New Freedom Commission on Mental Health

The controversial New Freedom Commission on Mental Health was established by U.S. President

President of the United States

The President of the United States of America is the head of state and head of government of the United States. The president leads the executive branch of the federal government and is the commander-in-chief of the United States Armed Forces....

George W. Bush

George Walker Bush is an American politician who served as the 43rd President of the United States, from 2001 to 2009. Before that, he was the 46th Governor of Texas, having served from 1995 to 2000....

in April 2002 to conduct a comprehensive study of the U.S. mental health

Mental health

Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...

service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness

Mental illness

A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...

and children with a serious emotion

Emotion

Emotion is a complex psychophysiological experience of an individual's state of mind as interacting with biochemical and environmental influences. In humans, emotion fundamentally involves "physiological arousal, expressive behaviors, and conscious experience." Emotion is associated with mood,...

al disturbance.http://www.mentalhealthcommission.gov/ The commission, using the Texas Medication Algorithm Project

Texas Medication Algorithm Project

The Texas Medication Algorithm Project is a decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of psychiatric management guidelines for doctors treating certain mental disorders within Texas'...

(TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drug

Psychoactive drug

A psychoactive drug, psychopharmaceutical, or psychotropic is a chemical substance that crosses the blood–brain barrier and acts primarily upon the central nervous system where it affects brain function, resulting in changes in perception, mood, consciousness, cognition, and behavior...

s that entered the market in recent years.

A broad-based coalition of mental health

Mental health

consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission's findings as a launching point for recommending widespread reform of the nation's mental health system.

Opponents of the plan have questioned the motives of the commission, largely from a civil liberties

Civil liberties

Civil liberties are rights and freedoms that provide an individual specific rights such as the freedom from slavery and forced labour, freedom from torture and death, the right to liberty and security, right to a fair trial, the right to defend one's self, the right to own and bear arms, the right...

perspective, asserting the initiative campaign is little more than a thinly veiled proxy for the pharmaceutical industry, which, in its pursuit of profits

Profit (accounting)

In accounting, profit can be considered to be the difference between the purchase price and the costs of bringing to market whatever it is that is accounted as an enterprise in terms of the component costs of delivered goods and/or services and any operating or other expenses.-Definition:There are...

, is too eager to foster psychotropic medication interventions. Some opponents contend that its objectives are to foster chemical behavior

Behavior

Behavior or behaviour refers to the actions and mannerisms made by organisms, systems, or artificial entities in conjunction with its environment, which includes the other systems or organisms around as well as the physical environment...

control of American citizens. However, no commission recommendations specifically call for increased drug use and the commission did call for closer scrutiny of psychiatric drug treatment, months before the Food and Drug Administration

Food and Drug Administration

The Food and Drug Administration is an agency of the United States Department of Health and Human Services, one of the United States federal executive departments...

(FDA) started taking these steps in the wake of reports of increased rates of suicide

Suicide

Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

, especially during the first months of drug use.http://www.mhreform.org/emergency/emergencyresponse_execsummary.htm

Commission reports

On July 22, 2003, the President's commission returned a report containing nineteen formal recommendations, organized under six proposed national goals for mental health. The report of the commission was viewed favorably by most major consumer, provider and other mental health interest groups. Much of the support for the program has centered on the commission's emphasis on recovery from mental illness, its call for consumer and family-centered care, and its recommendation that states develop a more comprehensive approach to mental health.

The commission reported that "despite their prevalence, mental disorders often go undiagnosed," so it recommended comprehensive mental health screening for "consumers of all ages," including preschool children, because "each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders."

According to the Congressional Research Service

Congressional Research Service

The Congressional Research Service , known as "Congress's think tank", is the public policy research arm of the United States Congress. As a legislative branch agency within the Library of Congress, CRS works exclusively and directly for Members of Congress, their Committees and staff on a...

, the commission did not specifically recommend a nationwide screening program for mental illness, although it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care) where research has shown that very high proportions of youth have these disorders. The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Commissions Recommendations

The commission recommended to the president a transforming of the mental health care system to a recovery

Recovery model

The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasizes and supports each individual's potential for recovery...

oriented system , this is against forced drugging of any kind, seclusions, restraints or punishment like behaviors on the part of mental health workers , it is person-centered and proposes the idea that anti-psychiatric alternatives should be used . Of the 22 members on the commission, some were persons who have recovered from mental illness. It was clearly stated in their definition of recovery that some people do make full recoveries from mental illness with out pharmaceutical interventions . So any interpretation that medication was the main idea or concept of the commission is a fallacy. The least restrictive environments proposed were further deinstitutionalization and less dependency from medical (or pharmaceuticals) It would appear that the commission has done extensive research in to the stigma and overall community ignorance with regards to mental health issues.
http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html This public ignorance is often demonstrated in those untreated for their mental illness.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies

Pharmaceutical company

The pharmaceutical industry develops, produces, and markets drugs licensed for use as medications. Pharmaceutical companies are allowed to deal in generic and/or brand medications and medical devices...

, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry's use of front organization

Front organization

A front organization is any entity set up by and controlled by another organization, such as intelligence agencies, organized crime groups, banned organizations, religious or political groups, advocacy groups, or corporations...

s http://www.stanislausconnections.org/2004/07/opinion.htm and the compromise of scientific integrity under color of authority

Under color of authority

Under color of authority is a legal phrase used in the United States indicating a person is claiming or implying the acts he or she is committing are related to and legitimized by his or her role as an agent of governmental power....

,http://nonpartisan.dailykos.com/story/2005/3/18/10135/0441 look askance at the irony

Irony

Irony is a rhetorical device, literary technique, or situation in which there is a sharp incongruity or discordance that goes beyond the simple and evident intention of words or actions...

of the commission's 'freedom

Freedom (political)

Political freedom is a central philosophy in Western history and political thought, and one of the most important features of democratic societies...

' descriptor, contending the commission is yet another example of the excesses of drug industry marketing,http://cjr.org/issues/2005/4/lieberman.asp http://www.nytimes.com/2005/08/06/politics/06fda.html?hp&ex=1123387200&en=faad45ae3cb9265b&ei=5094&partner=homepage and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

A coalition of over 100 advocacy organizations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement

Psychiatric survivors movement

The psychiatric survivors movement is a diverse association of individuals who are either currently clients of mental health services , or who consider themselves survivors of interventions by psychiatry, or who identify themselves as ex-patients of mental health services...

, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long time member and Gesundheit Institute founder Patch Adams

Patch Adams

Hunter Doherty "Patch" Adams, M.D. is an American physician, social activist, citizen diplomat and author. He founded the Gesundheit! Institute in 1971...

, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. "He needs a lot of help. I'll see him for free," said Adams.

TMAP origin criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in Texas

Texas

Texas is the second largest U.S. state by both area and population, and the largest state by area in the contiguous United States.The name, based on the Caddo word "Tejas" meaning "friends" or "allies", was applied by the Spanish to the Caddo themselves and to the region of their settlement in...

, Pennsylvania

Pennsylvania

The Commonwealth of Pennsylvania is a U.S. state that is located in the Northeastern and Mid-Atlantic regions of the United States. The state borders Delaware and Maryland to the south, West Virginia to the southwest, Ohio to the west, New York and Ontario, Canada, to the north, and New Jersey to...

and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas

University of Texas at Austin

The University of Texas at Austin is a state research university located in Austin, Texas, USA, and is the flagship institution of the The University of Texas System. Founded in 1883, its campus is located approximately from the Texas State Capitol in Austin...

, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prison

Prison

A prison is a place in which people are physically confined and, usually, deprived of a range of personal freedoms. Imprisonment or incarceration is a legal penalty that may be imposed by the state for the commission of a crime...

s and State psychiatric hospital

Psychiatric hospital

Psychiatric hospitals, also known as mental hospitals, are hospitals specializing in the treatment of serious mental disorders. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients...

s. The person primarily responsible for bringing these issues to the public's attention is Allen Jones

Allen Jones (whistleblower)

Allen Jones, who worked as an investigator in the Pennsylvania Office of the Inspector General , gained widespread attention as a 'whistleblower' after voicing concerns about attempts by the pharmaceutical industry to implement a mental health screening plan, based on the controversial Texas...

, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the "political/pharmaceutical alliance." It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotic

Antipsychotic

An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...

s and antidepressant

Antidepressant

An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...

s. He further claimed this alliance was "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab."

A bill, 'The Parental Consent Act of 2005', or HR 181, has been introduced in the US House of Representatives

United States House of Representatives

The United States House of Representatives is one of the two Houses of the United States Congress, the bicameral legislature which also includes the Senate.The composition and powers of the House are established in Article One of the Constitution...

by Ron Paul

Ron Paul

Ronald Ernest "Ron" Paul is an American physician, author and United States Congressman who is seeking to be the Republican Party candidate in the 2012 presidential election. Paul represents Texas's 14th congressional district, which covers an area south and southwest of Houston that includes...

, a Republican from Texas. The proposal forbids federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents.

Commission reports

Commissions Recommendations

Opposition

TMAP origin criticism

See also

US government

Commentary