“All human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act towards one another in a spirit of brotherhood.”

 Universal Declaration of Human Rights

Article 1

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"People with mental disabilities have the same rights as everybody else.
It is time to act, unite and empower people to improve
mental health and human rights"

Mental Health Policy and Service Development
Department of Mental Health and Substance Abuse
World Health Organization
Geneva, Switzerland

Attorney Jim Gottstein discussed inappropriate use of psychiatric drugs

The World Health Organization Recognizes an Epidemic of Violations of Rights Mental Patients

The care available from mental health facilities around the world including the USA  is not only of poor quality but in many instances hinders recovery.  There are also significant problems here in the USA.  Because the care of mental patients occurs behind closed door and there is secrecy to the legal proceeding concerning involuntary treatment and forced commitment -  this is a silent victim.  Training of staff is minimal and outdated and the level of knowledge and understanding about the human rights of persons with mental disabilities is very poor. Thus staff often respond with forced drugging and restraints for staff convenience with little regard to the human rights of the patient.  It is common for people to be locked away in small, prison‐like cells with no human contact, or to be chained to their beds, unable to move.  Inhuman and degrading treatment practices are common, and people in facilities are often stripped of their dignity and treated with contempt. Violations are not restricted to inpatient and residential facilities. Many people seeking care from outpatient and community care services are disempowered and also experience extensive restrictions in their basic human rights.Violations often occur behind closed doors and go unreported ‐ unless people know that they are going on, action cannot be taken to stop them.

The Equal Protection Clause of the Fourteenth Amendment requires that the government treat all similarly situated people alike. Violations of the Equal Protection Clause are actionable under 42 U.S.C. § 1983.

"When we lose the right to be different, we lose the privilege to be free."

-- Justice Charles Evans Hughes

(1862-1948) Chief Justice of the U.S. Supreme Court

Discrimination Against Persons with a Mental Health Disability

Discrimination and the absence of legal protections against improper and abusive treatment cause much of the hardship faced by people with mental health disabilities.  Improper discrimination may also take place against people with no disability at all – if they are improperly viewed as having a mental disorder, or if they once experienced a mental disorder earlier in life.  People with mental disabilities are subject to de jure discrimination – the arbitrary denial of rights that are afforded to all other citizens.   People with mental disabilities are often deprived of liberty for prolonged periods of time without legal process; subjected to neglect in harsh institutional environments and deprived of basic health care.

Persons who have been diagnosed with a mental illness are often deprived of the right to give or withhold informed consent, whereas individuals with other diagnoses are accorded the right to give or withhold informed consent for treatment. For example, a diabetic who refuses an amputation is provided a hearing before such a procedure can occur and a person with a communicable disease gets a hearing before she can be quarantined.  The fact that the State has singled out people with mental illness as unworthy of due process constitutes discrimination based on disability.

Mental Health Rights

Undeniable rights

  • The right to treatment services which promote the potential of the person to function independently. Treatment should be provided in ways that are least restrictive of the personal liberty of the individual.
  • The right to dignity, privacy, and humane care.
  • The right to be free from harm, including unnecessary or excessive physical restraint, isolation, medication, abuse, or neglect. Medication may not be used as punishment, for the convenience of staff, as a substitute for, or in quantities that interfere with the treatment program.
  • The right to prompt medical care and treatment.
  • The right to religious freedom and practice.
  • The right to participate in appropriate programs of publicly supported education.
  • The right to social interaction.
  • The right to physical exercise and recreational opportunities.
  • The right to be free from hazardous procedures.

Additional rights

Additionally, every mental health client has the right to see and receive the services of a Patients' Rights Advocate. All patients also have the following treatment rights:

  • The right to give or withhold informed consent to medical and psychiatric treatment, including the right to refuse medications except in emergency situations where danger to life is present; or by court order where the patient is found to lack the capacity to give or refuse informed consent via either a Capacity Hearing and also known as a Riese hearing or via conservatorship.
  • The right to refuse psychosurgery.
  • The right to refuse electroconvulsive therapy (ECT) unless court ordered.
  • The right to confidentiality.
  • The right to inspect and copy the medical record, unless specific criteria are met.
  • The right to have family/friends notified of certain treatment information with patient's permission.
  • The right to an aftercare plan.
  •  

Deniable rights with good cause

Psychiatric facilities must also uphold the following specific rights, which can be denied only when "good cause" exists.

 

  • The right to wear one's own clothing.
  • The right to keep and use one's own personal possessions, including toilet articles, in a place accessible to the patient.
  • The right to keep and spend a reasonable sum of one's money for small purchases.
  • The right to have access to individual storage space for one's own use.
  • The right to see visitors each day.
  • The right to have reasonable access to phones both to make and receive confidential calls.
  • The right to have access to letter-writing materials, including stamps.
  • The right to mail and receive unopened letters and correspondence.

With good cause

Denying a patient's rights requires good cause. Good cause is defined as the belief of the professional in charge of care for the client that the specific right would cause

  1. a danger to self or others;
  2. a serious infringement on the rights of others; or
  3. serious damage to the facility;

and that there is no less restrictive measure that would protect against those occurrences.

Patient rights cannot be denied as a condition of admission, nor as part of a treatment plan (a doctor may not designate patient rights a 'privilege' or 'punishment'). Any time a right is denied under good cause, it must be documented in the patient's medical record and explained to the patient. The denial must be reviewed regularly and removed once good cause no longer exists.

When a right is denied, the reason given for denying the right must have some clear relationship to the right denied. For example, a patient may be denied the right to keep his cigarettes (the right to keep and use personal possessions) because he is burning himself and lighting fires, and lesser restrictive alternatives (supervision during designated smoking times) have failed. This rule prevents facilities from denying rights as a form of punishment; for example, if a patient misbehaves by throwing food at another person, then the facility cannot take away personal possessions or deny visitors for the day.

Without good cause

If a right was denied without good cause, a patient can instruct his or her appointed public defender to file an Ex Parte application with the court to restore the right. After filing the application, a hearing is set and an opportunity to be heard by the judge concerning the merits of the case is reviewed; the judge determines if the right will be restored or remain listed as a "good cause" denial. An Ex Parte can bring relief in a matter when a person is deprived of any interest in liberty or property without due process of law.

If someone is placed on a 72-hour hold as a danger to themselves or others and admitted to a facility for treatment, they are prohibited from purchasing or possessing firearms for five years from the date of admission to the facility.

If someone has been placed on a 14-day hold, they are prohibited from purchasing or possessing firearms for five years under state law and for life under federal law.

Testimony At Toronto City Hall On You Tube. This was the 10th annual Conference on Human Rights and Psychiatric Oppression Toronto, Canada on 14 to 18 May 1982 . Testimony is about psychiatric drugs, electric shock treatment and lobotomy. In the video you see Judy Chamberlin, Leonard Frank and Others. The testimony is that of Donald Johnson.

"What finally emerges from the 'clear and present danger' cases is a working principle that the substantive evil must be extremely serious and the degree of imminence extremely high before utterances can be punished... It must be taken as a command of the broadest scope that explicit language, read in the context of a liberty-loving society, will allow."

Justice Hugo L. Black

(1886-1971) US Supreme Court Justice

Source: Bridges v. California

The First Amendment’s protection of free speech also protects freedom of thought.  By forcing individuals to take mind-altering drugs against their will, the medical staff forcibly changes the ability of such individuals to formulate particular thoughts. The involuntary administration of psychotropic drugs affects patients’ mental processes, interfering with their freedom of thought.

“… it is the inherent nature of all human beings to yearn for freedom, equality and dignity, and they have an equal right to achieve that.”

 

His Holiness The Dalai Lama, New York, April 1994


Mental Illness and Decision Making Capacity

The MacArthur Treatment Competence Study, published in 1995, confirms that mental illness cannot be equated  with incompetence, that many individuals with mental illness retain full decision-making capacity, and that even when such illness impairs capacity in one area, it may leave capacity unimpaired in others. The study measured four criteria of decision-making capacity — communicating a choice, understanding relevant information, appreciating a situation and its consequences, and reasoning about treatment options — and concluded that nearly one half of the schizophrenic subjects and 76% of the depressed subjects performed in the “adequate” range across all decision-making measures, and a significant portion performed at or above the mean for persons without mental illness.  

See Thomas Grisso & Paul Appelbaum, The MacArthur Treatment Competence Study III: Abilities of Patients to Consent to Psychiatric and Medical Treatments, 19 LAW & HUM. BEHAV. 149, 171 (1995).

Paul S. Appelbaum, Assessment of Patients’ Competence to Consent to Treatment, 357 NEW ENG. J. MED. 1834, 1838 (Nov. 1, 2007).

Magnitude of Impairment in Decisional Capacity in People With Schizophrenia Compared to Normal Subjects: An Overview, 32 SCHIZOPHRENIA BULL. 121 (Jan. 2006).

Bruce Winick, The MacArthur Treatment Competence Study: Legal and Therapeutic Implications, 2 PSYCHOL. PUB. POL’Y & L. 137, 158-61 (1996).

Johannes Hamann et al., Patient Participation in Antipsychotic Drug Choice Decisions, 178 PSYCHIATRY RES. 63 (June 2010).

Christine Katsakou, et al., Coercion and Treatment Satisfaction Among Involuntary Patients, 61 PSYCHIATRIC SERVS. 286 (March 2010).

Patient Satisfaction and Administrative Measures as Indicators of the Quality of Mental Health Care, 50 PSYCHIATRIC SERVS. 1053,  1056 (August 1999).

Riittakerttu Kaltiala-Heino, Pekka Laippala and Raimo Salokangas, Impact of Coercion on Treatment Outcome, 20 Int’l J. Law & Psychiatry 311 (Summer 1997).

Francine Cournos, Karen McKinnon and Barbara Stanley, Outcome of Involuntary Medication in A State Hospital System, 148 AM. J. PSYCHIATRY 489 (April 1991).

Paul Appelbaum, Commentary, in MOVING FROM COERCION TO COLLABORATION IN MENTAL HEALTH SERVICES (David Pollack ed., 2004).

Francine Cournos, Karen McKinnon and Carole Adams, A Comparison of Clinical and Judicial Procedures for Reviewing Requests for Involuntary Medication in New York, 39 HOSP. & CMTY. PSYCHIATRY 851, 855 (Aug. 1988).

Irwin Hassenfeld and Barbara Grumet, A Study of the Right to Refuse Treatment, 12 BULL. AM. ACAD. PSYCHIATRY & L. 65, 72 (1984).

Steven Hoge & Thomas Feucht-Haviar, Long-Term, Assenting Patients: Decisional Capacity and the Quality of Care, 23 BULL. AM. ACAD. PSYCHIATRY & L. 343, 349 (1995).

Julie Zito et al., The Treatment Review Panel: A Solution to Treatment Refusal?, 12 BULL. AM. ACAD. PSYCHIATRY & L. 349, 357 (1984).

Are the mentally ill really the violence problem?

A Washington State evaluation of more than 300 mentally ill offenders released from prison found that only 2% committed serious violent crimes in the first 18 months of a scheduled 5 year follow-up.

Dawson, J.M. and Langan, P.A. (1994). 1988 Department of Justice study.  

Tina Minkowitz is one of the Chairpersons of the World Network of Users and Survivors of Psychiatry and a Lawyer.

Tina was extensively involved with the drafting and negotiation of the UN Convention on the Rights of Persons with Disabilities and was one of 12 NGO members on an official working group that produced the first draft text.

Part 1: Human Rights Framework;
Psychiatric Disability; UN Convention on the Rights of Persons with Disability; Legal Capacity.

Link: www.wnusp.net

This interview is from the DVD "Visions" - for further info - www.qldalliance.org.au

International Enforcement of Mental Health Human Rights

The Vienna Declaration reaffirms, people with mental disabilities are protected by the same human rights law that protects all other individuals – including the provisions of binding human rights conventions. International human rights law creates a number of broad protections that provide important rights to people with mental disabilities.

These provisions of human rights conventions affirm the rights of personswith disabilities the following rights:

(1) the right to the highest attainable standard of physical and mental health;

(2) protections against discrimination

(3) protections against torture, inhuman, or degrading treatment;

(4) protections against arbitrary detention.

The major UN conventions, including the ICCPR and the ICESCR, create treaty-based supervisory bodies. Governments that ratify conventions agree to report regularly on the steps that they have taken to implement the convention – through changes in legislation, policy, or practice.  Non-governmental organizations can also submit information for review by oversight bodies. Oversight bodies review both the official and non-governmental reports and publish their findings, which may include a determination that governments have not met their international obligations under the convention. The international oversight and reporting process thus provides an opportunity to educate the public about a specialized area of rights. This process can also be a powerful way to pressure governments to realize convention-based rights.

The UN Human Rights Committee was established to monitor the International Covenant on Civil and Political Rights (the ICCPR).  Although it has yet to issue a general comment specifically on the rights of people with mental disabilities. It has issued General Comment 18 that defines the protection against discrimination against people with disabilities under article 26.52 In its comments on Article 7, it specifies that the protection against “torture...cruel, inhuman or degrading treatment” applies to “medical institutions, whether public or private.” In order to demonstrate compliance with Article 7, all governments that have ratified the ICCPR: should further address the conditions and procedures for providing medical and particularly psychiatric care.   Information should be provided on detention in psychiatric hospitals, on measures taken to prevent abuses in this field, on appeals available to persons interned in a psychiatric institution and on any complaints registered during the reporting period.

"What finally emerges from the 'clear and present danger' cases is a working principle that the substantive evil must be extremely serious and the degree of imminence extremely high before utterances can be punished... It must be taken as a command of the broadest scope that explicit language, read in the context of a liberty-loving society, will allow."

Justice Hugo L. Black

(1886-1971) US Supreme Court Justice

Source: Bridges v. California

Mental Health and Human Rights - Sell Supreme Court Ruling

There is a  vicious cycle of using mental health patients to court ordered treatments. Many thousands mental health patients are denied liberty disingenuously and upon bases that have no relationship to case law or to statutes. There is a  systemic problem of medical fraud within mental health facilities and the violation of human rights protections for the mentally ill in the USA.  There is essentially no enforcement of protections for human rights for those who are considered mentally ill,  this makes medical fraud within this closed medical community very easy and profitable.  There are billions of dollars of federal taxpayer monies paid on US medicare and medicaid payments for what is essentially a system of using the mentally ill as "cash cows".  It would probably be difficult to find any US psychiatrist working with the mentally ill who has not, at a minimum, exaggerated the dangerousness of a mentally ill person's behavior to obtain a judicial order for commitment.  Emergency crisis admissions occur in order to establish a new Medicaid billing cycle.  There are ping pong arrangements between cooperating facilities that permit maximum billing for both.  There is lack of due process in court ordered treatment and no real protection of human rights through the guardianship system.  There is up coding, fraudulent billing, fraudulent diagnosis - leading to life long in hospital treatment, and multiple diagnosis to allow maximum medicaid/medicare payments with little increase in charting time spent.  This means that doctors are paid to make the patient look as crazy as possible - with the only proof of their "craziness" the written record produced by the doctor who will financially benefit the most.

Many patients are forced into life long forced treatment often by the court system.  There is little scientific basis for these forced treatments  and they are permanently damaging hundreds of thousands, if not millions, of people.  In no other field of medicine is this kind of forced treatment allowed.  There are many people who see psychiatrists and voluntarily, even eagerly, take psychiatric medications.  This concern is not about a patient's right to make an informed choice to take medication,  nor of his legal guardian acting properly in his/her behalf to authorize medications or even the right of patients to get their medications paid by the US Medicaid/Medicare system.  The concern is instead regarding forced treatment where there has been no due process to protect human rights in the court system and no informed consent for treatment.   Many psychiatrists, with the full understanding and tacit permission of the trial judges, regularly lie in court to obtain involuntary commitment and forced medication orders.  Courts accept testimonial dishonesty, specifically where witnesses, especially expert witnesses, show a high propensity to purposely distort their testimony in order to achieve desired ends.  Experts frequently and openly subvert statutory and case law criteria that impose rigorous behavioral standards as predicates for commitment. 

Thus the US mental health court system is a system that: 

(1) dishonest testimony is often regularly (and unthinkingly) accepted;

(2) statutory and case law standards are frequently subverted; and

(3) insurmountable barriers are raised to insure that the allegedly "therapeutically correct" social end is met

 

There is an increased use of the force of law (court orders) to compel people to submit to unwarranted psychiatric treatments they do not want.  What  unfolds is travesty of denial of due process in a legal system of Catch-22's for the patients and one where the courts have not only abdicated to "professionals" their responsibility to protect the rights of people coming before them, but also condones perjury in furtherance of this abdication.  The concept of "the doctor knows best" prevails and therefore it is OK to have the pretense of procedural due process without substantive real due process.  Legal guardianship in relationship to court ordered treatment is a farce and does not protect the mental health patient from  human rights abuse.   This outright disregard of the law has lead a growing revolt among principled psychiatrists over the abuses of forced psychiatry.

In the Supreme Court Decision of Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174 (2003), which while a competence to stand trial case, demonstrates much less deference to "professional judgment" than has been suggested the Supreme Court held in Youngberg.   In Sell, the U.S. Supreme Court  laid down the following constitutional guidelines:

 

While Sell is a competence to stand trial case, it is hard to see how a person facing forced drugging in the context of civil commitment has fewer rights than a person convicted of a criminal act.  These may be good guidelines that delineate basic constitutional principles that should be applicable to the civil forced psychiatric medication context.See the website:   PsychRights and the legal case: Myers v. Alaska Psychiatric Institute, S-11021,

No Deprivation of Liberty based on Disability

"The greatest right of a civilized person is to be left alone, unless he does harm to others or is threatening to do harm to himself."

-- Justice Arthur Joseph Goldberg

Forced Intervention

"Antipsychotic drugs have both an inherent potential for abuse and an actual history of indiscriminate use by the psychiatric profession. In this respect they are similar to psychosurgery and electroshock therapy, highly invasive treatments which psychiatrists embraced enthusiastically and used indiscriminately — until their tragic effects became publicized and their use was curtailed by legislative, judicial, and scientific pressure. Because many psychiatrists will not heed the warnings in the scientific literature as to the dangers and misuse of neuroleptic drugs, independent and unbiased decision-makers should decide whether orders for forced medication are justified."

Supreme Court Justice, John Roberts in the Amicus Curiae Brief of the American Psychological Association in Support of Respondent at 13-14, Washington v. Harper, 494 U.S. 210 (1990) (No. 88-599).

"Never impose on others what you would not choose for yourself." Confucius

Rennie v. Klein case, 1977 New Jersey

In the Rennie v Klein, filed in this District in 1977, a former pilot and flight instructor and other patients in New Jersey psychiatric hospitals, sued to block the State from forcefully drugging them. The patients were represented by lawyers from the New Jersey Department of the Public Advocate. District Court Judge Brotman recognized the constitutional right of the patients to refuse treatment, and found that a regulation substantially similar to the Three-Step Process used today in New Jersey insufficiently protected patients’ substantive constitutional rights. Consequently, Judge Brotman issued an order requiring State hospitals to hold hearings to determine whether patients may be medicated against their will, to provide a lay “patient advocate” to represent patients at hearings, and to retain independent psychiatrists to make the ultimate determination at those hearings. Rennie v. Klein, 476 F. Supp. 1294, 1313 (D.N.J. 1979).

In the legal cases: Washington v. Harper, 494 U.S. 210 (1990); Riggins v. Nevada, 504 U.S. 127 (1992), and Sell v. United States, 539 U.S. 166 (2003) — the Supreme Court held that the right to refuse medication is guaranteed by the Fourteenth Amendment’s Due Process Clause.

Did You Know?

"Over ninety percent  of persons with mental illness have no history of violence. "

Serper, M, Bergman, A. (2003)

Psychotic Violence: Methods, Motives, Madness, Psychosocial Press of Madison, CT.

Patient's right to refuse medication

Forced drugging occurs on a regular basis within residential treatment facilities for mentally ill patients and also with patients as outpatients. Forced drugging occurs among school children in America’s schools as in the Teen Screen program, despite federal legislation that prohibits the coercion of parents to medicate their child as a condition for special services.  Those who are for forced drugging content that the issue of safety supersedes the right of the individual to refuse treatment.  The US Supreme Court had ruled that the government may involuntarily administer antipsychotic medications to a mentally ill criminal defendant in order to render him competent to stand trial, "but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests."

The United States Supreme Court decisions of Youngberg v. Romeo, 102 S.Ct. 2452, U.S.Pa.,1982,  Mills v. Rogers,  102 S.Ct. 2442 (1982) and Rennie v. Klein, 102 S.Ct. 3506 (Mem), U.S.,1982,  have been widely interpreted as holding that federal constitutional safeguards involving a person's right to refuse psychiatric medications are mostly defined by state law and that federal protection is limited to whether the treatment is "a substantial departure from accepted professional judgment, practice or standards" (the "Professional Judgment" standard).   

However, none of these decisions address the problem of invalid medical practice standards that are not supported by scientific evidence of improved mental functioning due to drug administration. Actually in contrast, depressed people are routinely given medications that the FDA has demanded be labeled with a black box warning that the medication will increase the likelihood of suicide and violent behavior.  None of these Supreme Court Decisions actually address the human rights of the patient or the possibility of medical fraud, misdiagnosis, malpractice or greed on the part of those running psychiatric and mental health facilities.  Nor has the pervasive influence, both political and financial, of the pharmaceutical industry been taken into account.  It is clear that  the Supreme Court of the United States doesn’t regard the views of clinical Ph.D. psychologists as equal or as valid to M.D. psychiatrists.  Psychiatrists have a drug license and primarily treat patients with drugs, psychologists use talk therapy and other methods like biofeedback and hypnosis to treat patients. The concept of parity for patients who want non drug therapy has not been considered by the court and instead a pro-drug mentality has prevailed.  So as long as the psychiatrist is willing to treat the patient with a drug that other psychiatrists use - even if it is an "off label use" or an unapproved use or even still not even approved by the FDA and in clinical drug trials  - the Supreme Court  has through many court cases still considered that within the professional standard.  What is the real rationale to force drug experimentation on a patient and making them a ward of the court with no civil rights in order to use unapproved drugs on them or "off label" treatments with an FDA black  box warning that the drug increases the risk of suicide and homicide? Why does the US court system  not care if the medication forced on a patient under civil commitment,  causes the patient to have racing homicidal thoughts or causes them to commit suicide?   The courts have routinely prevented disclosure of the adverse effects of these drugs through restriction of discovery and sealed records  as well as the acceptance of secret out of court settlements.

It would appear that the Supreme Court  had in many decisons allowed forced drugging as long as most psychiatrists would drug a patient (the professional judgment standard). This  meant that most mental health patients did not have meaningful protections for their human rights.  It meant that the mental patient has no legal right to their own brain or to prevent forcible coercion for the rest of their life so that they will provide a “meal ticket” and be a “cash cow” to the medical-pharmaceutical community.   Do not underestimate the value of this mental patient for financial gain, as most facilities charge a base rate of $500 to $1,000 a day for care and that does not include treatments, diagnosistic procedures and other therapies.  There are also payments of increased housing costs borne by federal programs and increased charting for Medicaid and Medicare as well as targeted case management costs and social welfare payments billed to the federal and state taxpayer. There are also increased court costs as the patient becomes a ward of the court for the purposes of enforcing compliance with the forced drugging order and costs of court appointed attorneys and routine hearings on guardianship matters.

But in an important more recent Supreme Court decision, a more reasonable standard was proposed. In the Supreme Court case of Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174 (2003), In the Sell case,  the Supreme Court held and that the Professional Judgment standard never was supposed to apply to forced medication cases.  While Sell is a competence to stand trial case, it is hard to see how a person facing forced drugging in the context of civil commitment has fewer rights. See,  Reevaluating Substantive Due Process as a Source of Protection for Psychiatric Patients to Refuse Drugs, Indiana Law Review, 1998, 31 INLR 937. In Sell, the U.S. Supreme Court  laid down the following constitutional guidelines:

  1. The court must find that important governmental interests are at stake.
  2. The court must conclude that involuntary medication will significantly further those concomitant state interests.
  3. The court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results.
  4. The court must conclude that administration of the drugs is medically appropriate, i.e., in the patient's best medical interest in light of his medical condition.

Myers v. Alaska Psychiatric Institute, S-11021, which was presented by Attorney Jim Gottstein, invalidated Alaska's forced drugging statute and required the court to find by clear and convincing evidence that in addition to all of the statutory criteria, the forced drugging is in the person's best interests and there are no less intrusive alternatives available.


Legal Cases -Right to Refuse Treatment

App. of Pres. & Dir. of Georgetown., 118 U.S. App. D.C. 80, 331 F.2d 1000 (1964)

Super. of Belchertown v. Saikowitz, 383 Mass. 728, 370 N.E.2d 417 (1977)

Guardianship of Richard Roe III, In Re, 383 Mass. 415, 421 N.E.2d 40 (1981)

Rennie v. Klein, 720 F.2d 266 (3d Cir. 1983)

Rogers v. Commissioner, 390 Mass. 489, 458 N.E.2d 308 (1983)

Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028 (1990)

Myers v. Alaska Psychiatric Institute, S-11021

So finally there has been changes in attitudes and also court decisions in both federal and state courts and legislatures, towards respecting the right of individuals to refuse unwanted psychotropic medication and providing due process protections for the enforcement of this right.  In the legal case,  Mills v. Rogers, 457 U.S. 291, 299 (1982), the Supreme Court recognized that the federal Constitution recognizes a liberty interest in avoiding the unwanted administration of antipsychotic drugs. Much more recently, a court in this District ruled that the right to refuse unwanted medication is grounded in the individual’s right to be free from bodily intrusion. Brandt v. Monte, 626 F. Supp.2d 469, 486 (D.N.J. 2009) (citing Rochin v. California, 342 U.S. 165, 172-74 (1952)). The same court ruled that the right to refuse unwanted medication is further grounded in the individual’s right to autonomy and to exercise control over her mental faculties. Brandt, 626 F. Supp.2d at 486 (citing Lawrence v. Texas, 539 U.S. 558, 562 (2003) (“Liberty presumes an autonomy of self that includes freedom of thought....”)). Moreover, the Supreme Court has observed that psychotropic drugs are “mind altering,” Mills, 457 U.S. at 293 n.1, and “alter the chemical balance in a patient’s brain, leading to changes . . . in his or her cognitive processes.” Harper, 494 U.S. at 229. See also Scott v. Plante, 532 F.2d 939, 946 (3d Cir. 1976) (“It is sufficient to recognize that the involuntary administration of drugs which affect mental processes, if it occurred, could amount, under an appropriate set of facts, to an interference with [a person’s] rights under the first amendment.”).

The International Basis of Psychiatric Rights - CRPD

In 2009 the USA signed but still has not ratified the Convention on the Rights of People with Disabilities (the “CRPD”). One of the purposes of the CRPD is “to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.” (CRPD, Art. 1.) Among the many rights of people with disabilities protected by the CRPD are the rights to equal recognition under the law (Art. 12), access to justice (Art. 13), and to live in the community, with choices equal to others. (Art. 19.)   Under the Vienna Convention on the Law of Treaties, once a nation signs a Convention, it is “obliged to refrain from acts which would defeat the object and purpose” of that Convention. (Vienna Convention on the Law of Treaties art. 18, May 23, 1969, 1155 U.N.T.S. 331.13)  Although the United States has not yet ratified the CRPD, the U.S. Supreme Court has made it clear that “the opinion of the world community, while not controlling [the Court’s] outcome, does provide respected and significant confirmation for [its] own conclusions.” Roper v. Simmons, 543 U.S. 551, 578 (2005).http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf

Recognizing Extrapyramidal Symptoms from Psychiatric Medications

The Real Truth about Outcomes on Psychiatric Medications

These  drugs, over time, produce these results:

 

a) They increase the likelihood that a person will become chronically ill.

b) They cause a host of debilitating side effects.

c) They lead to early death.

Increased Risk of Suicide in Drug Treated Patients

In the largest study ever done to address suicide in schizophrenia patients it was found:

The widely cited lifetime rate of 10% for suicide in patients with schizophrenia is incorrect for both the pre- and post-community care eras.

The best estimate for the life time rate of suicide in patients with schizophrenia in the pre-community care era is of the order of 1% or less.

Although de-institutionalism is probably the single most important factor in determining suicide rates in patients with schizophrenia, pharmacotherapy appears to contribute to this risk, and is the element of  current care that is undermost clinical control.

Healy, D. Harris, M. at el. (2006) Lifetime suicide rates in treated schizophrenia: 1875-1924 and 1994-1998, In Brit J. of Psych, 18, 8, p. 223-228. http://bjp.rcpsych.org/cgi/content/abstract/188/3/223

Increased Risk of Death in Patients taking Neuroleptic drugs

 99 people diagnosed schizophrenic for 17 years were studied and it was found that the usage of even one neuroleptic drug increased the risk of dying by 3 fold (35% died).  The use of 3 neurleptics increased the risk of dying in 17 years by 7 fold! (57% died)

Joukamaa, M., Heliova, M., Knekt, P. at el, Schizophrenia, neuroleptic medication and mortality, In Bri. J of Psychiatry (2006), 188, P.122-127.

Steve Muccio, executive director of PEOPLe, Inc., a peer-operated program in Upstate New York, describes working without coercion to help people with a mental illness or substance abuse disorder reclaim their lives and their dignities. He appeared at a conference sponsored by The Bridge in New York City, at the Columbia University School of Law, Nov. 20, 2009

When trying to withdraw from many psychiatric drugs, patients can develop serious and even life-threatening emotional and physical reactions. 

In short, it is dangerous not only to start taking psychiatric drugs, but also can be hazardous to stop taking them.

Therefore, withdrawal from psychiatric drugs should be done under clinical supervision.

 

Clinical Case of young girl age 5, two days after STOPPING an antipsychotic. She developed Tardive Dyskinesia (TD) after the antipsychotic, called Invega, was stopped. She was only on 6 mg for one month, but has been on antipsychotics since she was 18 months old due to severe self-injurious behavior and aggression (including Risperdal, Geodon, Abilify, Thorazine, Seroquel, and Zyprexa). PLEASE understand the risks of antipsychotics before agreeing to give your child, or yourself, this class of drugs. Not only can abnormal movements occur while TAKING them, but (rarely) you will ONLY know you have Tardive Dyskinesia, or Extrapyramidal Symptoms, after you STOP these drugs. I am NOT giving you medical advice. You should talk to your doctor before starting or stopping any medicine, especially antipsychotics/neuroleptics.

Truth about Psychiatric Drugs

Warnings not clearly given to the public:

The drug industry makes it confusing that many psychotropic drugs have different names and different warning labels in different countries and thus what is known about dangerous side effects in one country may not be common knowledge for patients or even prescribing doctors in another country. There is suppression of the research findings of negative outcomes and also suppression of reports of clinical adverse events. There is little adherence to the guidance of the Food and Drug Administration guidelines in these matters, with hospitals and mental health professionals routinely ignoring FDA warning labels and withholding the truth from patients and their families.   Even a cursory view of the serious effects of these drugs would make any person be concerned.

The Falicy of Chemical Imbalance

Psychiatry doctors frequently mislead mental health patients.  So a few basic facts regarding how these anti-psychotic drugs work is necessary.  People with schizophrenia have no known “chemical imbalance” in the brain, antipsychotic drugs cannot be said to work by “balancing” brain chemistry. These drugs are not like “insulin for diabetes” nor are they like vitamins for the brain.  Neither do these drugs correct any chemical imbalance and they do not serve as a corrective to a known biological abnormality.  Instead, these powerful mind altering medications such as Thorazine or Clopazone and other standard antipsychotics (also known as neuroleptics) work by powerfully blocking dopamine transmission in the brain. The specific action of these drugs is to block 70% to 90% of a particular group of dopamine receptors known as D2 receptors. This prevents normal dopamine transmission.  Please remember that low levels of dopamine is what causes Parkinson’s disease.    

Informed Consent is a Requirement not a Courtesy

Informed consent is an essential human right which was guaranteed by the Nuremberg Code and an ethical principle approved by the World Health Organization, the United Nations and even the US government. This is a human right that all human beings have under both international law and under US Constitutional law. Mental health professionals need to honor the ethical and human rights principle of informed consent. The human right to have informed consent is a right that even prisoners of war and convicted felons have and yet mental health patients, who have been charged with no crime, have been routinely denied this basic human right. As a third party decision maker, the legal guardian stands for the human rights of the patient when the patient is incapacitated. The legal guardian needs to stand firm and insist that he/she be fully informed regarding all medical treatment choices including the dangers of all drugs and treatments given.

The right to informed consent is delineated in the federal regulation Protection of Human Subjects, 45 CFR 46 also known as the Common Rule under the authority granted by the U.S. Department of Health and Human Services. The Belmont Report was written concerning the Ethical Principles and Guidelines for the protection of human subjects of research. Since 1945, various codes for the proper and responsible conduct of human experimentation in medical research have been adopted by different organizations. The best known of these codes are the Nuremberg Code of 1947, the Helsinki Declaration of 1964 (revised in 1975), and the 1971 Guidelines (codified into Federal Regulations in 1974) issued by the U.S. Department of Health, Education, and Welfare Codes for the conduct of social and behavioral research have also been adopted, the best known being that of the American Psychological Association, published in 1973.

Respect for persons requires that patients, to the degree that they are capable, be given the opportunity to choose what shall or shall not happen to them. Information about risks should never be withheld for the purpose of eliciting the cooperation of a patient and truthful answers should always be given to direct questions about the treatment and research. But a lack of informed consent is exactly what has happened to many mental health patients. The medical information about these drugs is often conveyed to the legal guardian in a technical, disorganized and rapid fashion and thus there is often not sufficient time to consider the information or to question it. Often there is no substantive discussion with hospital or clinic staffs in which the views of the patient and the legal guardian were honored and listened to; instead patients are often ignored as if they did not have any rights to express their dislike for medications or treatment options. There is often no voluntary agreement to participate in research thus there was no valid consent. Informed consent requires conditions free of coercion and undue influence and it is clear that while incarcerated in a locked psychiatric hospital ward there is the use of coercion. There can also be the use of undue influence by the court appointed attorney through offers of inappropriate or improper reward in order to obtain compliance vulnerable patients. The doctor in his/her position of authority who can exert a commanding influence and who can threaten sanctions can easily force patients to take drugs against their consent.

Involuntary Drugging Violates Due Process Rights

Due process rights are not be adequately protected and  violations of  contemporary standards of due process occur because:

(a)  the forcible medication of patients who are competent to make medical decisions is allowed;

(b)  the forcible medication of patients occurs without a finding that the patients would pose a danger to themselves or others without medication;

(c) there is no legal representation provided to the patient;

(d) there is no truly independent psychiatric examination of patients who refuse medication;

(e) there is no notice provided to the patient;

(f) there is no right to confrontation;

(g) there is no decision by an impartial decision-maker who is independent of the hospital and Defendants’ supervision;

(h) there is no limit to the length of time a patient can be forcibly medicated;

(i) there is no requirement limiting the type or dosage of medication with which a patient can be forcibly drugged;

(j) there is no meaningful review of involuntary medication decisions; and

(k) patients have no realistic means of appealing involuntary medication decisions

Antipsychotics Increase Chonicity of Psychosis

There have been several research studies that actually prove that these medications do not provide long term positive effects even though they may initially decrease or curb psychosis over the short term.  But positive effects did not lapse and a year later, patient on these antipsychotics actually relapsed and made patients more psychotic over the long term. ( Schooler, N, et al. “One year after discharge: community adjustment of schizophrenic patients.” American Journal of Psychiatry 123 (1967):986-95.)  The NIMH conducted three different studies that compared antipsychotic treatment with “environmental” care that minimized use of the drugs. In each instance, patients treated without drugs did better over the long term than those treated in a conventional manner.  Rappaport, M, et al. (1978), Carpenter, W., et al. (1977) and Bola J, et al (2003).  In addition in the Guy Chouinard and Barry Jones’ research study (1978 and 1980)  they tested the theory that the reason for this relapse when patients are put on year long antipsychotics, was that the brain responds to neuroleptics and their blocking of dopamine receptors as though they are a pathological insult. To compensate, dopaminergic brain cells increase the density of their D2 receptors by 40% or more. As a result now the brain  is “supersensitive” to dopamine, and as a result, the person has become more biologically vulnerable to psychosis than he or she would be naturally.  So neuroleptics can produce a dopamine supersensitivity that leads to both dyskinetic and psychotic symptoms.  Thus the outcome of treatment with an antipsychotic drug would increase the possibility of dopamine supersentivity and thus predispose the patient to psychosis more than just the normal course of the illness.

50% of Schizophrenics do fairly well without drugs

“Every chronic schizophrenic outpatient maintained on an antipsychotic medication should have the benefit of an adequate trial without drugs.”

 

Jonathan Cole, Maintenance antipsychotic therapy. Is the cure worse than the disease? Am. J. Psychiatry (1977): 133:32-6.

 

"Our greatest glory is not in never falling, but in getting up every time we do."

Confucius

Effects of Psychiatric Drugs

These psychiatric drugs are not of small risk but instead cause massive changes in the way the brain functions. Long term studies have indicated that there are severe debilitating and sometimes fatal effects of these drugs. Possible negative effects were minimized or not even discussed at all. There are risks of long term psychological harm, physical harm, social harm and economic harm. Many of these drugs cause symptoms that can themselves be construed as mental illness.The probability of developing Parkinsons’ like symptoms is also great.  


NIDS - Neuroleptic Induced Deficit Syndrome:  

Neuroleptic Induced Deficit Syndrome (NIDS) can be caused by these medications which change in emotional awareness, sense of aliveness, and in the speed, and clarity of thought. The treatment effects felt by many people who have taken these medications are described as feeling like a zombie. Neuroleptic effect is present when the following features are observed:

1. Psychomotor Retardation – motor slowing, body not moving so well
2. Emotional indifference - not being emotionally responsive / not caring
3. Reduced initiative – not showing interest in initiating activity
4. Slowing of thought

As the dose of the medication increases, and more time elapses, it appears that the effects change – from sedative effects, into anti-psychotic effects, and possibly into other less desirable side effects; akathisia (restless leg syndrome), emotional parkinsonism (emotional blunting) and on into some other unwanted side effects. It is not uncommon when the first symptoms appear like apathy, emotional indifference, motor slowing or slow mentation that these were attributed to the underlying condition of the patient (the patient’s disease) when really they are the effects of the medication itself. A patient on these medications can initially demonstrate an improvement in symptoms only to later over time have that initial improvement go away or to only reach a certain point and then plateau or level off. There is also one more important one effect: neuroleptic dysphoria – which is like depression. When this happens when patients are often given even higher dosages of the drugs, leading to even more severe effects.

Many of the symptoms that are used to justify hospital treatment may actually be caused by the psychiatric medications given. So continuation of these medications only creates a self-filling prophecy that furthers the financial goals of the hospital institution and may cause further permanent brain damage.

Risk of Parkinson's symptoms

Many patients who take psychiatric drugs also develop Parkinsonian side effects - about 40-50% (or more) experience Parkinsonian symptoms.  Julia Child, a very famous cook over in the US and the actor Michael J Fox are both famous victims of severe Parkinson’s disease.  In Parkinson’s disease people lose these dopamine cells in the substantia nigra area of the brain. With antipsychotic medication, we’re not killing off those cells but we are affecting how they function and so Parkinson’s symptoms do occur in a fairly high rate of patients.

"Experience should teach us to be most on our guard to protect liberty when the Government's purposes are beneficent. Men born  to freedom are naturally alert to repel invasion of their liberty by evil-minded rulers. The greatest dangers to liberty lurk in insidious encroachment by men of zeal, well-meaning but without understanding."

Justice Louis D. Brandeis

US Supreme Court Justice 1928

Source: Dissenting, Olmstead v. United States, 277 US 479 (1928)

Therapeutic Drug Dependence - Neuroleptic Withdrawal Syndrome

Therapeutic drug dependence occurs with psychiatric drugs. Although these drugs produce no tolerance and no euphoria, they produce enduring post-discontinuation changes that are as extensive and long lasting as the changes underpinning current disease models of addiction. Patients also get withdrawal or discontinuation syndromes when they stop taking their medication or when their medication is lowered in dose. When anti-depressant or anti-psychotic medications have been in the brain for a while and then the dose is suddenly lowered, or if the medication is taken away too quickly there is a reaction to that change called Neuroleptic Discontinuation Syndrome. So when a patient runs out of medication or is suddenly put on a lower dosage they can demonstrate exacerbations of psychosis, become delusional or even hallucinate. Seizures can also occur from rapid withdrawal from these psychiatric medications.

The danger of withdrawal from antidepressants and antipsychotics is well documented.  The brain compensates for the blockage of the serotonin and dopamine receptors by growing additional receptors for these neurotransmitters.  When the medications are discontinued or suddenly decreased, these additional receptors contribute to 'overload' of serotonin and dopamine flooding the receptor.  This is known as distcontinuation syndrome.

What usually happens to the patient in withdrawal is that they end up back in the hospital again. These crisis admissions lead to being labeled with a new disease diagnosis – schizophrenia, or delusional or manic depressive and then placed on even greater dosages of even more dangerous drugs. The doctors in these instances are quick to blame the patient, for a relapse rather than considering when the patient last took his medication. Discontinuation syndrome can sometimes last for weeks or months - some people have said they can last as long as six months.

Discontinuation Syndrome

Risks of Psychiatric Medications


Adverse Effects of Atypical Anti-psychotics:


The so-called “atypical” antipsychotics are neither “atypical” nor “antipsychotic.” Not infrequently, these chemicals induce or enhance bizarre statements (disorganized speech or delusions), social withdrawal (depression), and sedation (encephalopathy), regardless of dose. The processes through which these medications exert destabilizing effects include receptor blockade (D2, ACH, histamine), electrophysiological (depolarization) blockade; direct toxicity (cell death); and induction of other disease processes (pneumonia, diabetes, hypothyroidism, PE). Unfortunately many prescribing clinicians are largely unaware of these problems and thus do not inform their patients.

Numerous psychiatric medications are dangerous and even life threatening adverse effects including: weight gain and diabetes, tardive dyskinesia (movement disorder), tremor, akathisia (restless leg syndrome), dyskinesia (uncontrollable movements, tics, tremors), dystonia, as well as the side effects of nausea, dizziness (low blood pressure), and insomnia. Dystonia is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. It is painful to even watch a video of someone with dyskinesia or dystonia. The doctors when prescribing these medications tell patients and their families just to disregard these potentially life threatening and life altering side effects.

Many of these drugs cause symptoms that can themselves be construed as mental illness. One drug Abilify or Aripiprazole, is known to cause neurological side effects, gastrointestinal signs, movement disorders, disturbances in thinking, anxiety disorders, sleep disorders and even suicidal behavior. These are the actually side effects of the drug – yet when these symptoms occur they are attributed often to what they claim is the medical diagnosis. Doctors reported to the FDA that their patients had hallucinations, psychosis, heart rate, diabetes, cardiac problems, liver dysfunction, coma, and blood coagulation problems while on Abilify. Even a very cursory review of the FDA warnings and listing of adverse side effects would cause any responsible legal guardian to reconsider the use of these drugs on a loved one.

 

Psychiatric Drugs cause Parkinson's Effects:


Many patients who take these drugs also develop Parkinsonian side effects about 40-50% (or more) experience Parkinsonian symptoms. Julia Child, a very famous cook over in the US and the actor Michael J Fox are both famous victims of severe Parkinson’s disease. In Parkinson’s disease people lose these dopamine cells in the substantia nigra area of the brain. With antipsychotic medication, there is not actually death of brain cells but the drug does affect how the brain cells function. So Parkinson’s symptoms do occur in a fairly high rate of patients.

 

 

 

Fatal Blood Problems:


The antipsychotic Clozapine can cause fatal blood problems as well as other side effects of serious concern. Clozaril (clozapine) is a drug which was known to be associated with fatal cases of aplastic anemia which causes low white blood cell counts and predisposes patients to infections. Clozapine has also been linked to high blood sugar and diabetes. Doctors are supposed to watch for unexplained fever, fatigue and low energy levels in patients taking Clozaril. Clozaril has been strongly associated with possible fatal heart problems. [Presto v. Sandoz, 226 Ga. App. 547 (1997)].

 

Saphris or asenapine by Merck:


A new drug recently put on the market is Saphris or asenapine by Merck. Saphris like other atypical antipsychotic drugs is known to increase mortality. This drug causes very serious side effects including the permanent and totally disabling disorder called Neuroleptic Malignant Syndrome, and also Tardive Dyskinesia, Hyperglycemia and Diabetes Mellitus, Weight Gain, Hypersensitivity Reactions, Orthostatic Hypotension and Syncope (fainting), Leukopenia, Neutropenia, and Agranulocytosis (white blood cell problems), QT Prolongation: (heart rhythm problems), Seizures: Potential for Cognitive and Motor Impairment and Suicide (a mother’s worst nightmare). Adverse reactions to the drug Saphris include causing akathisia (restless leg syndrome, unpleasant sensations of inner restlessness that manifests itself with an inability to sit still or remain motionless) oral hypoesthesia (loss of sensation in the mouth causes difficulty in eating and talking), somnolence (sleepiness) and dizziness.

Neuroleptic Malignant Syndrome - Life Threatening Psychiatric Emergency

Risks of Using Combinations of Drugs

Mental health professionals have an ethical duty to inform parents about the potential lethality of drug combinations as well as adverse effects of individual drugs. Yet some psychiatric drugs actually are combinations of drugs. As a medication for ADHD, Adderall was approved for unrestricted use for treatment of ADHD by the FDA in March 1996. Adderall is a combination of stimulants  (a combination of dextroamphetamine and amphetamine). In 2005 Adderall XR  was pulled off the market in Canada after regulators linked the drug to 20 sudden deaths and 12 strokes. Fourteen of the deaths and two of the 12 strokes were in children.  According to Canadian researchers the adverse reactions were not associated with overdose, misuse or abuse of Adderall XR. The effects of amphetamines and methamphetamine are similar to cocaine, but their onset is slower and their duration is longer. (U.S. Drug Enforcement Administration (DEA) fact sheet).

Stimulants are designed to enhance dopamine transmission.  Atypical antipsychotics are intended to block it.  Mental health professionals have an ethical duty to inform parents about the potential lethality of drug combinations as well as adverse effects of individual drugs such as the  combination of both an antipsychotic with a stimulant.  The use of stimulant plus atypical antipsychotic places the patient at risk of sudden death due to stroke or dysrhythmia (heart arrhythmia); neuroleptic malignant syndrome; tardive phenomena (irreversible movement abnormalities of face, tongue, neck, limbs, trunk); and diabetes.   In one sense, the pharmacodynamic effects of stimulants plus antipsychotics would be expected to oppose each other. In another sense, the brain’s adaptations to each class of medication might be synergistic.  This enhances the risk of movement abnormalities, dysphoria (an emotional condition in which a person experiences intense feelings of depression and discontent) , and psychosis.  There are neurotoxic effects of use of stimulants and antipsychotics together; the dangers include the inhibition of neurogenesis and the induction of neurodegenerative changes.  In other words, they prevent the healing process and can cause permanent brain damage and dysfunction.

Violence and SSRI use for PTSD and other mental conditions

No type of antidepressant is helpful in every clinical case or even indicated. These drugs can actually make the situation worse. As a class of drugs SSRIs can create a unique combination of side effects that may severely impair judgment and impulse control in individual patients. Excessive doses of antidepressants can cause brain dysfunctions including disorientation, confusion, and cognitive disturbances. In combat veterans suffering PTSD, impulsive behavior, especially if coupled with impaired cognitive functioning, can be dangerous. Antidepressants can also trigger similar, manic-like symptoms in people whose depression is part of a manic-depressive syndrome, which often gets overlooked when people are given SSRIs. Is public safety enhanced when “patients” are given SSRI’s and are persons on SSRI’s less likely to do gun violence? The pharmaceutical corporations would lead you to believe that a person taking these drugs is less likely to commit suicide and less likely to do gun violence to others. But is that really true?

Recent cases of mass violence such as the Joseph Wesbecker in Virginia that shot his co-workers, the Virginia Tech murders, the Columbine Shootings, and the shootings at Fort Hood, all point to the fact that anti-depressant and SSRI medication are dangerous to the public. These medications can cause homicidal thinking which results in public violence and also in suicides. The pharmaceutical industry wants to use the returning veterans as a huge potential pharmaceutical drug customer base. All veterans are trained to use weapons and often have weapons easily at hand. With Post Traumatic Stress a major problem in the returning troops, we have a social problem to deal with their mental health needs. With the US government picking up the tab, the pharmaceutical companies are lobbying heavily to increase their expected profits from the sales of drugs for Post Traumatic Stress Disorder (PTSD) sufferers. The huge numbers of returning veterans are a prime target of their sales efforts. Big Pharma pours lots of money into the political campaigns of those who support their agenda. These huge pharmaceutical companies have persons on the President's New Freedom Commission on Mental Health that are pushing to do wholesale marketing of selective serotonin reuptake inhibitors (SSRI's) and other mind altering drugs to veterans with PTSD. The constantly expanding prison population is another target for the SSRI drug marketing and especially those prisoners facing re-entry and who will soon have Medicaid/Medicare to pay their pharmaceutical bills.

When SSRI antidepressants such as Prozac, Paxil and Zoloft were first introduced in the late 1980's and early 1990's there were reports of increasing violent behavior including suicide and homicide. There were in 2003 reports by British authorities and the U.S. Food and Drug Administration about unpublished studies showing an increased risk of suicide in children and teenagers taking Paxil. Prior reports of suicidal and homicidal acts in adults taking SSRIs have been minimized by the pharmaceutical company defenders and mainstream doctors, who claim that suicide is common in depression anyway.

The recent violence Nov. 5, 2009 at Fort Hood in Texas in which a military psychiatrist shot and killed 13 people and wounded 30 others gives us good reason to reconsider these psychiatric drug treatments for military personnel and veterans. This incident reminded me of the Northern Illinois University mass shootings where former grad student Stephen Kazmierczak killed 5 students and wounding dozens of others before committing suicide himself. This gunman had been taking the drug Paxil prior to his mass killings. The drug manufacturer had been deliberately withholding information about violent behavior as an adverse effect of the medication. Now the drug Paxil carries a black box warning about homicide and suicide. On Sept 14, 2004, an FDA panel voted 18 to 5 to require manufacturers of all antidepressants to add black box warnings to their product labeling. A month later, the FDA adopted the panel's recommendations.

 

The warning reads in part: "Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior."

 

The warning specifically links antidepressant use to suicidal behavior in four percent of kids on these drugs compared to two percent for kids on placebos.

Psycho-social treatment has better outcomes

A 11 month study compared typical hospital treatment with pure psychological treatment, noting the most severe cases went to the psychological treatment without medication.  Results were no suicide attempts, elopements or other significant acts of violence in the psycho-social treatment group; however, typical hospital drug group with a higher staffed ward had 3 suicides.

 

Diekman, A., and Whitaker, L. (1979). "Humanizing the Psychotherapy ward: Changing

from drugs to psychotherapy."  Psychotherapy: Theory, Research, and Practice. 16

 (2):204-214.

Culturally Appropriate Community Supports for Mental Patients

The patient’s faith belief should be honored with what would be considered to be culturally appropriate alternatives to the medical and biochemical approaches to treatment. There should also be an effort to provide appropriate peer support or other alternatives to the traditional mental health system.

Psychotherapy is  preferable to psychopharmacological treatment, and in many studies it has shown to be more effective than drugs (especially for PTSD) without the potentially troublesome and dangerous side effects. There are proven psychosocial techniques for modifying inappropriate behavior or speech. Mind/body connecting/focusing activities can be helpful. It is valuable to “make contact” with individuals who are unresponsive to usual forms of communication. Also, the mere act of “being with” a person who is experiencing profound emotional distress can provide great solace. [See Dan Dorman’s book, Dante’s Cure, for a real-life story of a woman who made a complete recovery from psychosis, and how that journey occurred.]


People labeled with psychiatric disabilities should be able to select from a menu of independently available services and programs, including mental health services, housing, vocational training, and job placement, and should be free to reject any service or program. Mental health treatment should be about healing, not punishment. Accordingly, the use of aversive treatments, including physical and chemical restraints, seclusion, and similar techniques that restrict freedom of movement, should be banned. Moreover, in part in response to the Supreme Court's decision in Olmstead v. L C., state and federal governments should work with people labeled with psychiatric disabilities and others receiving publicly-funded care in institutions to expand culturally appropriate home- and community-based supports so that people are able to leave institutional care and, if they choose, access an effective, flexible, consumer/survivor-driven system of supports and services in the community.

News Stories on Integration into the Community

Press Releases by Brazelon Center
Judge Grants Enormous Victory for New York Adult Home Residents; Orders State to Provide Supported Housing for All Qualified Residents Who Want It (3/1/10)
Disability Groups Win Landmark Case Affirming Rights of People with Mental Disabilities in State-Funded Adult Homes (9/8/09)
Federal Court Upholds Rights of People with Mental Illnesses in Adult Homes (2/19/09)
Lawsuit Seeks Community Integration for Thousands of New Yorkers with Mental Illnesses
(7/1/03)

News
Judge: Mentally Ill Should Move Homes to Neighborhoods, ABC News, (3/4/10)
Judge Orders New York City to Move Mentally Ill Out of Large, Institutional Housing, The New York Times (3/1/10)
Judge Orders Out Mentally Disabled Residents of Adult Homes, If They Want To Live On Their Own, New York Daily News (3/1/10)
Federal Judge Rules NY Violated Americans with Disabilities Act in Housing Mentally Ill, AP (9/8/09)
State Discriminated Against Mentally Ill, Judge Ruled, New York Times (9/8/09) 

Press Releases in Illinois
Federal Court Asked to End Isolation of Illinois Residents with Mental Illnesses (4/23/06)

Federal Court Advances Challenge to Illinois Policy Warehousing Residents with Mental Illnesses (11/20/06)
Historic Agreement Reached to Transition Illinois Residents Unnecessarily Housed in Large, Dehumanizing Nursing Homes (3/15/10)

Press Releases by Brazelon Center
Lawsuit Challenges Unwarranted Confinement of People with Mental Illnesses in Connecticut Nursing Homes (2/6/06)

Statement from Bazelon Attorney (2/14/06)
Judge Denies Connecticut’s Request to Dismiss Charges that It Unnecessarily Warehouses People with Mental Illnesses in Nursing Homes, Violating Federal Law (4/1/10)
Media
Thousands with Disabilities Locked Away in Nursing Homes, The [New London] Day (12/19/04)

Many Mentally Ill in State Are Housed Without Proper Care, The [New London] Day (8/7/05)
Civil Rights Agency Probes State's Handling of Mentally Ill, The [New London] Day (12/4/05)
Group Probes Mentally Ill in Nursing Homes, Associated Press (12/4/05)
Mental Health Care Probed: Rights Group Questions State's Placement System, Hartford Courant (12/5/05)
Lawsuit Seeks End to Warehousing of Psychiatric Patients, WFSB-Eyewitness News(2-7-06)
Firm Willing to Talk with State about Lawsuit, The [New London] Day (2/15/06)
Rell Urged to Change Policies for Mentally Ill, Hartford Courant (2/15/06)
Mental Health Policy Costs State Medicaid Funds, Hartford Courant (5/3/08)

Media in Illinois
Mentally Ill in Illinois Win Right to Community Care, Psychiatric News (4/16/10)
Pact to Decrease Number of Mentally Ill People in Nursing Homes: Federal Judge OKs Settlement to Serve People in Community Settings
, Chicago Tribune in the Los Angeles Times, (9/30/10)

 


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Bola J, et al. “Treatment of acute psychosis without neuroleptics: two-year outcomes from the Soteria project.” Journal of Nervous Mental Disease 191 (2003):219-29.

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Crane, G. “Clinical psychopharmacology in its 20th year,” Science 181 (1973):124-128. Also see American Psychiatric Association, Tardive Dyskinesia: A Task Force Report (1992).

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FDA approval letter from Robert Temple to Janssen Research Foundation, December 21, 1993.

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Knable, M. B., Kleinman, J. E., & Weinberger, D. R. (1998). Neurobiology of schizophrenia. In A. F. Schatzberg & C. B. Nemeroff (Eds.), Textbook of Psychopharmacology, 2nd ed., (pp.595-596). Washington, DC: American Psychiatric Press.

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Lehtinen V, et al. “Two-year outcome in first-episode psychosis according to an integrated model. European Psychiatry 15 (2000):312-320.

Lieberman, J, et al. “Effectiveness of antipsychotic drugs in patients with schizophrenia.” New England Journal of Medicine 353 (2005):1209-1233.

Madsen A, et al. “Neuroleptics in progressive structural brain abnormalities in psychiatric illness.” The Lancet 352 (1998): 784-5.

 

Mattes, J. “Risperidone: How good is the evidence for efficacy?” Schizophrenia Bulletin 23 (1997):155-161.

Maloy, Analysis: Critiquing the Empirical Evidence ; Does Involuntary Outpatient Commitment Work? Mental health Policy Resource Center (1992).

McGuire, P. “New hope for people with schizophrenia,” APA Monitor 31 (February 2000).

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Rosebush, P. “Neurologic side effects in neuroleptic-naïve patients treated with haloperidol or risperidone.” Neurology 52 (1999):782-785.

Schooler, N, et al. “One year after discharge: community adjustment of schizophrenic patients.” American Journal of Psychiatry 123 (1967):986-95.

Shear, K et al. “Suicide associated with akathisia and deport fluphenazine treatment,” Journal of Clinical Psychopharmacology 3 (1982):235-6.

Seikkula J, et al. Five-year experience of first-episode nonaffective psychosis in open-dialogue approach. Psychotherapy Research 16/2 (2006): 214-228.

Sweeney, J. “Adverse effects of risperidone on eye movement activity.” Neuropsychopharmacology 16 (1997):217-228.

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 Van Putten, T. “Behavioral toxicity of antipsychotic drugs.” Journal of Clinical Psychiatry 48 (1987):13-19.

Van Putten, T. “The many faces of akathisia,” Comprehensive Psychiatry 16 91975):43-46.

Waddington, J. “Mortality in schizophrenia.” British Journal of Psychiatry 173 (1998):325-329.

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Whitaker, R. Mad in America. New York: Perseus Press (2002):279-281.

Wysong, P., PET Brain Scans Best to Determine Schizophrenics’ drug dosages, In Washington Post, April 12, 2000, Vol. 36, Issue 14.

Reference on effects of psychiatric medications:

Dr. Grace E. Jackson MD ‘What Doctors May Not Tell You About Psychiatric Drugs’ Public Lecture, UCE Birmingham June 2004

Reference on Iatrogensis:

Weingart SN, Ship AN, Aronson MD (2000). "Confidential clinician-reported surveillance of adverse events among medical inpatients". J Gen Intern Med 15 (7): 470–7. doi:10.1046/j.1525-1497.2000.06269.x. PMC 1495482. PMID 10940133.)


References on Tardive dyskinesia:

Breggin, Peter R., M.D. (2001), Tardive Dyskinesia Legal Settlement, Breggin.com
Brašić, James Robert, MD; Bronson, Brian, MD (21 January 2010), Tardive Dyskinesia: Treatment & Medication

Crane, George E. (Sep 1973a), "Is tardive dyskinesia a drug effect?", AJP (American Psychiatric Association: American Journal of Psychiatry) vol.130 (no.9): 1043–4, ISSN 0002-953X, OCLC 104768868, PMID 4727768

Crane, George E. (Oct 1973b), "Rapid reversal of tardive dyskinesia", AJP (American Psychiatric Association: American Journal of Psychiatry) vol.130 (no.10): 1159, ISSN 0002-953X, OCLC 104790755, PMID 4728916

Fernandez, Hubert H., MD; Friedman, Joseph H., MD (Jan 2003), "Classification and Treatment of Tardive Syndromes", Neurologist (Baltimore US-MD: Williams & Wilkins: The Neurologist) vol.9 (no.1): 16–27, doi:10.1097/01.nrl.0000038585.58012.97, ISSN 1074-7931, OCLC 111183504, PMID 12801428

Glazer, William M.; Morgenstern, Hal; Doucette, John T. (Apr 1993), "Predicting the Long-Term Risk of Tardive Dyskinesia in Outpatients Maintained on Neuroleptic Medications" JCP (Memphis US-TN: Physicians Postgraduate Press: Journal of Clinical Psychiatry) vol.54 (no.4): 133–9, ISSN 0160-6689, OCLC 119262955, PMID 8098030

Glenmullen, Joseph (2000), "Ch.1.", Prozac Backlash, New York: Joseph Glenmullen. Simon & Schuster, p. 38 .pdf

Gualtieri, C. Thomas; Barnhill, L.J. (1988), Wolf, Marion E.; Mosnaim, A.D., eds., "Tardive Dyskinesia, Biological Mechanisms & Clinical Aspects", Tardive Dyskinesia in Special Populations (Washington, D.C.: American Psychiatric Press): pp. 137–154, ISBN 0-88048-176-5

Hoerger, Michael (2007), "The primacy of neuroleptic-induced D2 receptor hypersensitivity in tardive dyskinesia", Psychiatry Online (Psychiatry Online) vol.13 (no.12): 18–26

Jeste, Dilip V.; Caligiuri, Michael P. (Feb 1993), "Tardive Dyskinesia", Schizophr Bull (Schizophrenia Bulletin) vol.19 (no.2): 303–315, doi:10.1093/schbul/19.2.303, PMID 8100643

Saltz, Bruce L., MD; Woerner, Margaret G., PhD; Kane, John M., MD; Lieberman, JA; Alvir, JM; Bergmann, KJ; Blank, K; Koblenzer, J et al. (6 November 1991), "Prospective Study of Tardive Dyskinesia Incidence in the Elderly", JAMA (Chicago US-IL: American Medical Association: Journal of the American Medical Association) vol.266 (no.17): 2402–6, doi:10.1001/jama.266.17.2402, ISSN 0098-7484, OCLC
116673469, PMID 1681122

Libby Zion Law - Serotonin Syndrome - Medical Error

1. Philibert I.; Friedmann P.; Williams W. T.; for the members of the ACGME Work Group on Resident Duty Hours (2002). "New Requirements for Resident Duty Hours". Journal of the American Medical Association 288 (9): 1112–1114. doi:10.1001/jama.288.9.1112. PMID 12204081. edit

2. Zion, Sidney (December 18, 1997). "Hospitals Flout My Daughter's Law". New York Daily News. Retrieved 2009-02-13. "After it became clear to everybody, including a New York County grand jury, that Libby's death was caused by overworked and unsupervised interns and residents, the Libby Zion law was passed: No more 36-hour shifts for interns and residents; from now on, attending physicians would be at the ready to supervise the young, inexperienced student-doctors."

3. Fox, Margalit (March 5, 2005). "Elsa Zion, 70. Helped Cut Doctor Workloads.". New York Times.

4. Jane Ellen Brody (February 27, 2007). "A Mix of Medicines That Can Be Lethal". New York Times.

5. Spritz, N. (August 1991). "Oversight of physicians' conduct by state licensing agencies. Lessons from New York's Libby Zion case". Annals of Internal Medicine 115 (3): 219–22. PMID 2058876.

6."Libby Zion".  New York Times. March 6, 1984.

7. Lerner, Barron H. (November 28, 2006). "A Case That Shook Medicine: How One Man's Rage Over His Daughter's Death Sped Reform of Doctor Training". The Washington Post.

8. Asch, D. A.; Parker, R. M. (March 1988). "The Libby Zion case. One step forward or two steps backward?". New England Journal of Medicine 318 (12): 771–5. doi:10.1056/NEJM198803243181209. PMID 3347226.

9. Sack, Kevin (November 1, 1991). "Appeals Court Clears Doctors Who Were Censured in the Libby Zion Case". New York Times.

10.  Lerner, Barron H. (March 2, 2009). "A Life-Changing Case for Doctors in Training". New York Times. Retrieved March 7, 2011.

11.  Hoffman, Jan (February 7, 1995). "Jurors Find Shared Blame In '84 Death". New York Times.

SSRI's and Suicidality and Violence

The Kauffman SSRI Study:


Joel M. Kauffman, Ph.D., professor of chemistry emeritus at the University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19104-4495,
Contact: kauffman@bee.net.

Journal of American Physicians and Surgeons Volume 14 Number 1 Spring 2009 11
Potential conflicts of interest: The author has neither a financial interest in any drug mentioned, nor in any alternate treatments for treating any mentalillness.

References:

Richard DeGrandpre.  The Cult of Pharmacology: How America Became the World’s Most Troubled Drug Culture
Durham, N.C.: Duke UniversityPress; 2006.

The Cult of Pharmacology: How America Became theWorld’s Most Troubled Drug Culture.
Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk forreported suicidal ideation and suicide attempts in pediatricantidepressant treatment. 2007;297:1683-1696.

Jørgensen AW, Hilden J, Gøtzsche PC. Cochrane reviews compared with industry supported meta-analyses and other meta-analyses of the same drugs: systematic review. doi:10.1136/bmj.38973.
444699.0B (publ Oct 2006).

Cohen JS. New York, N.Y.: Tarcher/Putnam; 2001.

Mackay FJ, Dunn NR, Wilton LV, et al. A comparison of fluvoxamine,  fluoxetine, sertraline and paroxetine examined by observational cohort studies. 1997;6:235-246.

Park L, Covi L. Nonblind placebo trial. 1965;336-345.

Cole JO. Therapeutic efficiency of antidepressant drugs: a review. 1964;190:124-131.

Kirsch I, Moore TJ, Scoboria A, et al. The emperor’s new drugs: an analysis of antidepressant medication data submitted to the U. S. Food and Drug Administration. 2002;5(1):23-33.

Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. 2008;5(2):e45. doi:10.1371/journal.pmed.0050045.

Healy D. One flew over the conflict of interest nest. 2007;6(1):26-27.

Healy D. New York, N.Y.: New York University Press; 2004.

Healy D. FDA Psychopharmacologic Drugs Advisory Committee hearings. Available at:: www.healyprozac.com/PDAC. Accessed May 13, 2007.

Wolfe SM, ed. SSRIs can have dangerous interactions with other drugs. 2008;14(1):2-5. www.citizen.org/hrg/. Accessed Feb 4, 2009.

Guide to This Website

General Information 

  

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Residential Abuse of Children  

 

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“Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment, or the smallest act of caring, all of which have the potential to turn a life around.”

― Leo Buscaglia

"Never impose on others what you would not choose for yourself."  Confucius

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Theodore Roosevelt- Excerpt from the speech "Citizenship In A Republic", delivered at the Sorbonne, in Paris, France on 23 April, 1910