Overdosed

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http://www.workingforchange.com/article.cfm?itemid=18442

 

Overdosed

 

Bill Berkowitz - WorkingForChange

 

01.26.05 - In October 2003, Rep. Grace Napolitano (D-CA) introduced

House Concurrent Resolution 292. Her resolution expressed " that

Congress should adopt and implement the goals and recommendations

provided by the President's New Freedom Commission on Mental Health

through legislation or other appropriate action to help ensure

affordable, accessible, and high quality mental health care for all

Americans. " Although Rep. Napolitano's resolution is yet to be

accepted, the new Congress will likely take up the issue. When it

does, expect a passionate debate over the role the federal government

should play in promoting a broad array of mental health services.

 

When the Bush Administration set up the New Freedom Commission on

Mental Health in April 2002, it was the first such national focus on

mental health since the Carter Commission of the mid 1970's. Charged

with conducting a " comprehensive study of the United States mental

health service delivery system " the New Freedom Commission unveiled a

set of sweeping recommendations in a report entitled " Achieving the

Promise: Transforming Mental Health Care in America " in July 2003. To

its credit the report promotes a vision that individuals with mental

illness can recover if they are provided access to effective treatment

and community assistance including health care, housing and job supports.

 

While there is widespread support by mental health consumers,

advocates and professionals for the Commission's goals, the report is

not without controversy:

 

# Consumer/client and ethnic organizations/providers are concerned

that the Commission's goal of promoting " evidence-based " or

science-based services may squeeze out support for emerging treatments

that are not yet mainstream;

 

# Privacy watchdog groups and conservative organizations are troubled

by the report's Recommendation 4.2 which states: " The key to improving

academic achievement is to identify mental health problems early and,

when needed, provide appropriate services or links to services. The

extent, severity, and far-reaching consequences make it imperative

that our Nation adopt a comprehensive, systematic approach to

improving the mental health status of children " ; and Recommendation

4.3 which backs the " systematic screening procedures to identify

mental health and substance use problems and treatment needs in all

settings in which children [and] youth... are at high risk for mental

illnesses or in settings in which a high occurrence of co-occurring

mental and substance use disorders exists. In addition to specialty

mental health and substance abuse treatment settings, screening for

co-occurring disorders should be implemented when an individual enters

the juvenile or criminal justice systems, child welfare system,

homeless shelters, hospitals... "

 

# Others are concerned that the lack of new funding for goals and

priorities will result in a federal shell game as existing dollars are

either reshuffled or actually reduced. For example, Medicaid, which

provides essential funding for state mental health services to the

poor, is being held flat or is actually declining as a result of new

federal requirements. States such as Mississippi, Utah and Washington

are cutting the scope of mental health services as well as who is

eligible. Other funding priorities, most notably the wars in Iraq and

Afghanistan, leave little to no room for the expansion of mental

health services.

 

One of the biggest potential problems with the Commission's

recommendations, however, is the unacknowledged influence of the

pharmaceutical industry in the Commission's support for the adoption

of medication algorithms that promote use of new generations of

expensive antidepressants and antipsychotic drugs; the biggest

customers for these drugs are cash-strapped state Medicaid programs.

 

According to a January 2003 report from the Center on Budget and

Policy Priorities, " prescription drug costs [are] the fastest-rising

component of Medicaid costs " and they " are rising sharply because of

increases in the number of prescriptions used, increases in the prices

of prescription drugs, and the tendency for prescriptions to shift

from older, less-expensive drugs to newer, more-expensive ones. In the

past year, the great majority of states have adopted initiatives to

limit the cost of, or access to, prescription drugs to slow Medicaid

spending growth. "

 

The New Freedom Commission cites a Texas-based project called the

Texas Medication Algorithm Project (TMAP) as an evidence-based

practice that leads to better consumer outcomes. Launched in 1995,

while George W. Bush was still Governor, TMAP was developed through an

" expert consensus " process that included the University of Texas, the

mental health and corrections systems of Texas, and representatives

from -- or with strong financial ties to -- the pharmaceutical

industry. TMAP was funded through a grant by the Robert Wood Johnson

Foundation as well as money from ten drug companies.

 

The new generation psychiatric drugs -- both antidepressants and

anti-psychotics -- represent a growth market for drug companies.

" National sales of antipsychotics reached $6.4 billion in 2002, making

them the fourth-highest-selling class of drugs, behind

cholesterol-lowering drugs, ulcer drugs and antidepressants, said IMS

Health, a company that tracks drug sales, " the New York Times' Erica

Goode reported in May 2003. In 2002, according to NDCHealth, another

company monitoring the industry, " more than 7.4 million prescriptions

were written for Zyprexa and more than 7.6 million for Risperdal. "

Antidepressants and antipsychotics thus constitute two of the four top

classes of drug sales.

 

The Texas program -- which tends to support the first line use of

these newer, more expensive antidepressants and antipsychotic drugs --

became the subject of a national debate when Allen Jones, an employee

of the Pennsylvania Office of the Inspector General, turned

whistle-blower and revealed that key officials with influence over the

adoption of TMAP in Pennsylvania had received money and perks from

drug companies involved in promoting the medication algorithm. Jones'

removal from the investigation is now under FBI examination.

 

In his report, posted on the Web site of The Law Project for

Psychiatric Rights, Jones documented that the " pharmaceutical industry

has methodically compromised our political system at all levels and

has systematically infiltrated the mental health delivery system of

this nation. They are poised to consolidate their grip via the New

Freedom Commission and the Texas Medication Algorithm Project. "

 

The influence of the pharmaceutical industry has become so

controversial that the National Institutes of Health recently proposed

new restrictions on its employees' financial relations with drug

companies. According to a mid-July report in Mental Health Weekly, NIH

employees would be limited to no more than 400 hours of outside work

with payments equal to no more than 25% of base pay. Much of this

outside employment and consulting has been on the payroll of the

pharmaceutical industry. If this is a new NIH limit, imagine the

extent of prior drug company direct financial influence.

 

Allen Jones not only investigated the conflict of interest of

Pennsylvania officials but also pointed out that the companies that

funded the start up of the Texas project were big contributors to

Bush's reelection campaign. In addition, some members of the New

Freedom Commission have served on advisory boards for these same

companies, while others have direct ties to the Texas Medication

Algorithm Project.

 

According to a May 2004 New York Times report, drug companies are

using new strategies to capture the government's lucrative Medicaid

and Medicare markets that involved a " focus on a much smaller group of

customers: state officials who oversee treatment for many people with

serious mental illness. Those patients -- in mental hospitals, at

mental health clinics and on Medicaid -- make states among the largest

buyers of antipsychotic drugs. For Big Pharma, success in the halls of

Congress has required a different set of marketing tactics. " And for

the states, increased spending on psychiatric medications is one of

the biggest drivers for the current fiscal crisis that is resulting in

the denial of care to Medicaid recipients and the uninsured.

 

Psychiatric medications are essential to the recovery of many people

with mental illness, but they are not without risk. The dramatic

increase in the use of medications in the treatment of children has

given rise to questions about safety, effectiveness, and the

" off-label " use of drugs without adequate age-specific scientific

research. The role that antidepressants might play in adolescent

suicide has recently made headlines in Britain and the US. There is

also mounting evidence of the serious and even lethal health effects

of the new antipsychotic medications -- including diabetes, serious

weight gain, and heart arrhythmias.

 

While these medications may help people with mental illness live

meaningful lives, the scientific verdict is not in on some of the

newer drugs. What we do know is that these new psychiatric drugs

consume a huge share of the public health care dollar -- often at the

expense of other services. Political influence and big money make

scary bedfellows when questions of health are in the balance.

 

During the past year a number of federal agencies have been developing

policy initiatives and restructuring funding incentives to promote the

Commission's recommendations. In January, the new Congress is expected

to consider related funding increases. Although mental illnesses

remain four of the top ten causes of disability in the US according to

the World Health Organization, it is unclear whether Congress will

move beyond lip service and address our national crisis in mental health.

 

According to a recent Bazelon Center Mental Health Policy Report,

President Bush, rather than actively supporting his Commission's

recommendations, had actually " proposed cuts in his... 2004 budget to

the jail diversion grants program ($7 million) and the seniors mental

health program ($5 million) " -- two areas of critical need according

to the New Freedom Commission.

 

Mental illness is not a Republican or Democratic issue. And while

there are specific grant initiatives that will be dealt with by

Congress, no comprehensive legislative package is " being proposed at

this time, " Leah Young, Director of Media Services at SAMHSA

(Substance Abuse and Mental Health Services Administration), told me

in a telephone interview earlier this fall. " There will be a report, a

roadmap " that will be issued later this year that will discuss " where

we are going from here, " she said.

 

This article was written with the assistance of my wife, Gale

Bataille, the Director of Mental Health for Northern California's San

Mateo County.

 

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