Bush plans to screen whole US population for mental illness

A whistleblower who uncovered evidence that major drug companies sought to influence government officials has been removed from his job and placed on administrative leave.

Allen Jones, an investigator at the Pennsylvania Office of the Inspector General (OIG), was escorted out of his workplace on 28 April and told "not to appear on OIG property" after OIG officials accused him of talking to the press. Reports of Mr Jones's findings were widely reported in the New York Times, BMJ (7 February, p 306), and elsewhere.

His findings showed that the pharmaceutical company Janssen had paid honorariums to key state officials who held influence over the drugs prescribed in state-run prisons and mental hospitals.

Mr Jones filed a suit on 7 May against his supervisors charging that the OIG's policy of barring employees from talking to the media was "unconstitutional." Mr Jones claims, in the complaint filed in the Middle District Court of Pennsylvania, that he is being harassed by his superiors and Pennsylvania governmental institutions in order to "coverup, discourage, and limit any investigations or oversight into the corrupt practices of large drug companies and corrupt public officials who have acted with them."

Mr Jones had been earlier removed as lead investigator on the case after being told by a manager that "drug companies write cheques to politicians on both sides of the aisle."

In July 2002 Mr Jones was appointed lead investigator when he uncovered evidence of payments into an off-the-books account. The account, earmarked for "educational grants" was funded in large part by Pfizer and Janssen Pharmaceuticals. Payments were made from the account to state employees who developed formulary guidelines recommending expensive new drugs over older, cheaper drugs with proved track records.

One of the recommended drugs was Janssen's antipsychotic medicine risperidone (Risperdal)—a drug that has recently been found to have potentially lethal side effects. The Food and Drug Administration issued a warning letter to Janssen on 27 April saying that Janssen's "Dear Healthcare Provider" letter about risperidone was "false or misleading" because it failed to disclose or minimised risks of the drug relating to "serious adverse events including ketoacidosis, hyperosmolar coma, and death."

Don Bailey, Mr Jones's attorney, said the case is a critical test of the right to a free press. "If they shut the employee up and they have all the documents locked up in a drawer there is no free press," he said.

Amy Wasserleben, spokeswoman for the OIG, said they would not comment on Mr Jones or the corruption allegations. When asked about the status of the corruption investigation she refused to answer. In response to a question about whether the state OIG could withhold information of public interest, she said, "The OIG is specifically exempt from right-to-know laws."

The Pennsylvania formulary is based on the Texas Medication Algorithm Project that has been exported to about 12 states and was recently commended as a model programme by President Bush's New Freedom Commission.

However, Dr Peter J Weiden, who was a member of the project's expert consensus panel, charges that the guidelines are based on "opinions, not data" and that bias due to funding sources undermines the credibility of the guidelines since "most of the guideline's authors have received support from the pharmaceutical industry."

The connection to pharmaceutical companies and their efforts to buy policy is the more immediate issue, I admit, but given the totalitarian drift of the Bush administration, I have other worries.

1980 – Congress proposed new legislation (PL 96-398) called the community mental health systems act (crafted by Ted Kennedy), but the program was ended by newly-elected President Ronald Reagan. This action ended the federal community mental health centers program and its funding.
1980 – Congress passed legislation (PL 96-416) tile Civil Rights of Institutionalized Persons Act (CRIPA) allowing the Justice Department to sue state governments if they violate the civil rights of the mentally ill or mentally retarded in their state hospitals (the Act was focused originally on prisons).
1981 – Congress passed legislation (PL 97-35) sought by Reagan, titled the Omnibus Reconciliation Act of 1981 that shifted funds to the states vial block grants. States had the option of using their funds to continue to support mental health centers.
1987 – Congress passed new legislation (PL 99-319) developing rules for the protection and advocacy for the mentally ill and offered dollars to the states to set up human rights agencies and regulations to insure rights of the mentally disabled.
1987 – Congress passed new legislation (PL 99-660) requiring that for states to receive block grant monies for mental health and substance abuse, the states had to develop plans for how they would care for the mentally ill who were released from state hospitals and the staff who needed to be retrained.
1987 – Congress passed new legislation (PL 100-77) called the Stewart B. McKinney Homeless Assistance Act, to assist the states in providing housing for the homeless who are mentally ill.

Many experts pointed to the "deinstitutionalizing" of patients in mental hospitals that occurred in the Sixties and Seventies as part of the problem. In the early 1960s, days of heady and high-minded social reform, the decision was made to begin closing the "snake pits" -- mental hospitals -- and to create a new system of local mental health centers. To that end, President John F. Kennedy signed the Community Mental Health Centers Act in 1963. It was hoped that new wonder drugs would enable many patients to function once they were reintroduced into society. The result: the number of patients in state mental hospitals declined from over 500,000 in 1960 to 150,000 twenty years later. But community-based services were not adequate to take up the slack; by 1988 it was estimated that most of the nation's largest cities had no more than 10% of the institutional placements necessary for the mentally ill.

Where, then, did the mentally ill go? By the mid-Eighties, reliable studies revealed that about one-third of the homeless fell into this category. Some were former mental hospital patients while the rest were younger mentally ill individuals who had never received institutional care. And the other two-thirds of the homeless? According to Dr. Irwin Perr of the Rutgers Medical School, the conventional wisdom was that 25-50% had alcohol or drug abuse problems. The rest were the "new poor" -- the jobless or those displaced by the gentrification of inner city areas. The number in low-income families unable to find affordable housing rose from 8.9 million in 1974 to 11.9 million in 1983. In New York City, tax abatements in the early '80s encouraged developers to replace flophouses with luxury condominiums. Similar urban policies had the same effect across the nation. Restrictions on the sale and rent rates of subsidized federal housing, approved in the 1960s, were expiring. Between 1974 and 1983, according to Harvard's Joint Center for Housing Studies, nearly 900,000 SRO (single-occupancy units) that rented for less than $200/month were lost. The number of SROs in New York fell by 89%, from 127,000 to 14,000. Where once the ranks of the homeless were dominated by single men, now at least a third were families without homes, often unwed mothers with small children.

The Reagan administration was slow to acknowledge the problem, much less respond constructively to it. In 1981, the federal government's Temporary Emergency Food Assistance Program was designed to deliver surplus agricultural products to the needy. But by 1986 it was clear that almost none of this food was actually getting to the homeless. The president was chastised by activists when he stated that most street people were in that situation because they chose to be. Presidential Counsellor Edwin Meese claimed that people went to soup kitchens because they didn't want to pay for their meals. Reagan and Meese were clearly mistaken; the majority of the homeless did not choose or prefer their fate -- a life of little sleep, little food, and precious little social interaction. "I'm getting to the point where I can't talk to people," admitted a Philadelphia homeless man named Red. Violence was a fact of life; nearly every homeless person would be beaten, robbed or raped at least once. In some cities, the police rousted the homeless out of public parks and subway systems.

The federal government belatedly tried to address the problem. While federal support for subsidized housing had been slashed from $32 billion in 1981 to $7.5 billion in 1988, the Reagan administration sought to subsidize low-rent tenants with cash vouchers given directly to the poor. But that didn't always help in a nation where housing prices had increased nearly 50% in less than a decade; even with vouchers many poor families couldn't find affordable shelter. Reagan then signed the MicKinney Homeless Assistance Act, which authorized $1 billion in aid over two years. The 1986 tax reform package offered corporations a tax credit for investments in low-income housing. And in 1988 the president signed the Housing and Community Development Act, which assisted 152,000 needy families and called for the renovation of 10,000 public housing units. In addition, Congress appropriated over $200 million in the mid-Eighties to be dispersed by the Federal Emergency Management Agency. These were steps in the right direction, but didn't provide nearly enough funding to have a significant impact. A study suggested the country would need 7.5 million new low-income housing units by the year 2000; estimated cost: $300 billion. Faced by record budget deficits, the administration hoped supply-side economics would provide cities and states with more funds to finance their own remedies. It was largely left up to local governments, churches and community groups, and private citizens to make a difference.

OTM. It's all about the Benjamins.

Its my understanding that the word 'consumer' got pushed by advocates for the mentally ill. The term is supposed to be empowering unlike the passive 'patient'. I've always thought this was a bit stupid but the intention wasn't bad.

that shatteringly obvious public service announcement was brought to you by the entire wedge of camembert i just ate.

Was it a good wedge?

oh well, my mum still calls it camemberet

Maybe BUsh oculd give free cheese to the mentally ill - it would not sto[p me floating in the air three hours after I forget to take my pills, but we would have something french to go with the fries.