Nurses for Human Rights

…and rightfully so. Ted Scouten, reporter for the local news in Fort Lauderdale, FL, CBS4, is getting concerns about Dr. Punjwani, the prescriber of multi-drugs to 7 year old Gabriel Myers before his self-hanging suicide. Another family steps forward to tell their story of their son, Emilio Villamar. Emilio was only 16 years old when he died of a heart attack brought on by the multiple psychiatric drugs he was prescribed by the now famous Dr. Punjwani. It is also reported that 13% of children in the DCF foster child system are on psychiatric drugs. 16% of those are being given drugs without parental consent. 13% of this population is higher than the national average of 4% being prescribed these mind-altering drugs. As doctors continue to prescribe many of these drugs off-label to children, we will have to question ourselves, as nurses, as to our support of this treatment. Again, I have to point to our Code of Ethics and any support to harmful practices. There are also many questions as to Full Informed Consent  being given or not to these parents. We know that the children aren’t going to be given any information as to what they are putting in their mouths, trustingly, from the adults in charge of their care. But I implore my fellow nurses to push our Code of Ethics in this arena and question such use without Full Informed Consent and for God’s sake grow a backbone and say no if you think it’s harming these children. You’ll sleep better at night.

At least according to the National Institute of Mental Health. That means 57.7 million people are “suffering” from a diagnosable mental “disorder” in any given year. They claim, per their statistics, that 6% of these are suffering from a “serious” mental illness. To further put that in perspective, my mother had 4 boys. One of us is mentally ill according to these statistics and probability. I think they would probably pick either my oldest or next youngest brothers because they are devoted Christians and this is considered a mental disorder according to the DSM IV. My mother is also a devoted Pentecostal, so it’s obviously genetic. It seems just believing in a Supreme Being is a “crazy notion” to some people and certainly a psychosis that can be “helped” by antipsychotic medication.
What is even more startling to me is that the NIMH says that mental disorders are the leading cause of disability in the U.S. and Canada for ages 15 to 44. The World Health Organization says that mental illness accounts for more than 15% of the burden of disease in “established market economies”, such as the United States.  Our welfare agencies are swarmed by people who are unable to function in their lives because of mental disorders. I would imagine they lump emotional disorders under mental illness, but I think these are different things from my observation.

I also learned recently that 31% of men and 33% of adult women are obese per the CDC. We know that obesity has contributing factors to health problems. There is a whole list of problems like cardiovascular, orthopedic, sleep apnea, and respiratory problems but mental illness was not mentioned in the report I read. It just made me wonder if clearly over 50% of our U.S. population was either mentally ill and disabled or obese and disabled. 50% of our population…makes me wonder how anything can get done productively at all. To me, these two identified national health problems are the easiest to fix. I will acknowledge that the 6% of the serious mentally ill might not be “curable” (I have a theory that they can), but at least the other 20% can be intervened with and brought to a higher level of functionality. I know for a FACT that obesity can be handled and done with enough actual resources that would solve the 30% of our nation of the “side effects” of diseases that come with obesity. As a matter of fact, it’s being done everyday in clinics around the U.S. Unfortunately, it is not the mainstream medical clinics that are having the most success. There are people getting relieved of their mental “illnesses” and living better lives. There are people handling their overweight issues and living healthy lives. My question is why hasn’t the U.S. government, FDA, or the NIMH looked at these cases as clinical evidence and said “let’s do this on a broad scale public health program”? That’s a question we really need to ask ourselves. What do you think?

By now you have heard of the story of Gabriel Myers, 7 year old foster child in the Florida DCF placement home who committed suicide. He was obviously over-medicated with psychotropics and being given anti-psychotics when it’s not indicated. He had no evidence of schizophrenia. But according to one of the many psychiatrist, Dr. Punjwani, in the “huge group practice”, his justification is that it’s the pharmaceutical companies fault for not doing enough clinical trials on children (I summarized). I think this points to several treatment errors. The fact that a child might see several psychs in a “huge group practice” indicates the conveyor belt mentality you get with groups of physicians who don’t see the same patients or do the followup themselves when treating children with psychotropics. Not that this excuses them for using these drugs at all, but it’s an error waiting to happen as probably not one of the psychiatrist can tell you what Gabriel was on taking on the day he killed himself. Dr. Punjwani also points out that it is not illegal to prescribe drugs to children off-label and that the prescribing of these to young children is “routine”. Wow, that scares me. It’s like there is no acknowledgment that these are chemicals and that they adversely affect young children. Even with black box warnings on them. I smell the fragrance of arrogance when I hear these statements and the puffed out chest of MDs that are “board certified” to do whatever they think is for the good of their patients.

My heart breaks for this child and the many that are being subjected to this type of thinking. But I’m also concerned that NOT ONE NURSE OR NURSE PRACTITIONER has come forward to either condemn what is being done or complained about it, filed a report against, or championed the children’s Human Rights that are obviously being trampled on by the medical community agreeing with this practice. I cannot believe that this “huge group practice” does not employ office nurses, clinical experts with RN behind their names, ARNPs with Psychiatry as their specialty who did not see, recognize, or just plain cared enough to question this practice with Gabriel or any other child under this groups care. I’m floored with that thought. I can’t wrap my head around the idea that these nurses condone drugging children for behavior problems. It’s like they are intentionally ignoring the evidence that there is no evidence of chemical imbalance or biological reason for children’s behavior and that it has never been clinically evident that a child does better in life LONG TERM with drugs as therapy.

Without nurses being the champion and advocate for children in this arena, and standing up to bad practices such as poly-pharmacy in children with behavior issues, no child, including Gabriel, has a chance to living a life under their own volition and with their own sanity intact. Gabriel didn’t have a chance under the present DCF system.

CBS News reports a trend in parents foregoing the routine and sometimes mandatory vaccination of their children. Mothers are citing their ” mistrust of the government, a mistrust of the pharmaceutical companies, and mistrust of the big blanket thing that says this is what everybody has to do”. More and more parents are saying “no” to routine MMR vaccinations and absolutely “NO” to the offer of Hepatitis vaccinations for their newborns. With the invention of vaccinations, lives were saved in whole communities from the ravages of common communicable diseases. Whole disease enitities like Polio were suddenly extinguished from the general population. So what happened?

It’s my belief that this trend is fueled by the failure of the FDA to protect the general public from harmful pharmaceuticals. Something created a situation that relaxed the availabillity of drugs with harmful side effects to proliferate through the society. It is more common to have a drug pulled from the general population AFTER there are a significant number of deaths reported then not approved by the FDA. It can be up to ten years after the use of the drug has done its harm before it’s pulled or given Black Box Warnings. How many of the mentally ill getting first generation antipsychotics and antidepressants would change their mind after developing EPS? Tardive Dyskinesia? Heart dysrhythmias? What happened to allow this trend of disbelief in pharmaceutical research and why did it happen at all? You have to read this book to find out: Side Effects: The Hidden Agenda of the Pharmceutical Drug Cartel by Present Time Books.

An article by psychiatrist Dr. David Kaiser in the Psychiatric Times gives us a glimpse of the chasm that continues to widen between biological psychiatry and more humanistic psychiatry. It’s one thing for those of us outside the profession of psychiatry and psychology to point our fingers and say “something’s wrong”, but it can not be said clearer than from inside the family. There is plenty to debate in this field of endeavor since it’s so subjective to the observer and to date medical science has not been able to find it’s holy grail of evidence that aberrative mental states or inappropriate emotional distress comes from a physical source exclusive to the brain. We, in nursing or any other health field, do not have to answer the question of “what’s it coming from” to chose a therapeutic intervention that doesn’t harm temporarily or permanently the sufferers while we look for a conclusive, acceptable and workable answer. Here is one of the many quotes I’d like to bring to nurses in the psychiatric field to think with while they treat their patients:

“I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. However, this does not stop psychiatry from making essentially unproven claims that depression, bipolar illness, anxiety disorders, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin, and that it is only a matter of time until all this is proven. This kind of faith in science and progress is staggering, not to mention naive and perhaps delusional. ”

This organization, Nurses for Human Rights, is dedicated to changing the idea that treatment of patients in mental health requires chemical restraints, electroshock, deprivation in institutions, forced drugging or forced shock treatments, etc. Let’s follow the motto of our predecessors of “First, Do No Harm”. We are ingenious enough to come up with a better solution, even if it means to abandon the current model. But we first have to break from the mental chains of a false doctrine, that mental illness is biological. It both leads to more calamity for nurses and their patients and denies the possibility that man has a spiritual nature, that the mind is more that a brain and nerve network, and that mankind is limited to only being the effect of chemical reactions and wholly at the mercy of the environment. I don’t agree with that viewpoint, and never will.

The American Journal of Nursing printed a great article in their Viewpoint section from Marcia Lynn Weiser, RN, CLNC, soon to be MS at USF. She writes that “Nurses shouldn’t rely on these drugs for residents with dementia”. With black box warnings about early death and the multiple side effects of psychotropics, we have to re-think the care of the elderly and how we manage restless or agitated seniors with or without dementia diagnosis. She rightfully questions the ordering of antipsychotics as a means to manage these patients since it has been shown to be largely ineffective for dementia and are “associated with falls and fractures.” She correctly sites the nurse to patient ratios as a reason for the increase use of antipsychotics to “manage” the restless and agitated dementia patient. I see this as very true being that I know many nurses in the LTC arena who are constantly supporting this viewpoint. And who gets “written up” when a patient falls or hurts themselves?

There’s a later article in the AJN December 2008 “In the News” section where they offer good ideas to better help manage dementia patients that don’t require drugs. Really, the art of Nursing is just such in this over-medicated world. We can be more creative in our care than to drug people into submission. We are only cutting their lifespans and the quality of life. It is their Human Right to live without being enslaved by mind-altering, sensory depriving drugs. They have a right to life, to not be enslaved by chemical restraints. Nurses, let’s protect their Human Rights and question the use for our patients.

I found a disturbing report from Janne Larsson, investigative jounalist in Sweden. In 2005, the agencies reporting on unnatural deaths and suicide included parameters to detect what causation could be traced to psychiatric drugs. The results are both alarming and telling. 1255 people committed suicide in 2006 from their report. 71% of women and 48% of men during this time were recently or currently treated with some category of psychiatric drug. I am including the link here for my fellow Legal Nurse Consultants as this is a key action we can take when a family comes in suspecting an unexpected death was caused by the side effect of a medication. The media is reporting more and more that prescription meds are the culprit in unexpected deaths. More deaths are attributed to prescription medications than illegal street drugs. But, just as important, we nurses need to take a step back and ask ourselves are these drugs necessary for the high population we are giving them too? Is it really necessary to treat all children in the foster home programs for PTSD like they are doing in my home state of Florida? Is it safe to add an antipsychotic to children already taking meds for ADHD? It is my personal hope that the stellar nurses in the legal profession put their opinions in writing and band together to change our profession toward more humane mental health treatment. There are a lot of areas we can improve on in the nursing profession. I hope we improve on our right to voice our opinions on the topics that are exploding in the media today. We should be vocal, steadfast on our committments, and banded together collectively to make our intentions to have safe, clinically effective health care delivered to our patients.

More and more drugs intended for adults are being prescribed by doctors to children. Bloomberg reports that diabetes type II meds, statins for cholesterol, and high blood pressure meds are on the rise. More alarmingly meds for ADHD continue to rise for off-label use. An interesting quote: “There was also a 40 percent rise in drugs for attention deficit hyperactivity disorder with the increase for girls, at 63 percent, rising faster than for boys, at 33 percent.

The researchers also saw a boost of ADHD drug use in 15 to 19 year olds, an age group for which use typically declines as teenagers are taken off the medications. That may be a sign that ADHD drugs are being used more as stimulants to help teens keep up with schoolwork or for recreational use, Cox said. There is a sense that they are being used at that age for productivity at school,'’ said Cox.”

Failure to keep our children healthy with so much proven information available makes me shudder. We really have a problem on our hands as a society when we are feeding our kids the wrong foods for health and ignoring what is known about truly healthy lifestyles. As a nurse, it’s my job to counsel parents on what is right and wrong about the foods we eat. Although social-economics comes in as a factor and cultural dietary habits as well, it means that people are more willing to eat what they feel “everyone else” is devouring without the thought of the consequences. It also tells me that we as a society, do not make the right foods available to everyone. If you have the money available for fresh vegetables and fruits, high grade proteins, etc. then you are the privileged few versus the “get whatever” processed, high simple carbohydrate, devoid of vitamins and mineral foods we can afford. The high-fat dollar menu is our budget savior.

Our future depends of clear thinking, healthy minds. We need leaders who have healthy bodies and good stamina to handle the stress of leadership. Always notice the age and health changes of our presidents after 4 or 8 years in office. The stress takes it’s toll. Our future leaders of industry need creative minds, not minds dulled by atherosclerosis or drug use. Do my fellow nurses have an opinion on this?