My name is John Breeding. Some of you know me from past opportunities I have testified to your committee on issues related to specific mental health legislation. In this testimony, I speak to issues relevant to virtually all mental health legislation in this 80th regular session of the legislature.
My main work is as a mental health professional, a practicing psychologist, going on 25 years here in Austin. I have worked as a counselor with people at every level of care from acute to moderate to severe levels of psychological distress. I counsel people in my office. This year, I counseled a group of young people and parents in a West Austin home after a 20-year-old college student shot himself in Bentwood Park. The next day, I met with someone at the Austin State Hospital. I have testified on occasion at hearings on involuntary incarceration and forced drugging at local psychiatric hospitals. I have written a few books and articles on psychology and psychiatry and the delivery of mental health care in our society.
How to fix or improve our mental health system here in Texas? I am bound first to declare my view that we really don't have anything close to what I would call an authentic way of responding to people in distress and promoting psychological well-being. Not unlike the rest of the nation, Texas treatment of the "mentally ill" is mostly determined by corporate special interests, and notorious for its history and current reality of fraud and corruption. Here are just three examples that have involved the legislature.
Endemic Ethical Failure: Three Examples of Mental Health System Fraud and Corruption
- In 1991, then Senator Mike Moncrief opened an investigation into allegations that the huge profits of the psychiatric hospitals of National Medical Enterprises (now Tenet) were a result of criminal and unethical exploitation of the people who had come for help. Senator Zaffirini was very involved. The Texas attorney general obtained a settlement for the maximum allowable amount of $10 million. NME eventually settled with insurance companies for over $200 million more.
- The last two Texas legislative sessions involved intense work, led by Representative Hupp, in response to CPS and foster care scandals. One aspect of this was (and is) the massive use of psychotropic drugs, and so-called polypharmacy, with our state's foster children. Comptroller Strayhorn's investigations have played a key role, as has the governor appointed inspector general for Department of Health and Human services, Brian Flood. In fact, the Houston /Chronicle reported that just last week Inspector General Flood sent out letters ordering five doctors to return Medicaid money for overprescribing psychotropic drugs to foster children. A bit of good news is that the paper also reported a 31% decrease in the number of foster kids prescribed 5 or more psychotropic drugs in the last five months since the state implemented new regulations stemming form the last legislative session. I see this as a tiny bit of progress in the face of the shameful and tragic practice of massively drugging these precious children in the care of our state. The former comptroller's December 2006 report on foster children, however, forces another hard look at this tragic state failure. One piece of that data is that fully ¾ of the Medicaid money spent on medications for these young people is for dangerous, harmful, unproven psychotropic drugs. This is an absolute disgrace.
- An emerging scandal involves the development and implementation of the Texas Medication Algorithm Project (TMAP) and its attendant children's version of CMAP. As local TV news investigator Nanci Wilson has revealed in a series of powerful exposes, the direct influence peddling of pharmaceutical companies on the development of these algorithms is an egregious example of the determination of state mental health policy and practice by corporate pharmaceutical interests. In the last legislative session, an amendment to SB 6, sponsored by Representative Lois Kolkhorst barred people with vested interests from participating in groups developing drug and treatment guidelines. The amendment was stripped out of the conference committee compromise on that legislation. Drug companies are settling massive class action lawsuits from consumers of some of the drugs on our state's TMAP and CMAP protocols. Our own attorney general, Greg Abbott, is suing a major drug company over the handling of one of these drugs. This session, there is important, related conflict of interest legislation sponsored by Representative Juan Escobar.
We do not have an authentic mental health care system. What we have is an unholy alliance of the corporate pharmaceutical industry, institutional psychiatry and the state government. What we have is a psychiatric labeling system and an attendant psychotropic drugging system, backed up by the full force of the state.
I have no expectation that this subject of force is a significant part of your considerations. Nevertheless, any truly meaningful consideration of mental health care reform must not exclude confrontation of the proverbial 800-pound gorilla in the living room. Institutional psychiatry is rooted in coercion; every year, thousands upon thousands of Texas citizens are incarcerated in psychiatric hospitals against their will, where they are forcibly drugged. Whatever the justification, anyone who locks people up against their will, and holds the key, no matter how they may refer to themselves, is a jailer—and jailers are severely limited in therapeutic influence.
It is my view that the legislature cannot do anything really significant to fix or improve our mental health system without first facing the fact that being a part of our mental health system today means accepting and enforcing the beliefs and practices of biological psychiatry, or bio-psychiatry for short. This system believes that human troubles, failures and distresses are due to incurable biologically or genetically based defects, called mental illnesses, and assumes that psychotropic drugs are absolutely necessary to "treat" these illnesses. Hence, roughly 1 of 7 of our state's school-age children are on psychotropic drugs; millions of our adults are on these drugs; thousands upon thousands are forcibly incarcerated and put on these drugs; thousands are brain-damaged further by electroshock. It is the tragic truth that this is basically what our mental health system offers—labels and drugs. And a truth I have told again and again in the halls of this Capitol is that all of this is done without scientific evidence or validation of a physical or chemical abnormality denoting even one of these so-called illnesses.
We cannot really fix or improve a system that is fundamentally flawed and based in unsubstantiated theories rather than proven facts.
We also cannot move forward in a positive way without making conscious at least two functions that the state mental health system tries to do, but simply cannot and will never be able to. One is to make our legal system better or more humane. Forensic psychiatry has been and is a disaster, interfering with justice and moral responsibility.
The other is that psychiatry deflects attention from issues of social and economic justice by explaining the suffering and distress that comes to individuals who are unable to find work that is purposeful and sufficient to meet their own and their family's needs as "mental illness." The simple truth is that legislative actions related to such things as education and work opportunities, living wages, and housing will always have a much more significant effect on the psychological wellness of our citizens than any psychological or psychiatric program.
This system is an utter failure, almost proudly declaring that so-called mental patients suffer from incurable disease, therefore the bar can be no lower as there is absolutely no expectation of cure or recovery! This is so tragic, as the evidence shows that both historically and even today in places that do not rely so heavily on these poisonous psychotropic drugs, over half of those designated with severe "mental illnesses" such as so-called schizophrenia do indeed recover. (See Robert Whitaker's book, Mad in America, for an excellent review and presentation of this readily available information.)
Three Primary Recommendations
1. Greater Accountability
This is not a time for granting more power and opportunities to expand Texas mental health services within the existing status quo. Rather, it is time for accountability. It is time for major ethics reform, time for closer examination of how the state of Texas is hurting, often irreparably, those in its care, and it is time to hold the leaders responsible. It is time to look at the real science, and re-examine programs such as TMAP that masquerade as science, but actually promote a pharmaceutical agenda. It is time to confront what is happening to our foster children and other young people, and to the victims of forced ":treatment" in our institutions.
2. Less Coercion
Given that current standard psychiatric "treatments"—psychoactive drugs and electroshock—do not affect a cure and are scientifically demonstrated to be at best about as good as a placebo, how in the world can we justify even greater coercion of people into the psychiatric system?
Given that the ethics breakdown is showing up all over this system, how can we justify forcing more people for longer periods into this system?
Given that the criterion for coercion is called "dangerous to self or others," and given that the research clearly shows that psychiatrists are no better at predicting dangerousness than the rest of us (who are generally unable), how can more coercion be justified?
3. Greater Protection of Citizens
Current news is overflowing with evidence of ethics breakdowns in Texas' mental health system. This alone is reason enough to say that the legislature's focus needs to be vigorous investigation, together with enhanced protection of its citizens. The fact that the state is hurting those deemed patients, and generally failing in the mission of providing care that heals people and improves lives, makes this an even more exceedingly clear imperative.
In sum, this is not the time to expand the power of the state to coercively or forcibly "treat" people. Nor is it the time to do more "mental health screening" or otherwise expand services. Right now, it is time to retrench, expand investigations and oversight, and work to develop ideas that have a chance of being truly helpful to people in need. What follows are just a few ideas of what truly effective assistance might actually entail.
Above said, there is still a need to respond to the troubled or troubling conduct of our fellow citizens. Fortunately, the how-to's of authentic care and support of psychological well-being are not all that complicated. There are many ways to do it. Here are a few that I would like you to consider:
- Physical health affects psychological well-being. Sleep, nutrition and exercise are key components of psychological well-being; disruptions, deficits, or imbalances in any of these can result in "symptoms" that get labeled as, for example, attention deficit disorder or depression.
- Meaningful social, interpersonal connection is fundamental to psychological well-being. Psychological care must be rooted here.
- Mental and emotional distress often results from having been hurt. Emotional discharge, such as crying, expressing anger, or shaking with fear, is not a psychiatric symptom, but a necessary part of the recovery of psychological well-being.
- It is very sad that the overwhelming takeover of our psychological care by the proponents of biopsychiatry has all but eliminated hope for people in extreme states of mind. Nevertheless, it remains true that even people in extreme states of mind, often diagnosed with severe "mental illnesses" such as clinical depression, bipolar and schizophrenia, can and do recover without drugs or electroshock. The Soteria Houses, sponsored by the National Institute of Mental Health more than four decades ago, showed this. So have others, such as the Windhorse Institute, and the National Empowerment Center.
The information and resources are available. Please do not hesitate to contact me if I can be of assistance.
John Breeding, PhD
5306 Fort Clark Dr.
Austin, Texas 78745