Sunday, November 8, 2015

Mental Health Consumer Protection Legislation - [Your State Here]

(in progress, still very drafty, comments welcomed)

Preface

Recipients of both voluntary and involuntary mental health services have long been the subject of discrimination and social maltreatment. The history of this in the United States is well documented and includes over 50 years of strategic eugenics on political and social levels. This historic context of discrimination has allowed egregious harms to be perpetuated against recipients of mental health services in the past. Such harms continue to this day, and urgently require effective, corrective legislative action to remediate.

For this reason, those receiving (or at risk of receiving) mental health care deserve legal status under American law as a protected class. Any legislation seeking to curtail the rights of class members should be treated with strict scrutiny. In addition, protective legislation is needed in order curtail current abuses and prevent further harm.


Part 1: A Consumer Protection Bill Requiring Informed Consent and Truthful Advertising in the Prescription of Psychoactive Medications

Rationale

The most urgent current abuse in need of corrective legislation is happening with regard to the prescription of psychoactive medications as a treatment for what is currently being defined as ‘serious mental illness’ (hereafter ‘SMI’).  In Anatomy of an Epidemic, Pulitzer Prize finalist Robert Whitaker explored how the number of people disabled by SMI tripled over the past two decades. Whitaker’s work received wide acclaim for its investigative journalism, including the 2010 Book Award from the Investigative Reporters and Editors (INA).  The present reality, documented by Whitaker, includes the following:

  • Since the advent of psychoactive medications, disability rates for ‘SMI’ have more than tripled in the United States.
  • About 80 percent of people who are prescribed psychoactive medications for an ‘SMI’ do worse long-term rather than better.  
  • Psychoactive medications are highly toxic and result in permanent disability rates 90% or more when taken as directed.  
  • When taken as directed, psychoactive medications cause people to die (on average!) 25 years earlier than their non-complaint counterparts.  
  • Before the advent of these medication, as many as 2/3 of those diagnosed with ‘SMI’ would return to acceptable levels of social functioning.  
  • In Third World countries where people do not have access to these medications, as many as 2/3 of those diagnosed with ‘SMI’ also recover an acceptable level of functioning.  
  • The most successful program in the Western world for addressing schizophrenia uses psychoactive medications only about 20% of the time and then only as a last resort after non-medication interventions.  The program, Open Dialogue, holds mental health providers responsible to provide early, intensive and comprehensive support to families upon receiving notice that a family member is distressed.  Over 2-3 decades of consistent community-based practice, Open Dialogue has virtually eliminated schizophrenia in Finland. 
  • Numerous other effective, non-medical-model approaches for dealing with mental distress exist. Yet, due to funding, advertising and wide scale co-optation of the medical research establishment by the pharmaceutical industry, vulnerable citizens and their families are routinely being told by well-meaning healthcare providers that the only available treatment for their distressing mental status are highly toxic disabling psychoactive medications.  
  • This is a bald distortion of the evidence and requires immediate and aggressive consumer protection legislation to protect the public interests.  

Following is an analogy.   Imagine you purchase a lawn mower that the manufacturer knew, when used as directed, would:
  • Leave 80 percent of lawns looking worse than before they were mowed.
  • Over time, rendered unsalvageable over 90% of the yards it was used on.
  • Decrease the average person’s property value by  1/3.

Who would stand for this?  

As incomprehensible as it seems, this is the state of modern psychopharmacology documented by Whitaker in Anatomy of an Epidemic.  As a result of active collusion between the pharmaceutical industry, psychiatry and the medical research establishment, there is an astronomic market for a dangerous, ineffective, disabling product.  The public relations and marketing have been used so effectively to obscure the human carnage that someday we’ll look back fondly on the tobacco industry think it was selling life savers by comparison.  

As a result, protecting the public health and welfare now requires immediate, aggressive corrective action.  Such action is necessary in order to set the record straight and to prevent further, irreparable damage to innumerable  individuals and families who have already – or might still become - the unwitting victims of this deliberate, fraudulent marketing scam.  

Text of Legislation

Legislative Intent:

  1. To protect public health and welfare from intentionally distorted information about the efficacy of  psychoactive medications in addressing mental states that distres self or others.
  2. To protect public health and welfare from dangerous, disabling products that have been popularized as a ‘treatment’ for mental states that distress self or others.  
  3. To correct the widespread public misconception that psychoactive medications are the only available treatment for mental or psychiatric challenges
  4. To ensure that citizens who are considering taking psychoactive medications are adequately informed of the known and well-established risks

Required Protections:

Any practitioner who proposes to prescribe psychoactive medications to address a mental state that distresses self or others must:
  • provide the following warning / acknowledgement; and 
  • obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before prescribing such medication: 

Required Warning

  1. There is no proven genetic or biological cause of ‘mental illness.’
  2. Psychiatric medications do not correct any known biochemical imbalances in the brain.  After several decades of research, scientist still to do not know how they actually work. 
  3. Currently, there are very few current studies involving the efficacy of psychoactive medications that are not funded by Pharma and/ or conducted by Pharma-funded researchers. 
  4. The Pharma studies that do exist show that, at best, some people benefit from psychoactive medications. However, this is often at the cost of life-limiting, disabling or life-threatening ‘side effects’. 
  5. The non-Pharma studies that do exist suggest the following:
    • About 80% of people will be better off if they are never exposed to psychiatric medications;
    • People in Third world countries where medications are not widely available have a much higher long-term recovery rate from schizophrenia and bipolar disorder (33- 66% recovery) than people in first world countries where medications are routinely prescribed (only 8% recovery)
    • Recovery rates in the United States in the 1940s-1950s, before psychoactive medications were widely prescribed, were vastly higher for bipolar disorder and schizophrenia (33-66% recovery).  Today, with psychoactive medications are widely in use, recovery rates are only 8%.
    • People with serious mental health conditions who are medication compliant do worse and die sooner (25 years sooner!) that those who are non-compliant.
    • Many psychoactive medications have serious (sometimes irreversible) effects that may result in reduced physical, emotional or cognitive functioning, permanent disability and even death.   
    • Many psychoactive medications produce short-term, immediate relief from symptoms.  However, this should be weighed carefully because long-term prognosis often worsens as a result (including the likelihood of more frequent and more severe relapses).  
    • Those with the best recovery rates from serious mental illness are the people who are never exposed to psychiatric medications.
  6. Significant evidence now suggests that Pharma and the American Psychiatric Association have been materially misrepresenting the effectiveness of psychiatric medications for their own financial/ professional gain at great cost to both individuals, families and the public at large.
  7. Many people have successfully recovered from severe psychiatric conditions without the use of psychiatric medications.  
  8. Many people believe that finding alternatives to the use of psychiatric medications either enhanced or enabled their recovery.  

Part 2. A Consumer Protection Bill Requiring Accurate Assessment and Diagnosis in Mental Health and Psychiatric Settings

Rationale:


The National Council for Behavioral Healthcare is a national trade organization which represents behavioral health organizations nationwide.  In 2011, the National Council ‘broke the silence’ on the impact of trauma in behavioral healthcare.  In a special publication devoted entirely to the issue of trauma, National Council leadership called for behavioral health providers in mental health, substance use, criminal justice and public housing settings to recognize and respond to role of trauma in behavioral health.   In this publication, the National Council recognized that more than 90 percent of clients the public mental health system are trauma survivors.  Notably, A. Kathryn Power, then-Director of the Center for Mental Health Services (a division of SAMHSA) wrote:  “Interpersonal violence … is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system.”  Many also have suffered serious neglect and deprivation related to basic human needs like food, shelter and protection from the elements. 
The National Council also recognizes that trauma survivors have rights.  Significantly, these rights are based on our status as human beings and entitle us to effective, trauma-sensitive treatment and care. http://www.thenationalcouncil.org/wp-content/uploads/2012/11/Survivor-Bill-of-Rights.pdf.  Just as important, according to the National Council, universal trauma-informed care is a do-able, effective, cost-saving response to public behavioral healthcare needs. 
Accordingly:  Mental health providers can and should be required to uniformly screen for trauma and provide trauma –informed treatment.  There is no longer any excuse for providers – in Vermont or elsewhere – for offering citizens anything less than complete and competent trauma-informed responses to the behavioral health needs of its citizens.  The premiere organization representing behavioral health providers nationwide has spoken.  Trauma-informed care is the most effective standard of care for behavior health – both from a results and cost-containment standpoint.  There is no reason not to do it.  It is good for everyone.
Here is an analogy:
Imagine you went to your doctor with a common cold.  (Many people think that trauma is the ‘common cold’ of behavioral healthcare).  The reality is that most common colds get better with time even if untreated by conventional medicine.  Your symptoms including a cough, congestion and some wheezing,, which are also symptoms of lung cancer.  
The doctor you went to was a sincere, conscientious competent practitioner.  He read the medical journals and regularly attended meetings of his professional society.  
Unbeknownst to your doctor, however, his professional association had started making a lot of money by promoting cancer drugs and thus was no longer a trustworthy source of information. Consequently, by the time you presented with your symptoms,  everyone was convinced there was a ‘lung cancer epidemic.’  Moreover, aggressive, early high-dose cancer drug intervention had  become the standard of care.  The clear message from the professional licensing and medical research communities was that any medical provider who did otherwise was committing malpractice.  To the contrary, the paradigm shift had progressed so far that many professionals questioned whether the common cold had ‘really’ ever existed.  At the very least, nearly everyone was confident that the common cold was not the cause of the coughing, wheezing and congestion they were seeing today.    
As a result, your doctor never bothered to assess you for a common cold and proceeded to treat you as if you had cancer.  You got worse – because the drugs are highly toxic.  You eventually died (25 years before you would have!) from the effects of the drug.   At that point, people said how sad it was that there is a lung cancer epidemic and that you were its latest victim.  No one ever knew, because no one ever assessed you in the first place, that you had a common cold that probably would have gotten better with time if they had just left you alone.  All you really needed was a bit of support to rest and heal. 
Sound outrageous?  It is.  Yet, this kind of thing is happening in the mental health system every day.  The sad fact is that roughly 90% of those who present in clinical settings are trauma survivors.  Yet, they are being diagnosed and treated as if they have a serious mental illness of genetic or biological origin.  They are further being told that their only treatment option is to take highly toxic pharmaceuticals, which:
  • make 80% of those who take them worse instead of better; 
  • lead to permanent disability in over 90% of those diagnosed with SMI; and 
  • cause those who take them to die, on average, 25 years earlier that their untreated cohorts.   

The travesty this is wreaking on individuals, families and communities in Vermont is unforgivable. It is highly likely that, every day, thousands of Vermonters are being treated with highly toxic drugs for presumed illnesses that they do not have.  The damage being done is potentially huge and almost entirely preventable through proper assessment and treatment.  Accordingly, immediate, corrective action is now indicated in order to protect the public health and welfare from further damage, as well as to seek remedy the damage that has already been done to unknowing, unwitting citizens. 

Text of Legislation 

Legislative Intent: 

  1. To protect public health and welfare from ineffective, incomplete and harmful assessment, diagnosis and treatment involving mental states that distress self or others. 
  2. To correct the widespread public misconception that all distressing mental states are caused by genetic defects or brain malfunction. 
  3. To promote the health and welfare of individuals, families and communities in Vermont by ensuring that pre-existing trauma is assessed, diagnosed and responded to in trauma-informed, culturally-sensitive ways 
  4. To promote public health and welfare by ensuring that systems of care are equipped to offer culturally-sensitive, trauma-informed responses to every Vermont citizen experiencing a mental state that distresses to self or others. 
  5. To ensure that citizens seeking mental health services are accurately informed about, and screened for, the impact of trauma on their biopsychosocial well-being. 
  6. To ensure that actual sources of traumatic distress for Vermonters are properly acknowledged and addressed by mental health professionals. 
  7. To counter the widespread misuse of medication-only approaches that continue to ‘blame the victim’ and pathologize Vermonters’ legitimate responses to distressing life circumstances and events.

Part A: Requirement of Truth in Advertising and Informed Consent Related to Mental Health Assessment and Diagnosis

Required Protections:



Before assessing, diagnosing or treating any Vermont citizen for a mental state that distresses self or others, any behavioral healthcare practitioner in Vermont must:
  • provide the following warning / acknowledgement; and 
  • obtain, in writing, informed consent from the person (and their parent/ guardian, if applicable) before proceeding with such assessment, diagnosis or treatment:

Required Warning


  1. There currently is no accurate means of diagnosing a mental health disorder or distinguishing one so-called ‘disorder’ from another. After decades of research, so-called experts still cannot agree. 
  2. There is no known biological or genetic cause to ‘mental illness.’ To the contrary, recent advances in genetic mapping suggest that the neurological factors involved in ‘mental illness’ are even broader and more diverse than the factors involved in determining human intelligence. 
  3. By far, the most common correlate of mental health system involvement is trauma. Approximately 90% of those in the public mental health system, substance use treatment or corrections settings - and more than of 90% of homeless individuals – are survivors of childhood trauma. Many others may be experiencing the after-effects of a material, emotional, physical, economic, relational or existential traumatic stressor that occurred later in life. 
  4. Many of the symptoms of traumatic distress, including chronic adaptations to traumatic distress, are identical to those of serious mental conditions, including psychosis, dissociation, mood irregularities, motor/ speech/thought disturbances and suicidal/ homicidal ideation. 
  5. If you have not been screened for the after-effects of distressing or traumatic life experiences, events or circumstances, your service provider must do that now. 
  6. If you are suffering from the effects of traumatic distress (past or present): 
  7. Your symptoms may greatly reduce when the source of your distress is addressed and/ or your sense of safety is restored. 
  8. Your treatment provider should not diagnose you with a ‘mental illness’ or prescribe treatment for a ‘mental illness’ unless: 
    • the source of your distress has been substantially addressed; and 
    • your symptoms have not improved or remitted 
  9. Psychoactive medications may provide temporary relief from symptoms while you are working to alleviate the source of your distress. However, you should weigh the risks carefully because the long-term costs may be significant and irreversible. 
  10. Safe and effective alternatives to psychoactive medications exist. They include: 
    • trauma-informed care, 
    • Hearing Voices, 
    • Open Dialogue, 
    • person-centered therapy, 
    • motivational interviewing, 
    • family therapy, 
    • cognitive behavioral therapy, 
    • art or movement therapy, 
    • narrative therapy, 
    • Wellness Recovery Action Planning, 
    • peer respite stays, 
    • peer wellness centers 
    • Intentional Peer Support

Part B. Requirement of Accurate, Unbiased Assessment for Pre-Existing Distress and Trauma


Required Protections:


Before assessing, diagnosing or treating any Vermont citizen for a ‘mental disorder’ as defined in the DSM/ ICD, all behavioral healthcare practitioners in Vermont must offer:
1. Proper Screening: Whenever any person presents or is presented for a mental health assessment, the following is required:

  • ACES Screening upon admission 
  • Comprehensive screening for current, ongoing, or previously unaddressed biopsychosocial stressors. 
2. Proper Treatment: Where ACES or biopsychosocial factors are identified:

  • The admission reason for the current treatment episode shall be provisionally listed as such factor(s). 
  • Such factor(s) shall be accepted for insurance purposes as the provisional diagnosis. 
  • Unless and until the identified factor(s) are substantially resolved or addressed, the Initial treatment plan shall focus on: 
  • Such factor(s), and 
  • supporting the person to alleviate or cope with symptoms/ distress 
  • The reasonable costs involved in alleviating the persons traumatic distress shall be considered legitimate medical expenses and reimbursed as such by insurance, without regard to whether such costs include ‘traditional medical services.’ 
3. Proper Diagnosis: No person shall be diagnosed with a ‘mental disorder’ within the meaning of the DSM or ICD unless and until:

  • The assessments Part A.1. have been diligently conducted in good faith, properly documented in the record, reviewed with the service recipient and acknowledged in writing by both parties. 
  • The service recipient has been offered a broad selection of trauma-informed interventions, including any intervention (whether medication or non-medication) that the recipient requests and could be made reasonably available with due diligence on the part of the provider or the Designated Agency in the locality where service recipient resides 
  • All identified potential sources of traumatic distress have been substantially addressed; and 
  • The person’s symptoms have failed to remit or materially improve. 

Part 3. Preventing Systemic Re-traumatization


Rationale:


Systemic re-traumatization is a common and serious problem in emergency rooms, healthcare settings, and when emergency responders are called in to assist in containing an emerging situation. The trauma cuts all ways and affects everyone on all levels. This includes emergency responders, service providers and service recipients. Sadly, much of this trauma is needless and avoidable.

Numerous alternatives to involuntary ‘treatment’, including medications, exist. Moreover, some psychiatric inpatient settings have reduced their use of involuntary interventions, including seclusion and restraint by over 99% after making a concerted effort at training, prevention, and non-violent implementation over a period of years.

Text of Legislation


Legislative intent:


  • To protect citizens in healthcare situations from avoidable traumatization and/ or retraumatization associated with the mental healthcare intervention and treatment 
  • To protect citizens in vulnerable mental states from being traumatized by the very intenventions that are intended for their benefit. 
  • To make service recipients, the public, intervention teams, and health providers aware of the traumatic potential of the services that are being provided. 
  • To reassure all citizens, regardless of status, that all possible steps are being taken to prevent systemic retraumatization in the name of care. 

Required Protections:


1. Staff training:


All staff whose job roles include interacting with service recipients must be trained in trauma-informed care and eCPR. Training must including annual refreshers for both modalities.

2. Person-centered Assistance:


All service recipients who are receiving involuntary care (or who could be reasonably foreseen to be at risk for receiving involuntary care) – where at the inpatient or outpatient level, must have:

A. 24 hour access to someone (whether staff or volunteer) who is:
  • Trained in trauma informed care, Intentional Peer Support and communicating across alternate realities. 
  • Trained in supporting and facilitating communication for both people in distress and for people who experience communication deficits. 
  • Available within 15 minutes of a request to listen/ assist in person for at least 2 hours per day
  • Available for the remaining 22 hours by phone, text, internet, or in person. 

Such services are deemed necessary upon request and are billable to insurance at reasonable healthcare rates.


B. Daily access to non-medication trauma-informed group learning experiences (whether offered by staff or volunteers), including a minimum of one of the following per day and four different modalities per week:
  • Intentional Peer Support 
  • Hearing Voices Network 
  • Wellness Recovery Action Planning 
  • Icarus Project Groups/ Activities 
  • Harm Reduction for Coming off Psychiatric Mediations 
  • NAMI Peer-to-Peer 
  • Family Therapy 
  • DBT 
  • CBT 
  • Art/ Creativity 
  • Movement / Fitness 
  • Stress-Reduction training (Yoga, Mindfulness, Meditation, etc) 

3. Mandatory review


Every instance of involuntary care or treatment will be considered as a system failure and a potential trauma risk for both staff and service recipients - whether involved as participants or vicariously affected as witnesses. In order to prevent further/ future personal distress or systemic re/traumatization, such persons must be offered access to:

  • A safe, confidential, free avenue to process and make sense of their experience (within 1 hour). 
  • Independent advocates (within 24 hours) to assist them to communicate their concerns and make recommendations for systemic changes, including the following: 
    • coaching and in person communication assistance as requested to restore any relationships affected, whether in the healthcare setting or otherwise.
    • an in-person incident debrief meeting with agency management within 1 week
    • an in-person opportunity for facilitated resolution with others involved within 2 weeks

4. Penalties for non-compliance


Agencies are required to fully collaborate with these procedures and implement all reasonable remedial recommendations in good faith or face treble damages.

1 comment: