Advance Directives & Substitutes

...but how realistic is it to expect that the biological skew of Western psychiatry can be sustainably changed one small step at a time?

Richard Smith, the chair of the board of trustees at BMJ, penned an editorial yesterday bringing increased scrutiny to research misconduct and medical fraud in the UK. Smith identifies denial about the seriousness of the problem and the reluctance of universities to submit themselves to reviews as the two major reasons that Britain has failed to address these issues.

In 2004, the FDA added a black-box warning to SSRI antidepressants on the increased risk of suicide among children taking these drugs. A new study suggests that this warning has increased the proportion of children who begin an antidepressant on a low dose, but the majority are still receiving higher than recommended doses.

At a recent conference on legal capacity, I was struck by the failure of another invited expert to adhere to the paradigm of supported decision-making as articulated by the CRPD Committee. We still need to work to ensure that this paradigm is well understood and appreciated, despite the progress made in national reforms.

A recent article in the American Journal of Public Health calls for policy level interventions to reduce the use of benzodiazepines, drugs commonly prescribed...

Researchers examine psychiatrist-client interactions and find that clients are often left with few opportunities to make explicit requests to change their medication regimen.

A discussion of the role of epistemic injustice in the experiences of patients diagnosed with psychiatric disorders.

Various instruments of the United Nations have commented on forced treatment, or involuntary confinement, or both (for details, see Burstow, 2015a), and a number of truly critical additions to international law have materialized. Arguably, the most significant of these is the Convention on the Rights of Persons with Disabilities. What makes it so significant? For one thing, it is because this landmark convention puts forward nothing less than a total ban on both involuntary treatment and the involuntary confinement of people who have broken no laws.

With the explosion of genetic testing and the emerging field of pharmacogenetics, patients can now take a DNA test and receive psychiatric drug recommendations customized to fit their genetic makeup. In an editorial for the latest issue of the Journal of Nervous and Mental Disease, Columbia University Psychiatrist Robert Klitzman warns that clinicians need to be aware of the limitations of these genetic tests being marketed to them.

It is time to create an entirely voluntary psychiatric system. International conscience is clear. The singling out of people with psychosocial disabilities is not worthy of a free society. There are better, safer ways to address legitimate public needs.

Two facts about Robert Califf are beyond question. He is an expert on clinical trials, who is already seen as a leading architect of the future of medical research. And as the New York Times put it, he has “deeper ties to the pharmaceutical industry than any FDA commissioner in recent memory”. A lot of senior figures in medicine support Califf in spite of his ties to Pharma. The guy is just so bright, and understands the nuts and bolts of drug research so well! Surely a person like this is more useful than some outsider who offers only a squeaky-clean resume, they argue.

I lived through forced ECT from 2005-2006 at the Institute of Living in Hartford, Connecticut. My experience with ECT was the impetus for me to become involved in the antipsychiatry and Mad Pride movements, although I am not entirely opposed to voluntary mental health treatment. The following is the comment I submitted to the FDA on its proposal to down-classify the ECT shock device.

In an effort to reduce coercion, researchers isolate associated factors including age, relationship status, location, and diagnosis.

Two recent court rulings argue that pharmaceutical companies have a first amendment right to market drugs “off-label” with a lack of scientific evidence, threatening...

Concerns have been raised about inconsistent and unreliable results, which may lead to injustices in sentencing or even wrongful convictions.

Dr. Dainius Pūras argues that the status quo in mental health treatment is no longer acceptable and demands political action to promote human rights.

The report has succeeded in being supremely ambitious in its breadth, whilst remaining disappointingly cautious in its goals. The emphasis is on smaller changes in the immediate future, and kicking more progressive reform into the long grass. It alludes to but does not enshrine a rights-based approach.

In an Op-ed for the Times Union, Madeleine Ringwald explains how the Helping Families in Mental Health Crisis Act “would severely disable protection and advocacy organizations from protecting the civil, legal and human rights of people in mental health services.” “Whether you examine it through a scientific, civil rights or bottom-line lens, Murphy's bill should appall you,” she writes. “Any legislation that bolsters institutionalization at the cost of community-based services seeks not to help those with mental health needs, but help society find ways to hide, suppress and silence them.”

Researchers believe that side-effect monitoring is critical because of the increase in the use of antipsychotics

In MinnPost, Susan Perry discusses a JAMA Internal Medicine study that found that, within 48 hours of being hospitalized, almost half of adults aged...

Most Americans would agree that we have problem with mental health in this country, but what many do not know when they consider that people who are in distress are not getting the help they need is that hospitals in this country are not giving people a choice when they are in the most need. This is based on laws that currently exist in 45 US States, which allow individuals to be petitioned into an inpatient psychiatric unit against their will if they are deemed to be a “danger to themselves or others.” I have worked for 3.5 years as a Peer Support Specialist within my local public mental health system, where I see this happen to the individuals I serve, on a regular basis. I myself have been forced.

The science magazine RUBIN provides an update on patients’ rights to refuse treatment in Germany's psychiatric wards. “In psychiatric wards in Germany, patients used to be medicated indiscriminately against their will if doctors considered it necessary. It was only after a Federal Constitution Court ruling a few years ago that patient autonomy has been strengthened.”

“We are concerned about the implications of this rule,” said Jennifer Mathis, a lawyer at the Bazelon Center for Mental Health Law, an advocacy group for patients. “It points a finger inappropriately at people with mental illness as a source of gun violence. It’s a bad precedent to start creating exceptions to the privacy law for people with mental illness, who are responsible for about 4 percent of incidents of gun violence.”

Oryx Cohen at TruthOut explains why the "Helping Families in Mental Health Crisis Act (HR 2646) - commonly known as the 'Murphy Bill' - appears to cater more closely to the desires of pharmaceutical companies than to the actual needs of people in psychological distress, perhaps because of Murphy's connections to key lobbyists." "If the Murphy Bill is passed, psychiatric hospitals and pharmaceutical companies will reap huge financial benefits as a result of increased hospitalization and forced treatment."

Today on Radio Times, U.S. Representative Tim Murphy (R-PA), Mark Salzer, professor and chair of the Department of Rehabilitation Sciences at Temple University, and Leah...