Thank you, Madame Chair Hupp, for your invitation to speak to the Committee today, and to all of you for this opportunity to testify.
My name is John Breeding. I am here today as a father, as a psychologist, and as director of a citizens group called Texans For Safe Education. Some of you know me from 2003 testimony in support of the two new Texas laws resulting from House Bills 1406 and 320 in that legislative session. In essence, these laws back off a bit the persistent tendency of the schools and of Child Protective Services to pressure and coerce parents to have their children labeled with various so-called mental illnesses and administered various psychotropic drugs. The consensus of Texas legislators was that employees in these two state institutions were overzealous in pressuring parents to drug their children, and that these new laws were necessary to protect parent rights to make these kinds of decisions on behalf of their children without pressure or interference from school employees or CPS workers. I mention these laws because they stem from the same overzealous and harmful practices that have made necessary your own Committee inquiry into the use of psychotropic drugs in our foster care system.
Regarding today's subject, my testimony will address two levels. First, I will present a very brief picture of part of what we are dealing with regarding the use of psychotropic drugs with our precious children. Second, I will suggest seven directions for legislation on the issue of psychotropic drugs in foster care.
We all know we are here because the reality of our foster care system is tragic. The system is broken and we are failing our children and families in many ways. Comptroller Strayhorn's report is one excellent window into this truth. Regrettably, it appears that DFPS is unable to even remotely approach an adequate response to the Comptroller's report, taking substantive action on only 7 of 87 recommendations.
When I began testifying on psychiatric drugs in Texas schools, to the State Board of Education in 2000, I presented data showing an estimated 8,000,000 school age children in this country on psychotropic drugs, meaning about 15% of our children, meaning about 1,000,000 of our Texas children. Incredibly enough, indicators today show an even greater number of our children are on these drugs. Many millions continue to be taking the stimulant drugs like Ritalin and Adderall, which are known to affect various organ systems of the body in a bad way, and can and do result in death. (There were an estimated 186 Ritalin-related deaths, mostly from heart damage, reported to the FDA in the 1990s. Experts estimate that this voluntary reporting system represents only 1-10% of the actual incidence, meaning up to 18,600 deaths from this one drug alone.)
The recent increase in numbers of children on these dangerous substances is largely due, however, to increase in other types of psychotropic drugs. You are probably aware of the recent storm of media and regulatory body activity flowing from revelation that the drug industry and the FDA had suppressed data showing that the so-called SSRI antidepressants caused troubling central nervous system states in a percentage of people who take them, and that these states tended to create or exacerbate violent thoughts and feelings, sometimes resulting in suicide or homicide. The daughter of a member of my organization killed herself by hanging at Cedar Park Middle School here in Travis County; her father, Glenn McIntosh, is here to tell you that her suicide was due to the effects of one of the SSRIs called Paxil.) We know these drugs are very dangerous. (In Great Britain, they are now effectively banned for children. Under great pressure, our own FDA agreed to put a very serious black box warning on these drug labels.) Nevertheless, there has been a very large increase in the numbers of children placed on SSRIs in the United States. Not only that, the fastest growing segment of users are age 0-5! (see Sacramento Bee table and attached article on Express scripts data for a glimpse of the trends of psychotropic drug use with children in the United States)
There is another class of psychotropic drugs, whose large-scale use in our mental health system has unleashed the largest epidemic of neurological disease in the history of the world. It is called Tardive Dyskinesia, and virtually anyone who takes the so-called antipsychotic neuroleptic drugs (eg., Thorazine, Haldol, Risperdal, Zyprexa) for a very long time is assured to suffer from permanent brain and central nervous system damage. The shameful and tragic fact is that psychiatry is now on a move to put more and more of our children on these drugs. (The attached table indicates a 281% increase between 1995 and 2001.)
Regarding our foster care system, many times greater than 15 percent of our foster kids are on psychotropic drugs than in the general population. Preliminary analysis of Medicaid data on foster children for November 2003, obtained from the Comptroller, show that over 70% of these children are on psychotropic drugs, about half of those on stimulants, about 15% on the so-called antidepressants. I have confronted this again and again over the years so I am not too easily shocked, but I have to tell you that I was really shaken when I saw that about 17% of these kids were on the antipsychotic, neuroleptic drugs. It is a very tragic, but very true statement that we are inflicting permanent neurological brain damage on these children. One more extremely troubling piece from this data: a very large number (869 in the private child placing agencies alone) are victims of what we call polypharmacy, the practice of giving children multiple psychotropic drugs at the same time.
Follow the Money
The so-called "perverse incentive factor" in child welfare is becoming well known. It is simply that things are structured in a very unfortunate way that allows child welfare agencies and placement facilities to grow and thrive financially by placing kids in more intensive need categories, rather than being rewarded for what should be the true mission of family preservation and restoration, and of succeeding in as little handicapping of kids as possible. It is an absolutely perverse foster care incentive that service providers are given more money for children who are labeled and drugged. Incredibly, the Medicaid data from November 2003 shows that roughly three-fourths of the prescription drug money spent on foster children is for psychotropic drugs, and the amounts are very large!
Psychiatric Diagnoses of Children are not Real Physical Diseases
I suppose the justification is that these children are sicker, more "mentally ill" than the general population, so in fact they are fortunate to be in our care because they receive needed "treatment."
I am here to tell you that many of us know better, and to support you in your important, deliberate investigation of this matter. The fact is we responsible adults are failing our children. We call it medicine, but the plain truth is twofold. One, children are profit points for Big Pharma. Two, we are using extremely potent and dangerous psychotropic drugs in an effort to make our children submit to a system that fails to meet their real needs, educational and otherwise.
These drugs are potent and dangerous. I won't say anymore about that. What makes it even more disgraceful is that we are drugging our precious children without evidence of real disease. As difficult as this is for many to believe, the plain truth is that there is no scientific validation of any of the supposed childhood psychiatric illnesses, which are said to justify giving our children these powerful, addictive, toxic and harmful drugs. Psychiatric diagnoses are entirely subjective. To get clear on the reality here, it is vital to make a sharp distinction between fact and opinion. You and I may disagree about whether it is a good idea to drug our children—that is a matter of opinion. In contrast, a matter of fact is that there is no way to make a legitimate medical diagnosis of child psychiatric illness by testing for an identifiable physical or chemical abnormality.
We call it medicine, but the sad fact is that we drug our children in order to avoid our responsibility—which is to organize our lives and our society in a way that encourages children to grow and learn and develop character in a drug-free state of mind. Our society is at a low point in terms of adult responsibility for children.
A Trauma Sensitive Perspective
The reality of our foster care is that a high percentage of the children who enter come out in worse shape than when they entered. Comptroller Strayhorn detailed many of the reasons. A big one is the subject of this hearing today. They come out with more labels and more drugs in their system. We are hurting the children. Many are already traumatized, and they are all traumatized further by separation from family. Why are we not guided by a trauma-sensitive perspective? Why instead do we label the children themselves as defective and drug them? There is no evidence of disease. There is vast evidence of trauma.
The good news is we know how to help with trauma. We know what children really need to heal from trauma and be well. It is not a great mystery. I could help with this, and so could many others. That help will be limited severely, however, until we agree to stop poisoning them.
I have one general recommendation, and six more specific.
1) It is my conviction that nothing we do will be really effective if it is not guided by a decision to reorient DFPS toward its correct mission of family restoration and preservation. That is paramount. For DFPS to be truly effective in helping our state's children and families, Family Preservation and Restoration must be its guiding light. There are clear precedents and guidelines for how to go about such a mission.
2) Institute a tracking and reporting system to be very clear and specific about which children are placed on what drugs. Look for patterns of variability by area and section, and by physician. Most definitely include a mechanism for reporting and red flagging any activity of so-called polypharmacy as it is especially grievous and dangerous to be placing our precious children on multiple psychotropic drugs. At the very least, any incidence of a child being placed on 3 or more psychotropic drugs should be red flagged, reported to the medical examining board, and investigated.
3) Institute a rigorous program of authentic informed consent. Richard Lavallo has developed some very good ideas for this, ideas which were, in an egregious example of why legislation is necessary to handle this horrible situation, rejected by the THHS Advisory Committee on Psychotropic Medicines. Psychotropic drug treatment is a whole different animal than other examples of medical drug treatment. ADHD is not like diabetes; one is a subjective opinion, the other an objectively verifiable physical illness. Just as this legislature rightly decided in House Bill 320 that a parent's refusal to consent to a psychiatric evaluation or a psychotropic drugs for a child is not in the same category as refusing insulin for a diabetic child, and therefore does not constitute medical neglect, so is it necessary to be real about informed consent. I wholeheartedly support Mr. Lavallo's rejected recommendations. Personally, I would even go much farther. (I have an article on informed consent and the psychiatric drugging of children on my website at http://www.wildestcolts.com/mentalhealth/consent2.html, and I would be happy to share my thinking on this.)
4) Ban all psychotropic drugs for children in state care who are under age 6. It is tragically harmful to unnecessarily damage the developing bodies and minds of our young children.
5) Ban all SSRI antidepressants and neuroleptic drugs for children of any age in state care. The SSRIs are extremely harmful and addictive; and can cause or exacerbate suicidal or homicidal tendencies; withdrawal is painful and dangerous. As I said earlier, neuroleptics consistently cause permanent neurological damage in those who take them for very long.
6) Institute an external monitoring and enforcement system. Those who have created this tragedy and who continue to defend and resist reform are not capable of ensuring these changes will happen. External monitoring and auditing is vital to success, in large part due to conflicts of interest and perverse financial incentives to label and drug our children.
7) Institute training on at least two items: a) the facts about psychiatric diagnoses and drugs, and b) the nature of psychological trauma and recovery, especially emphasizing issues of separation, and the nature of and necessary conditions for psychological healing.
I am happy to respond to any questions. Thank you.