an equal focus on alcohol/drug problems compared to mental health. One big reason for the emphasis on mental health was that the mental health budget was big, about 6 times greater than that for addictions. And that doesn’t even count the hidden funding for psychiatric drugs which probably added another 30 or 40% to mental health —atypical antipsychotics are a lot more expensive than Antabuse.

What if your doctor told you about data collected on antidepressants AFTER they had been released on the market. New Zealand data that shows aggression and death are as common as dizziness in reports from doctors about adverse reactions to antidepressants. That suicidal ideation and suicide attempt are as common as insomnia. Imagine you were told that while being exposed to these risks, the data showed that the most likely adverse reaction you would experience would be that the drug didn't work or stopped working. How might your decision on this particular treatment option be affected?

The controversy surrounding Justina Pelletier and her family has expanded its scope in recent months, and has now become a general public scrutiny of Massachusetts’s Department of Children and Families. I think there’s a very real risk of confusing some issues here. Every state in the US has a social services department, one of whose statutory responsibilities is to investigate reports of abuse and/or neglect. The system isn’t perfect. But this I do know: the spotlight has been taken off psychiatry. This is critical, because without the “diagnosis” of somatic symptom disorder and the subsequent allegation of medical child abuse, none of what’s happened to Justina and her parents could even have gotten off the ground.