Calling all DU mental health professionals

[juslikagrzly]

see this thread:

www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=104&topic_id=2413903&mesg_id=2413903

We should contact our various professional organizations and find out their position on this and let them know ours.


Sorry if I linked incorrectly. Somewhat computer illiterate :)

[whistle]

1. By showing that all Americans are mentally ill, Bush can claim....

...his mental illness is normal.

[Warpy]

4. Worse, it's likely to be politically loaded

and set up to identify people who will resist orthodoxy.

That's what Stalin did.

[demoHere]

20. wow

scary

[HuckleB]

2. If the screening was offered to everyone, but not mandatory...

what would your thnk about the proposal then? What would you say to your professional organization about it?

[juslikagrzly]

5. I'd like to know

where the organizations stand on this. My stand is that it sounds too much like it could easily be abused. I'm also not sure that the schools are the place to handle this. They can barely (if at all) manage what they're mandated (no funding) to do now. I also have issues with the movement toward diagnosing "disorders" that are actually just life problems, social ills, etc. As someone said in the other post, paraphrased, "a pill for everything" is not the answer we need to be looking for.

Edit for typos

[HuckleB]

6. Are you a member of the APA?

Oh, I just got shudders, thinking about their style book. But I digress, as usual.

What type of abuses do you anticipate from such a program? Do you see them occurring even if it's not mandatory?

Who do you see as diagnosing "disorders" that are actually just life problems? Where does this occur? Who is doing the treatment for these overdiagnosed folks, and why?

Just curious. I'm really trying to understand what you're saying.

Thanks.

[juslikagrzly]

21. Gone from this thread for awhile, sorry

and it appears you may have put us all on ignore, but I'll attempt to answer your questions. BTW, what are your opinions? All I've seen are questions.

No, I am not currently a member of APA, dropped my membership several years ago. Oppositional personality, and it's just too damn expensive.

Possible abuses? Poorly trained personnel manning the programs; well done assessments require specialized training and experience and there is no way such a program will properly fund what would be needed to carry out such assessments. Hell, No Child Left Behind isn't even funded well. Funding issues leading to short-cuts, quick fixes rather than reasoned, well-thought out responses. Based on my experience in both practice and academics, we the American people, seem to believe that all can be fixed with medication and "behavioral programs" based in part on what we see in TV ads. Well, here's a question for you? How can hunger, poor medical care, poverty, or just a plain old crappy life be fixed with medication and behavioral programs? I'm not completely against meds, they are quite helpful for some people. But, the FDA is currently reviewing its policies regarding the use of psychopharmaceuticals in young people. We just don't know enough about how drugs affect kids. As I stated in the other thread, harried, underpaid teachers may be more likely to refer kids for assessment just because the kid gets on his/her nerves. If there are actually so many mentally ill children out there who are in need of such a program, WHY? Why aren't we addressing the social ills that underlie many so-called disorders? Because it's cheaper, and faster, thats why.

Any kind of program like this, mandatory or not, should scare all of us silly.

Life Problems vs. Diagnoses? The question should be why have we decided that sadness or grief is automatically depression? Why is active curiosity now ADHD? Why is caffeine addiction in the DSM? There ARE mental illnesses, of course, and people may need help and guidance to work through those issues or learn to cope, but these algorithms remove the humanity from the equation. Mental health diagnosis is subjective and very susceptible to bias and prejudice. The best minds in the field can't agree.

Where does it occur? In every community mental health center, psychiatric hospital, counseling center, etc. We have students in practicum at all kinds of sites and I hear about it everyday. I'm certainly not implying that all mental health professionals are unethical money-grubbing idiots. Most go into this field with a true sense of altruism and compassion. It's the system that is broken, not the folks in it necessarily.

Who is doing the treatment and why? Depends. Since most states now license masters level counselors, and since they generally can be hired for less money than Ph.D.s, they tend to bear the brunt of this. Most (not all) masters programs do not focus on assessment and testing. As I said earlier, proper and ethical assessment requires specialized coursework and supervised experience. And not all Ph.D. mental health professionals specialize in assessment. I'm not sure there are enough assessment specialists out there for this kind of program.

Now you know what my opinions are, what are yours?

And I recommend reading Thomas Sasz. An oldie, but a goodie.

[HuckleB]

24. Thank you very much for your thoughtful response.

I will respond later today, when I find the time to respond in kind.

[HuckleB]

30. Finally...

Regarding assessments, yes, your concern about a shortage of pediatric mental health professionals is valid, by any current measure. However, this is a screening program, not a program intended to offer full assessment for every child. Screening in schools can be done via RNs, LCSWs and others, with referrals made to more highly trained mental health professionals for those children who present with serious symptomalogy. This is no different than screening for vision or scoliosis. We don't send opthalmologists and surgeons to do the screenings in schools for those matters. Still, I certainly acknowledge your concern about the shortage of pediatric mental health professionals. This is part of the problem in regard to assessment for diagnoses such as ADHD and depression in children today. Full and competent assessment is not provided in far too many cases.

Your concern regarding funding, leading to shortcuts is, of course, also valid. This is probably my biggest concern for such a program, though it doesn't make such a program inherently evil, in and of itself. Follow-up must be available to make such a program worthy of itself. Currently, it's not available in many parts of the country, and not just for mental health matters.

As for your opinion of the "American people" and the quick fix. I agree that this is an issue for some. I don't see it as widespread in the general population as you do, however. Further, I see increased mental health care parity as one of the few ways to begin to educate the public and general practitioners of the need for more complete, competent and ongoing assessments, in addition to more robust treatment for those with an actual, viable diagnosis, including therapy, medication when truly warranted, with consideration of environmental issues, including the family and school. Further, we've all had teachers send children for assessment where it was clearly not warranted. That's a problem of education and professionalism on one end. Of course, if a physician or mental health care professional concurs without truly doing full assessment, with an ongoing component, and merely feeds the child medicine, that, too, is a failure of education and professionalism. It has been my experience that both sides of that coin are working harder to address matters more holistically as time goes on. Of course, no human system is perfect, and, in the end, the balance of risk versus benefit is always tenuous.

Again, I don't see evidence that sadness is being diagnosed as depression on any widespread scale. Yes, there are some general practitioners prescribing SSRIs without a full and ongoing assessment. This, too, is something that is changing, as more and more GPs do not choose to prescribe psychotropics, at least without full consultation with a mental health professional. Yes, most health care diagnoses end up being subjective, to some extent. The reality is that health care is still very much an art, regardless of the science involved. Still, those who use the DSM for diagnosis, and who were taught at reputable schools, understand that diagnosis cannot be made for mere sadness, for example. Further, they know that the diagnosis cannot be made without the client facing serious deficits in function.

Also, I am wondering if you have ever seen an assessment where anyone gave the diagnosis of caffeine addiction?

Oh, what social ills do you see as underlying ADHD, depression, etc... and how do those ills affect the genetic component of these diagnoses?

I guess you hear about it every day. I don't. That's interesting.

I do wonder about your last statement regarding who is doing the treatment. Yes, it's true that LCSW's and masters level therapists now abound on treatment teams everywhere. And it's true that they did not receive the same level of education and training in assessment as psychologists do. However, your earlier concern about the quick fix via medication doesn't connect to this concern about masters level therapists, in my opinion. These folks can't prescribe, and neither can psychologists except in New Mexico, and it's not my experience that these folks are stuck in a quick fix mode, or are the folks jumping to a conclusion about an ADHD diagnosis (which must be made only after excluding all differential diagnoses, in addition to meeting the rest of the criteria across environments with serious functional deficits involved -- and, yeah, I know that doesn't always happen).

As for me, I don't think such a program should be mandatory, but I see no inherent evil in such a program. Early intervention can actually keep many children off medications, and could provide for more even growth and development curve. However, I don't see such a program as anything but window dressing unless it coincides with programs intended to increase the number of pediatric mental health professionals who can do ongoing care, increase the education of teachers on mental health and development, and increase the available health care funding to pay for more holistic treatment.

Again, thanks for your thoughtful response.

[HuckleB]

7. FYI -- The APA opposed the Ron Paul Amendment.

http://www.apa.org/ppo/issues/pihastertltr904.html

[bobbieinok]

16. do I understand correctly? the APA thinks it's ok to have mandatory

mental health screening?

if so, we have another instance of the bushco cleverly using words to appeal to target groups who fail to understand the implications because of their own narrow concerns (see a problem and are looking for help)

[HuckleB]

18. What is it that the APA fell for in this case?

What are the implications you write about? What are the APA's own narrow concerns?

[Eloriel]

8. There's no reason for the federal government (or state either)

to get involved in diagnosing ANY illness, let alone mental illness. There's no reason for them to keep records about the state of our physical and ESPECIALLY not mental health.

MY question is why are you not seeing the danger here -- even if it's "not mandatory"? The incursion into our rights to privacy alone are entirely anti-democratic and unAmerican. Add to that little, inconsequential fact that the FASCISTS are currently in charge of every freakin' thing and it's even more appalling that anyone would pose any question based on the premise that it could possibly be a "good" thing.

:grr:

And that's not even touching on the pharmaceutical industry ties with this administration, the pharmaceutical ties with fascist Nazi Germany, the pharmaceutical ties with the CIA, the Bushes' love of eugenics, the PNAC plan's interest in bioweapons that specifically target certain genetic groups.

I repeat: :grr: :grr: :grr:

[HuckleB]

9. If it's not mandatory, how is there an incursion into rights to privacy?

What are your thoughts about Universal Health Care? From your statements in this post, it would seem that you must be opposed to it wholeheartedly. But I don't want to make such an assumption.


On edit...

And I'm sorry, but I don't see the connection you attempt to make in asserting that I am somehow unAmerican for asking questions about the stances people have taken on this matter. In fact, I find the assertion to be quite unfounded. Quite scary, and quite siimilar to the actions which you purport to be so aghast by. But that's just my little old opinion. Take it for what it is or isn't.

[Eloriel]

12. If Universal Healthcare includes doctors as state employees

and the government making diagnoses and meting out treatment, then I'm afraid I'd be against it.

I don't believe that the government has any right to control over its citizens' individual health, and especially not mental health. If you'll re-read my previous post (and also read the thread linked to in the OP), you'll see that there are MANY serious and quite real reasons for grave concern about this proposal.

Further, have you ever know of ANYthing George W. Bush did that was intended to benefit the country or its people rather than reward his cronies, raid the Treasury, curtail rights, accelerate environmental degradation, etc.?

And I'm sorry, but I don't see the connection you attempt to make in asserting that I am somehow unAmerican for asking questions about the stances people have taken on this matter. In fact, I find the assertion to be quite unfounded. Quite scary, and quite siimilar to the actions which you purport to be so aghast by. But that's just my little old opinion. Take it for what it is or isn't.

Nowhere did I even imply that YOU are unAmerican. (Having a bad reading comprehension day?) Here's what I said:

MY question is why are you not seeing the danger here -- even if it's "not mandatory"? The incursion into our rights to privacy alone are entirely anti-democratic and unAmerican. Add to that little, inconsequential fact that the FASCISTS are currently in charge of every freakin' thing and it's even more appalling that anyone would pose any question based on the premise that it could possibly be a "good" thing.

In case you're still missing it, I said the proposal is antiAmerican and anti-democratic because of the violation of privacy rights. Is it your proposal? If not, I'm not saying YOU are anti-democratic or anti-American.

But I still find it appalling that you (a) don't see the dangers on your own, and (b) are working from some inexplicable premise that this administration is even capable of doing ANYthing to benefit regular people. And now I'll add (c) that you would twist my words thusly.

[HuckleB]

13. OK.

So you repeated what you said but didn't understand why I would think you were calling me unAmerican? Wow!

Further, you didn't answer my questions. All I've read thus far is overblown rhetoric and hysteria. I am trying to find someone who will actually discuss this on a level where the discussion can have some real world meaning. I'm not sure why this is so difficult to find at DU anymore.

Thanks, but I don't think it's worth my time discussing this matter with you. My reading comprehension is quite fine. Thanks. Umm. But if you want to actually answer the questions I asked, I might find the answers interesting. This post basically ignores my questions, and simply restates the generalities you've offered without offering a basis for them.

Hasta...

[Eloriel]

14. Wow yourself.

Such a clever debating style you've got there. Your original charges and mischaracterizations have been rebutted, your w questions answered implicitly or explicitly, yet you repeat your twisted allegations, this time in such a way as to make me look like a bully. Remarkable. I can only say that if this isn't intentional on your part, your reading comprehension (or logical thinking processes, one of the two or both) is most certainly NOT "quite fine."

So you repeated what you said but didn't understand why I would think you were calling me unAmerican? Wow!

Right. I didn't THINK of you as unAmerican, and I certainly didn't call you unAmerican. I said the PROPOSAL was unAmerican and reiterated that unless YOU developed the proposal, I wasn't calling YOU unAmerican. That you can't read what's written (twice now and this makes thrice) and understand the meaning is not, I'm afraid, my problem.

Further, you didn't answer my questions.

Yes, I did. You had 2 questions:

If it's not mandatory, how is there an incursion into rights to privacy?

and:

What are your thoughts about Universal Health Care?

I answered both of them both implicitly and explicitly in my first two paragraphs which included the subject line:

If Universal Healthcare includes doctors as state employees
and the government making diagnoses and meting out treatment, then I'm afraid I'd be against it.

I don't believe that the government has any right to control over its citizens' individual health, and especially not mental health. If you'll re-read my previous post (and also read the thread linked to in the OP), you'll see that there are MANY serious and quite real reasons for grave concern about this proposal.


But you ARE right about one thing:

Thanks, but I don't think it's worth my time discussing this matter with you.

If you are unwilling or unable to read and understand what's written in order to respond in an appropriate, intelligible and cogent way, then you ARE wasting your time.

[HuckleB]

17. Thanks more adrenaline fed meanderings.

Yeah, I was right. And you made that oh so clear with this post. Of course, you could actually take a deep breath, step back and think about what other people write before you respond. Nah. That wouldn't be any fun for you, would it? Just stick with what's fun. It's ok. I'll get along without you.

:eyes:

On edit:

And, yeah, you offered an answer on Universal Health care, albeit without context and without thought for what's available otherwise. You did nothing to answer how privacy rights are an issue for a non-mandatory program, however.

I'm adding you to ignore now.

[Eloriel]

22. And who is it that's hysterical?

I think Ignore is entirely appropriate -- glad you thought of it.

[jwirr]

23. Well maybe you would like to

talk to me. If you have not read the book "War Against the Weak" by Edwin Black then you should. The last time the eugenicists/society did a survey of persons with mental health the people were forced and/or coerced into those nice little institutions, sterilized and in general treated as "unfit". After reading the book, which is documented better than any textbook you have ever seen, I wrote to the institutions where my aunt and great aunt were held. They provided me with the records of both women. The older woman died in the institution and the younger one was released years later and did just fine. In the early 1900s they not only institutionalized the mentally ill but they also victimized families by coercing woman into being sterilized so they would not produce more "unfit" children. There was no voluntary about it. That may be what that Oklahoma doctor in the news recently was doing even today.

[HuckleB]

25. I think we're talking about two very different things.

This proposed screening has nothing to do with Eugenics. It does, however, hope to catch issues early on in order to provide early intervention treatments for children in need in order to avoid the increased trauma caused by untreated matters, including the loss of development.

Eugenics was a terrible thing, but it's got nothing to do with this proposal.

[H2O Man]

26. Correct me if I'm wrong ....

but the general proposal has to do with screening children in a school setting. It is not unlike the screening done in most of the public schools that I am familiar with. When we look at it from this position, than we can perhaps identify things that are good and bad in the programs as they are.

Just one obvious example: any bureaucracy will find what works best for the largest number of individuals, and use that as the method to serve everyone. The problem then becomes the individual with needs that appear similar to the larger group, but are indeed distinct.

Thus, if there are children with the attention deficit disorders being treated "successfully" with medications, a bureaucracy such as a school will tend to advocated that children who exhibit many of those same behaviors with the same medications. Yet there can be little doubt that a complex combination of genetics and environment come in to play; for a youngster, this includes the environment from one or more homes, and from one parent to two parents & two "step-" parents, an extended family that may be nurturing or unsupporting, etc etc. How many schools have the funding needed to do a thorough study? Let me guess: the No Child Left Behind program will fill the funding gaps?

Of course, we can always coordinate services with county agencies, right? How many of us have worked in a situation that involves a department of social services, a mental health clinic, a school, and a family in need? Through in probation and alcohol & drug abuse services? It can work remarkably well. But it often doesn't. The lack of resources plays as big a role as the bureaucracy and personalities involved.

So, even in an area as potentially important as screening in a school setting, there are a huge number of opportunities to help children and families, and a huge number of ways to either not help or even harm families. I suspect that to the extent that insurance companies and the drug companies dictate the services provided, damage will be done to children, to families, and to schools and communities.

The other potentially damaging force on a local level comes from having a general lack of democratic/leftists on school boards. We should be very aware that those from the "right wing" have limited definitions of what makes a healthy family, what is in the best interests of children, and what type of mental health service providers they want in the schools.

[HuckleB]

27. This is a screening program.

Children would be referred for a full assessment elsewhere, just like when children get screenings for scoliosis, hearing, eyesight, etc... In regard to ADHD, it's been my experience more and more that schools referring kids to psych providers for assessment of ADHD generally find psych providers rather skeptical of said referrals, leading to more appropriate, lengthy and ongoing assessments of diagnosis and any treatment that is provided.

There is little doubt that we live in an era where insurance companies have created a great deal of problems for those who provide health care and, of course, more pointedly to those who need health care. This is especially true of mental health. Of course, this leads back to our example above. Many kids end up getting referred to general practitioners who do not have the training, expertise or time to truly assess for ADHD, or any other mental health diagnosis. They cannot truly rule out possible different diagnoses due to these factors. So, yes, this is a huge weakness in our current system, regardless of the proposed screening program. This weakness is where the commission should have begun its proposals for improving mental health services in this country, IMHO.

In the end, yes, resources are a huge issue in providing services to children and adults. That issue overrides any such proposal for screening programs, as the problems inherent in providing ongoing treatment make such programs nearly irrelevant. However, that does not make such proposals inherently evil, as seems to be the consensus on this board.

Thanks for your thoughtful post. It's very much appreciated.

Salud.

[H2O Man]

28. One more thing .....

and I think it is what you are attempting, and doing .... and that is to bring the discussion to the community level. There is no need to discuss the issues here in terms unfamiliar with "common folk." The most successful "mental health" programs and interventions are based on common sense, not some esoteric knowledge. I enjoy reading your contributions on this topic.

[Cleita]

3. Another fuerher took an approach about physical

fitness and those unfit to breed another generation like Jews and Gypsies.

[Jackpine Radical]

10. Since the last thread seems to have died in place,

I'll recap my thread-killing comment here:

Abd BTW I dropped my membership in APA this year mostly because of costs.

I think that, in addition to being a bit-time payoff to Big Pharma, this proposed legislation is a lot like the old Soviet approach to dissidents, in which they would classify them as psychotic, institutionalizee them, & snow them with phenothiazines.

Only in this case it's probly more likely to be ADHD, depression, etc., to be treated with Ritalin, Adderal & SSRIs.

BTW--many or most ADHD kids turn out to be pretty creative as well as rebellious. Just the kind of kid the Neocons would want to get chilled out on Ritalin or dextroamphetamine.

Personally, I'm big into non-drug methods like EEG biofeedback & EMDR for helping people with all sorts of conditions & life problems.

[mia]

11. Good point!

many or most ADHD kids turn out to be pretty creative as well as rebellious. Just the kind of kid the Neocons would want to get chilled out on Ritalin or dextroamphetamine.


Here's a good audio series on the subject.
http://www.worldtalkradio.com/archive.asp?aid=2176

[chookie]

29. That's my sense of it

VERY weird that His Chimperial Majesty should raise mandatory screening for "mental health" issues at this point.

What is the point of "diagnosing" people?

If he is so fucking "compassionate" about the mentally ill -- why not start with leading on insurance parity for mental illness? Jeepers -- that is a really big problem!

What about starting with all the poor folks who got dropped from publically funded mental health care during Gipper's presidency, some of which became homeless and untreated for sometimes very serious disorders?

If diagnosed by His Chimperial Majesty's program, then what? I agree that it sounds like Big Pharmaa, in the guise of pitifully undertrained med techs, will dispense expensive "one-size-fits-all" meds, and His CHimperial Majesty will crow proudly about what a great success the program is, when in fact there is growing evidence that these drugs, while life-saving when given to the right people, can cause harmful effects in others who were not properly evaluated. Then there's the issue of long-term usage....

The Communist totalitarian history of government lead mental health programs leaps to mind. In USSR and CHina, ideologically driven doctors routinely diagnosed dissidents, who were unable to see that COmmunism was a perfect system of government, were obivously mentally ill, and were sent to re-education camps. While I think that may be kinda a hard sell in the US of today, it's not all that far-fetched. However, in an age where prospective employees are subjected to many humiliations when applying for jobs -- like peeing into cups, having your credit history checked, and your privacy scrutinized -- it sounds as though that the kind of climate His Chimperial Majesty says he will create that will be "favorable to business" (what used to be known as "serfdom" or "indentured slavery"), your boss would LOVE to know if you have any signs of psychiatric disorders. It's yet another form of power over you.

Imagine having a disagreement with your boss, and he or she being able to say, "Well, you *have* been disgnosed with histrionic personality disorder (or whatever), and you need to understand that you are deluded by your illness. It's not your fault, and I have great compassion for you, but fuck you."

Fuck Bush! There ALREADY isn't enough care for people ALREADY diagnosed with psychiatric disorders. There is ALREADY abuse and bullying of people with psychiatric disorders in society, even within the mental health field.

I see enormous red flags flying all over the place on this initiative. There is some hidden agenda. Beware.

[H2O Man]

15. One potential abuse:

In 1958, Princeton University social scientist Gresham M. Sykes wrote "The Society of Captives," a study of Trenton State Prison. In it, he noted that inmates with leadership abilities could be "neutralized through the use of solitary confinement or exhile to other state institutions." Sykes continued with a detailed description of how "troublesome slaves" in the Deep South were dumped into areas where their life expectancy was greatly reduced, and concluded that "mental hospital(s can) serve as a dumping ground" for "men recognized as leaders..."

On several occassions in the 1970s, my friend Rubin "Hurrican" Carter was placed in the Vroom Psychiatric Building in Trenton to punish his efforts to obtain humane treatment for the prisoners and guards in the New Jersey prison system. It was an example of the Soviet-style "mental health system."

I was employed at a progressive mental health clinic for three decades. I saw numerous examples of mental health professionals helping families and individuals improve the quality of their lives. But at best, services help 1/3rd of people; do little for 1/3rd; and fail for 1/3rd.

In recent years, services have become little more than a fast food delivery of medications that keep people from making the changes needed to improve their lives. Very few children should be prescribed medication. But it is becoming the "American way" to be drugged into a stupor where the unacceptable becomes acceptable. Our mental health system is being dictated by insurance companies and drug manufactorers.

Malcolm used to speak of people using dope as being like a patient having novacaine. It allowed the dentist to yank their teeth out without the patient struggling. We have far too many drugged people, having more than their teeth getting yanked, sitting with a dull glow from their legally prescribed dope .... and the blood just a dripping off their jaw.

[Swamp Rat]

19. good post

We have "novacaine on the brain" syndrome.