One in five Americans will be diagnosed with a mental illness in their life time. A majority of those diagnosed will be prescribed a pharmaceutical drug. Billions of dollars are spent for mental health across the nation every year. In the small State of Connecticut where I live, we spent $768.83 million dollars on mental health in 2022. $6.72 million was spent on behavioral health medications. Put simply, Americans are suffering, especially the children. Politicians write up laws guided by industry to address the tsunami of depression and anxiety sweeping the nation. Connecticut just passed an historic mental health bill expanding access to mental health services within public schools.
Under the bill, a "school-based mental health clinic" is a clinic that:
1. is located in or on the grounds of a school facility of a school district or school board or of an Indian tribe or tribal organization;
2. is organized through school, community, and health provider relationships;
3. is administered by a sponsoring facility (e.g., a hospital, community health center, or school system); and
4. provides on-site mental, emotional, or behavioral health services to children and adolescents in accordance with state and local law, including laws relating to licensure and certification.
Specifically all providers must be trained in the following:
Under the bill, any mental health service provider who staffs a school-based mental health clinic established in partnership with a local or regional board of education (1) must be knowledgeable about social- emotional learning and restorative practices and (2) may participate in social-emotional learning and restorative practices training provided to teachers and administrators of the schools governed by the board.
What are “restorative practices” and “social emotional learning”? How does it relate to mental health? According to the RAND corporation, Restorative practices, developed in the justice system as a way to mediate and repair relationships between offenders and their victims, are offering a way forward.” Social emotional learning is exactly how it sounds. Learning via emotions using restorative practices. Every one must participate, teachers, students, and ideally parents and the community at large. This is a brand spanking new social science being adopted worldwide. Supported by John Hopkins, the NIH, and The United Nations.
Schools across the nation are jumping on to this style of education in droves.
“Restorative Practices (RP) represent an attempt to reform school discipline and improve relationships among stakeholders while minimizing punitive disciplinary measures (Vaandering, 2010). Morrison and Vaandeering (2012) posit that RP address “power and status imbalances” by promoting the “soft” power of relationship building and understanding, rather than “hard” power of the institution to impart sanctions as a motivator.” Johns Hopkins School of Education
This is a pretty interesting quote from Johns Hopkins. I originally thought RP was “best practices”, I was surprised it was not. I also find it interesting that state legislators were specific to include RP into the language of the new mental health law. Restorative Practices appears to be a behavioral practice meant to reshape society entirely across the globe using emotions and psychological manipulation. I will dive deeper into this subject in part 2 of this series on mental heath. For now, best practices are the guides and standards that professionals and experts agree work. Industry is the force behind best practices via experts they pick and choose.
The pharmaceutical industry spends hundreds of millions dollars a year on lobbying both the federal government, and local governments across the country. Lobbying is big business in Connecticut. The Journal Inquirer reported in 2019, “More than $32.3 million was spent this year by nearly 1,000 lobbying organizations to push their agendas and try to persuade lawmakers into siding with them on key pieces of legislation.” Way more than $32 million is spent in Connecticut on lobbying though. Most of the time there are more lobbyists in Hartford than lawmakers and citizens advocating for legislation. According to the The Office of State Ethics, the total amount of money spent for lobbying in 2021 to 2022 was, $103,238,301.13. That’s a massive number. One is left wondering, who is writing the laws?
Industry shapes how medicine is practiced through lobbyists, legislation, and large grants to colleges and universities. Big money paid to colleges and universities produces the experts that the lobbyists use to testify in support of pet bills, and against bills it does not like. Industry develops the medical products from pills, injections, vaccines, and medical devices. Industry hires the experts, and funds the research. Industry also does the clinical studies that bring said products to market. Industry is a revolving door to government. For example, Dr. Scott Gottlieb, former head of the FDA, now sits on the board of Pfizer, and has Connecticut Governor Lamont’s ear.
What are the best practices for mental health and psychiatry? Simply put, mental illness is a chemical imbalance that can be genetic, it can be systemic and need life long medication. Your brain is broken, therefore pharmaceuticals are prescribed for long term use.
Decades after the release of the the first antidepressant, Prozac, the chemical imbalance theory for mental illness has been debunked. “A 2010 review of the literature summarized:
“Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy… Conclusions: The reviewed findings argue for a reappraisal of the current recommended standard of care of depression. Second, the "chemical imbalance" hypothesis—the notion that low serotonin causes depression and that antidepressants work by elevating those levels—has failed to find empirical support.Antidepressant medication is no miracle cure.” Psychology Today
Yet there are dozens of new SSRI drugs just like Prozac on the market with millions of people taking them. According Peter Gotzsche, a researcher and scientist, as well as a founding member of the Cochrane Collaboration. Cochrane Collaborative once prided itself on being independent of the pharmaceutical industry. Unfortunately, industry captured the Cochrane Collaborative, and Gotzsche was kicked out for his ground breaking work on psychiatric drugs and the data used to bring those drugs to market. Science requires questioning. Gotzsche went against an industry standard and he paid the price for reporting the truth about his findings. This did not stop him, Gotzsche went on to found, Institute for Science Freedom where he actively works to educate the public about psychiatric drugs.
All drugs manufactured in the United States must supply the FDA with a drug packet insert. The drug insert contains the clinical trials used to determine the drugs effectiveness, how it works, and the side effects. The insert also contains the post marketing data, which is the data collected after a drug goes to market. Post market data can change over time as we have seen with SSRI drugs and the new suicide warning added.
In 2004 the FDA required a blackbox warning on all SSRI drugs due to the reports of suicide risk from the Medicines Healthcare Products Review Agency, MHRA in the United Kingdom. In 2008 the age limit was raised to age 25 after a meta analysis of the data on antidepressants was conducted by the FDA.
A blackbox warning is supposed to be a means to warn prescribers and pharmacists about the potential dangers with usage of the drug. That no longer seems to be the case in the United States. Black box labeled drugs are prescribed all the time. Many times doctors are not even aware of a back box warning. In June of 2022, The National Library of Medicine quietly changed the definition of “black box” to “boxed”.
“Unfortunately, reports over the years suggest that the influence of black box warnings on physicians is not uniform owing to either a lack of understanding about the meaning of the black box or just simply being unaware of the warning itself. In a Harvard Medical School study of 930,000 ambulatory care patients, it was learned that 42% of patients had received prescriptions for black box labeled medications and that corresponding physician compliance with the recommendations on the label were “variable” in nature.” https://druglawjournal.com/black-box-warnings/
Even with the suicide warning for antidepressants, prescriptions are skyrocketing across all ages, especially in younger people. “Prescribing of antidepressants in children aged 5–12 years has increased by more than 40% between 2015 and 2021,” figures obtained by The Pharmaceutical Journal. During the pandemic and post pandemic the mental health of children and teens has deteriorated even more. A recent survey found alarming data about the mental health of Generation Z. In an analysis by Harmony Healthcare IT. 57% of the youngest generation is taking medications for mental health conditions!!
How is this possible? More than half of this age group has mental health issues? This is sobering. Many factors could be at play here, but it is fair to take a critical look at the role social media has played in the down turn in our mental health, especially our children. When we add in the pandemic and the government lock downs, it’s not surprising to see our nation is suffering. A captive audience locked inside their homes for two years bombarded by adds for pharmaceuticals is easy prey. With every ad a new disease is sold. You cannot sell a drug without a disease. A SMART Phone is in the hands of 99.9% of American teenagers.
In the 80s, the FDA allowed pharmaceutical companies to advertise directly to consumers. By the 90s there was a flood of drug ads across TV, radio, and print. With a few flimsy rules in place, pandora's box was opened. In the past pharmaceutical companies had to go through a doctor to reach patients. Sale reps visit doctor’s offices till this day to pitch new products with gifts and samples for the office. Every doctor’s office in the country is loaded with pharmaceutical samples and gifts. From posters promoting diseases and drugs, to pens with drug names, note pads with the latest drug name, a model of a spine or a heart stamped with a drug name. The pharmaceutical companies spend billions of dollars marketing to both doctors and their patients.
But social media really opened the flood gates, especially for our kids. Major marketing campaigns are waged that use influencers like actors and social media celebrities to promote diseases, and the drugs used to treat them. The United States and New Zealand are the only two countries in the world that allow drugs to be marketed directly to the public, this is known as DTCM, Direct To Consumer Marketing. Pharmaceutical companies spend billions of dollars a year on marketing. With social media it gets more personal and crafted. If you search up a disease, you will see ads for it.
“In 2020, the pharmaceutical industry spent 4.58 billion U.S. dollars on advertising on national TV in the United States, unsurprisingly representing a big shift in spending compared to the 2019 pre-covid market. In 2020 TV ad spending of the pharma industry accounted for 75 percent of the total ad spend.”
Imagine a 15 year old girl, just moved to a new town and has serious anxiety about school. She looks on line and finds information and links on social anxiety, which is now a disease with a drug for treatment. Next thing, she is actively looking to get her parents, and then family doctor to prescribe it. Will she get informed consent? Will her parents be made aware of keeping an eye on her if she is prescribed an SSRI? Will her parents be made aware of the serious risk of suicide?
Our modern world promotes and actively sells sickness to children. More and more legislation is being written across the country and especially in Connecticut that allows minors to access pharmaceutical products without parental consent or knowledge. A teenager is easily able to to get a prescriptions to psychotropic drugs and all the risks that come with it.
In the next part of this series I will cover the variety of drugs used to treat mental illness, and some of the most severe and rarely spoken about side effects, psychosis, akathisia, violence, and suicide. I will also go a bit deeper into Social Emotional Learning and Restorative Practices and how it relates to both children’s and adult’s mental health.