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Sunday, June 20, 2004

Insanity, thy name is Dubya...

According to a report on the BMJ (formerly the British Medical Journal) website another presidential commission is about to be heard from (and just about anyone who lives in BC will spot this for the colossal mistake that it is):
A sweeping mental health initiative will be unveiled by President George W Bush in July. The plan promises to integrate mentally ill patients fully into the community by providing "services in the community, rather than institutions," according to a March 2004 progress report entitled New Freedom Initiative. While some praise the plan's goals, others say it protects the profits of drug companies at the expense of the public.

Bush established the New Freedom Commission on Mental Health in April 2002 to conduct a "comprehensive study of the United States mental health service delivery system." The commission issued its recommendations in July 2003. Bush instructed more than 25 federal agencies to develop an implementation plan based on those recommendations.

The president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children. According to the commission, "Each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviours and emotional disorders." Schools, wrote the commission, are in a "key position" to screen the 52 million students and 6 million adults who work at the schools.

The commission also recommended "Linkage [of screening] with treatment and supports" including "state-of-the-art treatments" using "specific medications for specific conditions." The commission commended the Texas Medication Algorithm Project (TMAP) as a "model" medication treatment plan that "illustrates an evidence-based practice that results in better consumer outcomes."
Just in the above quoted text alone I find several references that raise warning flags:
"services in the community, rather than institutions";
"consumers of all ages";
"evidence-based practice that results in better consumer outcomes"
and, leaving aside the disturbing thought that anything coming out of Texas these days (excepting refugees, maybe) can be considered "model," there are other warning flags to be found in the rest of the article.

I've only had a chance to skim the report (and I'm trying to scare up some of the previous materials on this), but it looks like the US is going to make the same principal blunders that BC did: a) the way the report is worded suggests to me that the main direction the "initiative" is aimed is cost-cutting (by closing institutions and effectively shunting the costs of treatment out into the community); and b) there seems to be no acknowledgement of any negative impact that this "initiative" will have on the communities the patients (I absolutely loathe the use of the word "consumer") will be released into.

The recommendations of the commission look spiffy (and look at all the mentions of funding!) and necessary, but if Dubya's track record of implementing and then seriously underfunding programs ("No Child Left Behind" is the principal example) remains consistent, then the US is heading for a mental health disaster of epic proportions...