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Helping consumers add years to their lives, III: Psychoactive drug dependence and harm reduction

March 18, 2011
by Jack Carney, DSW
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This is the third in a series of articles and blogs that I’ve written devoted to the issue of mental health consumers’ premature deaths and the documented causal link to atypical neuroleptic drugs. Part I appeared on this site on February 17, Part II on March 4 (c.f. References, below).

My focus is the direct consequence of my own experience overseeing a New York City case management program for persons with serious mental illnesses, where in the last several years of my 16-year tenure, program consumers began to die from cardiac-related illnesses at a rate much higher than the national norm, much higher even than the rate revealed in the 16 state study conducted by the State Mental Health Program Directors (c.f References, below). Their average age at death was identical to that of subjects in the Program Directors’ study, 55 years of age.
 
My staff and I asked then and I ask again now, why do psychiatrists continue to prescribe zyprexa and seroquel and the other atypical neuroleptics despite the evidence that these medications are dangerous for those prescribed them?

I had written in Part II that the NY State Office of Mental Health had recently introduced a QA initiative in its licensed community-based clinics aimed at reducing the prescription of zyprexa and seroquel by 30% over the course of the current calendar year. The director of a clinic near to my home informed me that the initiative had met with great success and that his psychiatrists had exceeded their 30% goal in only a few short months. He then reminded me that a clinic’s participation was still voluntary.

So I now wonder why “voluntary” and why not a higher goal when the link between atypicals and consumers’ premature deaths appears unequivocal?

An answer of sorts was provided by Dr. Donald Levin, a psychiatrist in private practice in Pennsylvania. Dr. Levin was featured in a front page article in the Sunday New York Times on March 6, where he was portrayed as representative of many psychiatrists in this country. By his own admission, Dr. Levin’s following the money. Insurance companies have so reduced the reimbursement rates for psychotherapy, that Levin is quoted as saying he can’t maintain himself and his family at the standard of living to which they’ve become accustomed if he continues to spend valuable office time practicing psychotherapy.

He does admit to great ambivalence over the decision he believes he’s been obliged to make. Like most psychiatrists, he’s been trained as a psychotherapist. At the mental health center in Brooklyn where I worked for nearly twenty years, the psychiatry residency training program was rooted in psychoanalytic psychotherapy. I myself conducted seminars in family therapy for the psychiatry residents for several years.

Increasingly, particularly since the coming of managed care to behavioral health in the 1990’s, psychiatrists’ time with their patients, whether in Medicaid-financed public clinics or in private practice, has been allocated in fifteen minute chunks. This permits at best a cursory review of patients’ symptoms, i.e., whether the symptoms have improved or not, and the issuance of a new scrip. If a patient has any other immediate problems – loss of housing, income or relationships; or serious medical problems – Dr. Levin, and most other psychiatrists, will tell the person, “Talk to your therapist.”

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Jack Carney

Jack Carney

Jack Carney, DSW, is a practicing social worker with 42 years of experience in the field. He is...