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Thursday 28 November 2013

THE PSYCHOLOGIST DECEMBER 2013 - Sick children or sick society? – LISTEN to the Maudsley Debate


Sick children or sick society?  – 
the Maudsley Debate

Diagnosis rates for childhood mental illness have increased at pace in recent years. So too have the prescription rates for psychotropic drugs, such as Ritalin used to treat ADHD. Are these changes a sign of sick children or of a sick society? This was the question addressed at the 49th Maudsley Debate held  at the Institute of Psychiatry in October.
On the panel in front of a packed house were Claire Fox, BPS Fellow Simon Baron-Cohen, Stephen Scott, Ken McLaughlin and Chartered Psychologist Barbara Sahakian. Held as a satellite event of the Battle of Ideas, the Maudsley’s usual formal debating format was replaced by
a round-table discussion chaired by David Bowden of the Institute of Ideas.

Professor Baron-Cohen from Cambridge University defended the importance of mental health diagnoses for children. Many children have had years of bad experience before they arrive in the clinic, he said, and for them it’s a relief to hear that there’s a name for their problems. A positive development in recent years, he argued, is the idea of neurodiversity – recognising that some children have special needs and may not thrive in conventional environments.

Stephen Scott, Professor of Child Health and Behaviour at the Institute of Psychiatry, also supported the importance of diagnosis. While acknowledging the risk of over-pathologising, he argued that increased recognition of conditions like autism brings greater humanity. In a similar vein, Barbara Sahakian, Professor of Clinical Neuropsychology at the University of Cambridge, drew attention to the importance of early detection of mental disorder. Seventy-five per cent of mental health problems start before the age of 24, she said, and the longer a person goes without help, the worse their outcomes tend to be.

Claire Fox, director and founder of the Institute of Ideas, was more sceptical. She lamented the way that to have your behaviour legitimised today, you have to have it pathologised. Fox also argued that encouraging children to dwell on their feelings and to seek medical help for their problems was undermining their natural resilience. ‘Everyone is queuing up for a diagnosis,’ she said, ‘and it’s trivialising serious mental health.’

Scott retorted sarcastically: ‘I like your neo-Darwinian approach. Toughen up, get resilient. It’s very British. But the kids I see haven’t managed to toughen up.’ Fox was unabashed. ‘My advice to psychiatrists if you want us to be more resilient,’ she said to muted applause, ‘is to butt out of our lives. We’ll be much better off without you.’

Also arguing that it’s our society that is sick was Dr Ken McLaughlin, a lecturer in mental health at Manchester Metropolitan University. ‘The moral question over how we live our lives and what we consider acceptable behaviour is being recast as a psychiatric one,’ he said. cj

Watch the entire debate, including contributions from the audience, at kcl.ac.uk/iop/news/debates/index.aspxHTTP://WWW.kcl.ac.uk/iop/news/debates/index.aspx

ANTIPSYCHOTICS - Growing concerns over side-effects and soaring prescription rates of psychiatric drug Seroquel - WATCH NEWS ITEM - Courtesy of abc news (Australia)

HYPERLINK TO AN EXCELLENT NEWS ITEM: http://www.abc.net.au/news/2013-11-27/concerns-grow-over-top-selling-drugs-side-effects/5121068

"There are growing concerns about the side-effects of a top-selling anti-psychotic, with ambulance call-outs for emergencies involving the drug skyrocketing over the past decade.

Quetiapine, commonly marketed as Seroquel, has become a blockbuster pharmaceutical both in Australia and internationally.

Despite being an anti-psychotic drug, meant initially to be used to treat only serious conditions such as schizophrenia and bipolar disorder, it has become one of the highest-selling medications of any kind.

The drug is increasingly being prescribed for a range of conditions - anything from sleep disturbance to anorexia - but there is a growing body of concern about the harmful and disturbing side-effects it can cause.

Musician Heidi Everett has been on Seroquel, which acts as a powerful sedative, for a decade.

She started on a dose of 1,000 milligrams a day - more than three times the daily dose recommended by Australia's Therapeutic Goods Administration.

"I was in a chemical straitjacket. I was a zombie for 24 hours a day, sleeping incredibly long. When I did finally get out of bed, it was a struggle to get to the kitchen," she told 7.30.

"And then what happens on Seroquel is that it freezes your muscles and shuts your muscle system down. So, it's really hard to walk. And when I did walk I had no control over my ability to stop walking, so I walked into walls."

Ms Everett also developed a heart condition, known as tachycardia.

Growing concerns over side-effects and soaring prescription rates of psychiatric drug Seroquel

By Louise Milligan

Video: Concerns grow over top-selling psychiatric drug (10 MINS)

There are growing concerns about the side-effects of a top-selling anti-psychotic, with ambulance call-outs for emergencies involving the drug skyrocketing over the past decade.

Quetiapine, commonly marketed as Seroquel, has become a blockbuster pharmaceutical both in Australia and internationally.

Despite being an anti-psychotic drug, meant initially to be used to treat only serious conditions such as schizophrenia and bipolar disorder, it has become one of the highest-selling medications of any kind.

The drug is increasingly being prescribed for a range of conditions - anything from sleep disturbance to anorexia - but there is a growing body of concern about the harmful and disturbing side-effects it can cause.

Musician Heidi Everett has been on Seroquel, which acts as a powerful sedative, for a decade.

She started on a dose of 1,000 milligrams a day - more than three times the daily dose recommended by Australia's Therapeutic Goods Administration.

"I was in a chemical straitjacket. I was a zombie for 24 hours a day, sleeping incredibly long. When I did finally get out of bed, it was a struggle to get to the kitchen," she told 7.30.

    I was in a chemical straitjacket. I was a zombie for 24 hours a day, sleeping incredibly long.
    Heidi Everett

"And then what happens on Seroquel is that it freezes your muscles and shuts your muscle system down. So, it's really hard to walk. And when I did walk I had no control over my ability to stop walking, so I walked into walls."

Ms Everett also developed a heart condition, known as tachycardia.

"It's where your heart starts beating extremely fast and out of control. And I don't mean just a little flurry, I mean for two or three hours of extreme ... heart rate," she said.
'There have been recorded deaths'

Matthew Frei, the clinical director at Melbourne's Turning Point Drug and Alcohol Centre, says he has seen some worrying developments with the drug over the past few years.

"We were seeing people getting toxicity from the drug. So that's things like over-sedation, collapse, and even over-dosage where people required admission to hospital," he said.

"There have been recorded deaths as well."

He asked epidemiologist Belinda Lloyd to look into ambulance data to see how often the drug was showing up.

"We examined quetiapine-related ambulance attendances over a 10-year period," Ms Lloyd said.

    We were seeing people getting toxicity from the drug... There have been recorded deaths as well.
    Matthew Frei

"And looked at those in the context of other drugs that are used for the same purpose and in the same drug group. And what we found was a really substantial increase over the decade in people being attended by ambulance as a result of inappropriate quetiapine use."

In the decade to 2011, ambulance attendances for emergencies associated with the drug rose from 32 a year to 589 a year - something not seen with other similar anti-psychotics.

Victorian Coroners Court statistics for the past three years show it contributed to 10 per cent of drug deaths.

Mr Frei says a black market in the drug has emerged.

"People prescribed the drug [are] giving it, selling it, trading it with friends who aren't prescribed the drug," he said.
Questions over soaring rate of prescriptions

Seroquel, sold by pharmaceutical giant AstraZeneca, initially excited the medical community as it seemed a promising alternative to more addictive sedatives like Valium.

Medicare statistics show that in Australia, the prescribing of Seroquel grew from about 1,500 scripts a year in 2000 to almost a million by the end of last year.

The trend is not mirrored by other anti-psychotics, and forensic psychiatrist Erik Monasterio from the University of Otago says that raises questions.

"How has it come about that a medication that's designed for the treatment of a very rare condition has become so popular? That is the ultimate question that needs to be answered," he said.

    I think of it as the Swiss Army Knife drug ... it has all these different tools within the one tool for different applications.
    Iain McGregor

University of Sydney psychopharmacologist Professor Iain McGregor has charted the explosion in use of the drug for a host of maladies for which it is not approved or intended.

"We see quetiapine being used in anxiety, it's used in depression, it's being used for insomnia, it's used a lot in people who have drug and alcohol problems, it's used in things like anorexia nervosa," he said.

"Just about any condition where there's an emotional problem, you'll find quetiapine being used these days.

"I think of it as the Swiss Army Knife drug ... it has all these different tools within the one tool for different applications."

Until last year, Seroquel was the fifth-largest selling pharmaceutical of any kind, generating $6 billion in global sales for its manufacturer, AstraZeneca.

In 2012, the patent for Seroquel expired and AstraZeneca's sales plummeted. But it is estimated that sales of the generic drug quetiapine have only increased since then because it is so much cheaper.
AstraZeneca says Australians benefit from drug, champions its appropriate use

In the United States, AstraZeneca has been hauled through the courts.

In 2010, the company paid $520 million for marketing the drug off-label and for the debilitating side-effects patients experienced.

"It came to light that during the approvals process, AstraZeneca covered up some of the major side-effects of Seroquel in order to get it easily approved," Professor McGregor said.

In a statement to 7.30, AstraZeneca says it does not promote the off-label use of Seroquel.

    Our focus is to support prescribers to champion the appropriate use of medicine and ensure that patients receive this treatment only when there is a clear medical rationale for doing so.

"Quetiapine fumarate is a proven and effective medicine for its registered indications of schizophrenia, bipolar disorder, major depressive disorder and generalised anxiety disorder," the statement said.

"The medicine has been independently reviewed and licensed by the Therapeutic Goods Administration for these conditions. It is a fact that thousands of Australians have benefitted for being able to access this treatment for what are often difficult and complex mental health disorders.

"Our focus is to support prescribers to champion the appropriate use of medicine and ensure that patients receive this treatment only when there is a clear medical rationale for doing so.

"AstraZeneca does not promote or condone any use of quetiapine fumarate which is not consistent with the registered or approved indications."
Side-effects include weight gain and diabetes

In its US television commercials, AstraZeneca now includes long disclosures about a whole range of side-effects caused by the drug.

"Elderly dementia patients taking Seroquel XR have an increased risk of death. Call your doctor if you have fever, stiff muscles and confusion," one commercial said.

The biggest side-effect is explosive weight gain and diabetes.

"I was about 60 kilos before I was diagnosed and I went up to about 120 kilos afterwards," Ms Everett said.

The worst of the side-effects is, of course, death. Quetiapine has been associated with sudden heart failure.

A study in the Lancet medical journal tracking quetiapine patients in Finland over 10 years found some disturbing trends.

"They were more likely to be dead after 10 years than patients who were on other anti-psychotic drugs and there was also an increased risk of suicide as well," Professor McGregor said.

"This is one of the ironies with this massive increase in the prescription rate in Australia - when you stack it up against other medications and other treatments, it doesn't really stand out as a particularly good drug."

Patients should be aware that coming off quetiapine abruptly is not recommended and could cause side-effects. Anyone wishing to change their psychiatric medication should first consult their doctor.

Sunday 24 November 2013

Incarceration and Psychotropic Drug Use by Youth - Prescription rates increase dramatically after detention - Courtesy of JAMA Article March 2008 + Information from Wikipedia on Youth Justice Trends

Serious juvenile crime is down but children treated as adults is increasing rapidly.

Incarceration and Psychotropic Drug Use by Youth

March 2008, Vol 162, No. 3
Incarceration and Psychotropic Drug Use by Youth
Alison Evans Cuellar, PhD; Kelly J. Kelleher, MD, MPH; Sheryl Kataoka, MD, MSHS; Steven Adelsheim, MD; Joseph J. Cocozza, PhD
Arch Pediatr Adolesc Med. 2008;162(3):219-224. doi:10.1001/archpediatrics.2007.47.

To determine changes in psychotropic medication use before and after juvenile justice incarceration, contrasting stays in long-stay commitment facilities and short-stay detention facilities.
 Statewide administrative data (July 1, 1998, through June 30, 2003) from the Florida Department of Juvenile Justice and Florida Medicaid. Medication prescriptions filled before entry and after release from facilities were determined based on paid claims. Psychotropic medication was categorized by drug class based on the National Drug Code.
General community services.


All of the Medicaid-enrolled youth aged 11 to 17 years identified as having a stay in a juvenile justice facility. The total sample included 67 819 detention stays and 59 918 commitment stays.

Main Exposure  

Incarceration in juvenile commitment and detention facilities.

Main Outcome Measure  

Filled prescriptions for psychotropic medication by class 30 and 90 days before and after incarceration.


Ninety days prior to detention, 3666 youth (5.4%) had psychotropic drug claims. Among these, 2296 (62.6%) had any psychotropic medication claims in the 30 days after release. Among commitment cases, 29.6% continued medication use after release. Onset of medication use after release from detention and commitment facilities was relatively uncommon (1.7% and 1.9%, respectively). Youth in commitment facilities were less likely than youth in detention facilities to resume their medication use across drug classes after 30 days (χ23 = 6.28; P = .04) and after 90 days (χ22 = 7.62; P = .02).


The results find greater support for a disruption effect than a discovery effect from incarceration. The findings suggest several areas for further investigation and improvement of services for incarcerated youth.

Mental health disorders are extremely common and severe among youth in the juvenile justice system, particularly incarcerated youth.1 A growing awareness of these disorders and their importance to leaders in the correctional field has created an “ethos of mental health care” in the justice system.2

Each year, the juvenile justice system handles 330 000 cases where youth are held in detention facilities for short-term periods during case processing and another 150 000 cases where youth are incarcerated in commitment facilities for long-term custody and placement.3 The 2 types of facilities have differing health care standards as established by the American Correctional Association. The American Correctional Association recommends a broad set of services for youth in commitment facilities, where youth serve longer sentences, and somewhat less stringent standards for detention centers, where youth are held for shorter periods. In detention centers, the emphasis is on rapid screening for illicit drug use and injuries. In addition to the American Correctional Association standards, the American Academy of Child and Adolescent Psychiatry has outlined a set of practice parameters that span entry, incarceration, and release into the community to assist with treatment planning for youth who have psychiatric disorders.

Despite the fact that the juvenile justice system is being called on to provide or coordinate extensive mental health services, few studies have addressed how placement in a juvenile justice facility affects service use patterns for youth with mental disorders. A study4 of jail inmates found declines in mental health service use when comparing use at intake with use in a follow-up period in the community. Another study5 found that among youth detainees with major mental disorders, 15.4% received treatment in the facility and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first.

Investigators have argued that the handoff from one service system provider to another, such as from the justice system to the community mental health system, represents a place where disruptions in care may occur.6 However, the recent increase in mental health screening efforts by juvenile justice facilities5 could lead to greater discovery of disorder and more treatment. Whether the disruption or discovery effect dominates for youth who traverse the juvenile justice system is unknown. Answers to these questions could result in policy and program changes such as greater health insurance coverage or service systems coordination. Our study of Medicaid-enrolled youth in Florida who were placed in juvenile detention and commitment facilities attempts to address these issues. We examine the effect of justice placement on the use of community behavioral health services, focusing on psychotropic medications. We hypothesize that short-stay detention facilities will be less likely than long-term commitment facilities to demonstrate either a discovery or disruption effect. Overall, we hypothesize that both types of facilities will demonstrate declines in prescription medication use on return to the community.


The study used statewide administrative data from July 1, 1998, through June 30, 2003, from the Florida Department of Juvenile Justice and the Florida Medicaid program. We only observed health care use for youth enrolled in Medicaid. Youth aged 11 to 17 years throughout the study period were included because Medicaid and other insurers may change coverage after age 17 years. Florida state Medicaid enrollment data were linked to the state juvenile justice data based on name, sex, birth date, and identification number. Of the 723 017 youth identified in the Medicaid enrollment files, 133 733 (18.5%) matched with youth in the juvenile justice system data.

In addition to sex, Medicaid enrollment data also include race/ethnicity and category of Medicaid eligibility (data not shown). Of the justice-involved youth, 36.5% were female and 63.5% were male. The Florida Medicaid data do not distinguish race from ethnicity. Based on the reported categories, 41.7% of the justice-involved youth were white, 41.7% were black, 11.3% were Hispanic, and 5.3% were of other race/ethnic background. In addition, 13.5% were eligible for Medicaid owing to disability, 18.0% owing to foster care status, and 68.5% owing to low income or related eligibility.

The Florida Department of Juvenile Justice data document each youth's name, age, sex, date of offense, and type of offense. The justice data also document the processing of the case, including dates of detention and commitment, where applicable. Only cases involving stays in detention and commitment facilities were included. Given the low number of youth placed in residential treatment facilities (n = 130), these cases were excluded.

We hypothesized that facility type would predict service patterns. Youth in long-stay facilities are predicted to experience greater changes in medication use than youth in short-stay facilities. Consequently, we divided youth into those who stayed in detention facilities and those who stayed in commitment facilities. Cases with detention stays longer than 30 days (12.5% of detention stays) and cases with commitment stays shorter than 31 days (8.5% of commitment stays) were excluded. We further limited our sample to youth who were enrolled in the Medicaid program 90 days before and 90 days after their detention or commitment stays. Of the detention and commitment stays, 12.6% and 12.9%, respectively, were excluded because the youth were not enrolled in Medicaid 90 days after release. Consequently, the total sample from the justice system included 127 737 cases, of which 67 819 were detention cases and another 59 918 were commitment cases.

We then obtained data from the Medicaid claims and encounter files for all of the Medicaid-enrolled youth to examine service use. For each case, we determined medication prescriptions filled before and after the facility stay based on paid claims. Federal law prohibits Medicaid payments for care provided during incarceration at state correctional facilities. Medication is reported by the National Drug Code and was categorized into antidepressants, typical and atypical antipsychotic drugs, and stimulants. We also created an “any psychotropic drug” category, which included the former 3 categories plus benzodiazepines, sedatives, mood stabilizers, anxiolytics, and drugs for substance use disorders such as methadone.

We first examined the use of any psychotropic medication before and after the facility stay. We defined youth as having psychotropic medication use before incarceration if they had at least 2 claims for any psychotropic medication in the 90 days before the facility stay to avoid including claims that were filled once but did not represent ongoing medication use. All of the other youth were defined as nonusers. For both users and nonusers, we then assessed how many youth had any psychotropic medication claims in the 30 days after reentry into the community.

Subsequently, we examined psychotropic medication use for specific drug classes, including stimulants, antidepressants, and antipsychotic drugs. Stimulants and antidepressants were chosen because they are the most commonly prescribed psychotropic medications for children and adolescents. We also included antipsychotic drugs because they are often used to treat aggressive behavior in this population and their use is rapidly growing.7 For these subanalyses, we excluded youth who received more than 1 type of psychotropic medication, ie, polypharmacy use, before their facility stay. Among the remaining youth, we then determined what proportion had at least 1 psychotropic medication claim within 30 days after release or 2 claims within 90 days after release.

The study received approval from the institutional review boards of Florida State University, Columbus Children's Research Institute, and Columbia University.


The Figure shows the total number of youth detention cases in our sample. Among the 67 819 detained youth, only 3666 (5.4%) had 2 or more claims for psychotropic drugs in the 90 days prior to detention. Among these 3666 cases, 2296 (62.6%) had any psychotropic medication claims in the 30 days after release. Regarding new onset of psychotropic drug use, we found that among the 64 153 cases with no prior psychotropic medication claims, only 1073 (1.7% of previous nonusers) had claims in the 30 days after release from detention. Of 4739 total psychotropic drug users among detainees, 22.6% began receiving psychotropic drugs after incarceration.

Psychotropic medication use by Medicaid enrollees before and after juvenile incarceration. The study includes youth enrolled in Medicaid 90 days before incarceration and 90 days after release. Medication prior is defined as 2 or more psychotropic prescription claims in the 90 days prior to incarceration; medication after is defined as any psychotropic prescription claims within 30 days after incarceration.

The results for the 59 918 commitment cases were similar except that the proportion of cases with continued medication use after release was even smaller. Only 2649 commitment cases (4.4%) had 2 or more claims for psychotropic drugs in the 90 days prior to entry. Among these 2649 cases, only 783 (29.6%) had a psychotropic medication claim in the 30 days after release. Onset of medication use after release from commitment facilities was relatively uncommon. Only 1108 cases (1.9% of previous nonusers) had claims 30 days after commitment release. Of 3757 total psychotropic medication users among commitment cases, 29.5% began using the medication after incarceration.

We examined medication use prior and subsequent to a facility stay more closely by drug class. The Table shows youth who had 2 or more claims for a particular drug class only and no other psychotropic drug use in the 90 days before entry into a facility. We compared the number of youth receiving a drug in a particular drug class—and only that drug class—and examined what percentage used any psychotropic medication on release.
Table. Cases With Psychotropic Medication Use Prior to Facility Stay Only
Image not available.
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Among detention cases, we found that the percentage that resumed psychotropic medication use within 30 days after release was 54.0% for the antipsychotic-only group, compared with 43.8% for the antidepressant-only group (χ21 = 2.05; P = .15) and 51.1% for the stimulant-only group (χ21 = 0.23; P = .61).

By 90 days, the proportion of youth who resumed medication use had increased across all of the groups. Among the antipsychotic-only group, 76.0% had resumed use, compared with 60.4% for the antidepressant-only group (χ21 = 5.50; P = .02) and 73.9% for the stimulant-only group (χ21 = 0.18; P = .67).

The Table illustrates that the effects varied by facility type. Youth in commitment facilities were less likely than youth in detention facilities to resume their medication use across groups after 30 days (χ23 = 6.28; P = .04) and after 90 days (χ22 = 7.62; P = .02).

Among the antipsychotic-only group, only 15.9% resumed use of any psychotropic medication within 30 days of release, compared with 21.9% for the antidepressant-only group (χ21 = 1.11; P = .29) and 24.7% for the stimulant-only group (χ21 = 2.84; P = .09). Within 90 days, 20.5% of the antipsychotic-only group had a claim for some psychotropic use, which was lower than among the antidepressant-only group at 30.5% (χ21 = 2.50; P = .11) and the stimulant-only group at 33.6% (χ21 = 5.29; P = .02).

Our study found that both before and after contact with the juvenile justice system, few youth received psychotropic medications even in the face of prior research suggesting high levels of disorder. By comparison, a study of privately insured youth in 2000 found 15 993 of 473 954 individuals (3.4%) to have psychotropic drug use based on claims data. Although Medicaid-enrolled, justice-involved youth are at higher risk for psychopathology, the results of the current study indicate that only 4% to 5% of detained and committed adolescents receive psychotropic medication prior to justice involvement and even fewer receive medication on release. Moreover, following incarceration in a juvenile justice facility, there was a high rate of disruption of prior medication use, with only 30% to 63% of youth who were receiving a psychotropic medication prior to incarceration still using a medication within 30 days after release.

Despite lower-than-expected psychotropic medication use prior to incarceration, we also found that discovery of new cases was less than 2%. With the growing demands for use of standardized mental health assessments in juvenile justice facilities for screening and treatment planning, this finding is surprising. Furthermore, estimated prevalence rates of mental disorders are as high as 65%.1,8 Although some psychotropic medication use prior to entry may be inappropriate, it is unlikely that interruption on such a large scale is indicated unless the restrictive nature of incarceration causes dramatic improvements in many youth, a scenario that seems unlikely to account for the high number of disruptions in treatment. Another possibility is that youth receive some other intensive therapeutic intervention in the community in lieu of medication.

Because medication use declines over time even in the general population, we compared our juvenile justice sample to all of the nonincarcerated youth aged 11 to 17 years who were enrolled in the Florida Medicaid program on January 1, 2001. We defined users of psychotropic drugs as anyone who had 2 or more psychotropic drug claims within 90 days before our index day, ie, January 1, 2001. Among the 12 762 youth whom we identified as users of psychotropic drugs on the index day, 75.9% had at least 1 medication claim within 30 days (data not shown). Because we did not control for differences in sociodemographic and health characteristics, these results are only suggestive of the fact that declines in medication use in the general population may be substantially smaller than those observed among the incarcerated youth in our sample.

State and federal case law has established that incarcerated youth should receive some level of psychological services from trained staff, including professional evaluations, treatment plans, follow-up evaluation, and counseling.9 Juvenile justice facilities have expanded their provision of mental health screening and direct care services.10,11 In some cases, this expansion has been expedited as a result of federal lawsuits. Since 1980, the Department of Justice has investigated conditions of confinement in more than 100 juvenile facilities in 16 states under the Civil Rights of Institutionalized Persons Act (42 USC §1997a et seq). The most recent complaint against a juvenile correctional facility was brought in December 2006 (United States v State of Oklahoma) and among other allegations cites inadequate management of psychotropic medication and inadequate provision of mental health services and transition planning.


Theoretically, one could pose different arguments as to why the justice system might either increase or decrease the use of psychotropic medications for youth who are incarcerated. Medication prescriptions may still be in effect with refills remaining for youth with very short stays, whereas this is less likely to be the case for long-stay youth, leading to decreases. Increases in psychotropic medication use after incarceration may result, for example, if there is a discovery effect in that routine screening or assessment in the justice system reveals previously untreated or undertreated mental disorders. New episodes of medication treatment could occur if psychotropic medications are initially used in justice facilities as chemical restraints and then continued in the community. Overcrowded facilities have been found to make greater use of control measures and restraints.12,13

Our results find greater support for a disruption effect than a discovery effect. We suggest several possible reasons. First, while mental health assessment has become more widespread in juvenile justice facilities, the emphasis remains on emergent conditions such as suicide prevention rather than ongoing treatment. Despite this concern, there is evidence that facilities fail to meet even the basic recommendations for service provision.5 For example, fewer than a third of youth are in detention or correctional facilities that meet recommended suicide prevention measures.9 Further, only 56% of youth are housed in facilities that have mental health staff available daily, with even more limited access to child psychiatric care. Thirteen percent have no mental health staff available at all.

Second, the level of overcrowding in detention and commitment facilities makes it likely that treatment for chronic health and mental health conditions cannot be adequately maintained for many youth. Overcrowding makes it more difficult to identify youth in need of mental health services. A 2002 Juvenile Residential Facility Census found that 18% of detention facilities were above their standard bed capacity and another 14% were at capacity.10 In addition, high staff turnover is a problem in some areas.14

Third, whether medication treatment is continued on release from the facility may depend on the adequacy of aftercare planning, including whether the youth has adequate health insurance coverage and can pay for medications or whether the young person and his or her family can forge linkages back to community providers. We suspect that overwhelmed facilities struggle to provide and implement appropriate aftercare plans.

Fourth, our findings suggest that the type of facility appears to play an important role. Rates of resumption were higher after detention stays despite the fact that screening and service delivery are less extensive in detention centers than in commitment centers15 and despite the fact that many states preclude compulsory treatment to such preadjudicated youth.9 Our study design included only youth enrolled in Medicaid after release; therefore, observed differences in our study between detention and commitment are not due to the greater discontinuation of Medicaid for committed youth.

However, it is possible that the higher level of structure in commitment facilities may provide behavioral benefits, thereby allowing more youth to discontinue their medication while in the commitment facilities. The medications may then not be resumed after the youth return to the community. Aftercare may be more challenging for youth exiting commitment facilities than for those exiting detention because lengths of stay are considerably longer on average6 and youths' community ties are consequently more tenuous or difficult to reestablish. Involvement by probation or parole officers is more likely after commitments than detentions, although the role of such officers relative to community behavioral health care linkage and use is not clear.

Finally, this study finds differences in the degree of service resumption by medication class, indicating that following incarceration in a justice facility, the medication resumption may depend on the youth's psychiatric disorder. For some youth with externalizing disorders, the high degree of structure in these facilities may obviate the need for medication to control symptoms. The effect also may depend on the type of medication. Some forms of stimulants, for example, are potentially subject to abuse and may lead justice facilities to curtail their use. In either instance, medication use may not resume once the youth returns to the community.


This study of psychotropic medication use after juvenile justice system contact has a number of limitations. First, this study is based on data from Medicaid-enrolled youth in Florida and results may not generalize to the entire US population of juvenile offenders with mental illness. Second, our data on medications are based on claims paid by Medicaid. It is possible that youth received prescriptions after release that they did not fill, raising issues around patient compliance that we cannot address here. In addition, we do not have data on medication use in the facility. Although such data would not change the results of the study, it might inform us as to whether the service interruption began in the facility itself or whether it is a function strictly of postrelease planning and follow-up. Finally, this study is limited in its ability to determine the appropriateness of the medication treatment of youth in this sample. Further investigations are needed to determine whether youth in justice facilities are receiving guideline-based medication management and sufficient follow-up on release.

Although we are able to distinguish facilities by their length of stay, we are not able to measure or examine the effect of overcrowding, sentencing requirements, staffing patterns, services provided within the facilities, or combinations of these. To the extent that the service disruptions are a function of any of these items, additional study will be required.


The findings of this study suggest 3 main areas for further investigation and improvement of psychotropic medication services for incarcerated youth: appropriate psychiatric evaluation and treatment prior to detention or commitment, appropriate treatment while in justice facilities, and adequate follow-up on release. While in juvenile justice facilities, these high-risk youth are in need of thorough psychiatric evaluations that include assessment of the current medication treatment as well as the need for a new trial of psychotropic medications. Without appropriate treatment of psychiatric disorders, these youth remain vulnerable to potentially treatable conditions that may affect their recidivism in the justice system and their academic and social functioning.

Second, the health, mental health, and social service agencies in the community face a complex task of linking justice-involved youth to community services, especially for those being released from longer-stay facilities. In these facilities, medication discontinuity was much higher. Planning for multicomponent interventions for youth reentering the community is severely hampered by the challenges of coordination and reimbursement and by the willingness of the community and its social service agencies to care for youth who are seen as criminals. As in foster care institutions where systems have been developed to assist in the transfer of critical medication and allergy information, similar systems would seem important for youth in the justice system. Coordination with local mental health agencies will be an essential part of that process. At least as important is attention to financing and reimbursement to pay for those services, most likely through Medicaid.

This study sheds some light on problems in delivering psychotropic medications to youth after contact with the juvenile justice system. One of the greatest challenges in improving their care is the lack of systemic responsibility for youth reentering the community. Communities that do not develop coordinated plans will likely be subject to the psychiatric and criminal recidivism that seems inevitable when systems do not deliver effective services to severely disturbed youth.

Current Trends in Youth Custody  
Recently, forty seven states have made it easier to be tried as an adult,[7] calling attention to the growing trend away from the original model for treatment of juveniles in the justice system. A recent study of pretrial services for youth tried as adults in 18 of the country’s largest jurisdictions found that the decision to try young offenders as adults was made much more often by legislators and prosecutors (at a rate of 85%) than by judges, the people originally endowed with the responsibility for such discretion.[8]

The decreasing distinction between how youth and adults are tried in the criminal justice system has caused many within the legal system, as well as other activists and organizers, to be critical of the juvenile justice system.[citation needed]

The “tough on crime” attitudes of these recent legislative events reflect the popularity of such a stance in public opinion. This is true of the majority of criminal justice reform policies of the past couple decades, including California’s infamous Three Strikes Law.

Criminal justice—-and in particular juvenile justice—-reform battles are often fought in the court of public opinion. The popular news media have played a crucial role in promoting the myth of a new generation of young “super-predators” threatening the public.[9] Despite documented decreases in youth crime—especially in violent crime indicating a 68% decline in youth homicide in the 1990s — overall media coverage of youth crime is increasing.[10] Despite evidence to the contrary, 62% of respondents to a 1999 survey on youth delinquency believed that youth crime was up.[9] Advocates for juvenile justice reform focus considerable attention on amending public opinion and adjusting the gap between what threats people perceive and the reality of youth offending.

Profiles of Youth in Custody

A report by the federal Office of Juvenile Justice and Deliquency Prevention and U.S. Department of Justice, “Survey of Youth in Residential Placement: Youth’s Needs and Services," used data from more than 7,000 youth in custody gathered during interviews. The report's findings include: 70% of youth in custody reported that they had “had something very bad or terrifying” happen to them in their lives. 67% reported having seen someone severely injured or killed; 26% of those surveyed said felt as if “life was not worth living," and 22% reported having tried to commit suicide at some point in their lives; 84% of the youth surveyed said they had used marijuana, compared to a rate of 30% among their peers in the general population; 30% reported having used crack or cocaine, compared with only 6% in the general population. The report noted a significant gap between the profiles of boys and girls, with girls often reporting more pronounced difficulties: 63% of girls reported having problems with anger, whereas 47% of boys did; 49% of girls reported having hallucinatory experiences, whereas only 16% of boys did; 37% of girls reported having suicidal thoughts and feelings, whereas only 18% of boys did. Facilities that treat such youth also were shown to be inadequate in some core areas, according to the Justice Department. Among youth who reported four or more recent substance-related problems, only about 60% said they had been provided with substance abuse counseling in their current facility. Many youth in custody reported having attention problems and difficulties in school. Once in custody, only 45% report spending 6 hours a day or more in school, meaning that their learning time is below that of the general population.[11]

Proposition 21 in California

In 2001 California residents passed Proposition 21, a multi-faceted proposition designed to be tough on youth crime, incorporating many youth offenders into the adult criminal justice jurisdiction.

Opponents to this law included activists from Californians for Justice, Critical Resistance, the Youth Force Coalition, the Ella Baker Center for Human Rights, and the American Civil Liberties Union. Advocates in the ACLU challenged many portions of the law, including a provision automatically sentencing youth 14–17 years old in adult court. This portion of the law was struck down by the California Courts of Appeal in 2001.[41]

Opposing zero-tolerance policies

The term "zero tolerance" is not defined in law or regulation; nor is there a single widely accepted practice definition. The United States Department of Education, National Center for Education Statistics, defined zero tolerance as "a policy that mandates predetermined consequences or punishments for specified offenses".[42] The purpose of zero-tolerance policies, according to their proponents, is to send a message that certain kinds of behaviors are not tolerable on school grounds. About 94% of public schools in the United States have zero-tolerance policies for guns; 91% for other weapons; 88% for drugs; 87% for alcohol and 79% for tobacco.[42]

Opposition to zero-tolerance policies, especially at the local level, focus on critiques including charges that the program is discriminatory, unconstitutional, harmful to schools and students, ineptly implemented, and provides harsh punishment (suspension of education) for minor offenses (possession of tobacco).

A few infamous cases have been used by opposition groups, such as Amnesty International, to further their case against the policy. The Center for Juvenile and Criminal Justice released a story in 2003 about a 13 year old girl in Tuscaloosa, Alabama arrested and detained for 5 weeks for possession of what was thought to be marijuana, but turned out to be oregano.[43] The zero-tolerance practice in Illinois of sending any youth charged with drug crimes within 1,000 feet of any school or public housing project directly to adult court has resulted in the largest racial disparity in the country—over 99% of youth affected by this policy were minority youth.[44]

Opposition to zero-tolerance policies nationwide and locally is broad and growing. Organizational leadership has been provided nationally by Amnesty International and the American Bar Association, who has officially opposed such policies since 2001.[45]



Correspondence: Alison Evans Cuellar, PhD, Department of Health Policy and Management, Columbia University, 600 W 168th St, Sixth Floor, New York, NY 10032 (ac2068@columbia.edu).

Accepted for Publication: August 3, 2007.

Author Contributions:Study concept and design: Cuellar and Kelleher. Analysis and interpretation of data: Cuellar, Kelleher, Kataoka, Adelsheim, and Cocozza. Drafting of the manuscript: Cuellar and Kelleher. Critical revision of the manuscript for important intellectual content: Cuellar, Kelleher, Kataoka, Adelsheim, and Cocozza. Statistical analysis: Cuellar. Obtained funding: Cuellar and Kelleher. Administrative, technical, and material support: Cuellar, Kelleher, Adelsheim, and Cocozza. Study supervision: Cuellar.

Financial Disclosure: None reported.

Funding/Support: This work was supported by The John D. and Catherine T. MacArthur Foundation, the Children's Research Institute of Columbus Children's Hospital, and grant K01 MH067086 from the National Institute of Mental Health (Dr Cuellar). Medicaid data were provided under contract MED049 from the Florida Agency for Health Care Administration to the University of South Florida Florida Mental Health Institute.

Additional Contributions: Ren Chen, MS, was the programmer and Paul Stiles, JD, PhD, supervised the Medicaid data held at the Florida Mental Health Institute. Their work was supported by funding that we provided to the Florida Mental Health Institute. We thank the Policy and Services Research Data Center at the Florida Mental Health Institute.


Wasserman  GA McReynolds  LSLucas  CPFisher  PSantos  L The voice DISC-IV with incarcerated male youths: prevalence of disorder. J Am Acad Child Adolesc Psychiatry 2002;41 (3) 314- 321
Armstrong  S The emergence and implications of a mental health ethos in juvenile justice. Sociol Health Illn 2002;24 (5) 599- 620
Puzzanchera  CStahl  ALFinnegan  TATiernery  NSnyder  HN Juvenile Court Statistics, 2000.  Pittsburgh, PA National Center for Juvenile Justice2004;
Freudenberg  NDaniels  JCrum  MPerkins  TRichie  BE Coming home from jail: the social and health consequences of community reentry for women, male adolescents, and their families and communities. Am J Public Health 2005;95 (10) 1725- 1736
Teplin  LAAbram  KA McClelland  GMWashburn  JJPikus  AK Detecting mental disorder in youth detainees: who receives services. Am J Public Health 2005;95 (10) 1773- 1780
Evans Cuellar  AKelleher  KJRolls  JAPajer  K Medicaid policies and juvenile justice. Am J Public Health 2005;95 (10) 1707- 1711
Olfson  MBlanco  CLiu  LMoreno  CLaje  G National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006;63 (6) 679- 685
Teplin  LAAbram  KM McClelland  GMDulcan  MKMericle  AA Psychiatric disorders in youth in juvenile detention. Arch Gen Psychiatry 2002;59 (12) 1133- 1143
Parent  DGLieter  VKennedy  SLivens  LWentworth  DWilcox  S Conditions of Confinement: Juvenile Detention and Corrections Facilities.  Washington, DC Office of Juvenile Justice & Delinquency Prevention, US Dept of Justice1994;
Sickmund  M Juvenile Residential Facility Census, 2002: Selected Findings.  Washington, DC Office of Juvenile Justice & Delinquency Prevention, US Dept of Justice2006;
Silverthorn  B Juvenile Assessment Centers.  Atlanta, GA Southern Juvenile Defender Center, Southern Poverty Law Center2003;
Burrell  S Crowding in Juvenile Detention Centers: A Problem-Solving Manual.  Richmond, KY National Juvenile Detention Association & Youth Law Center1998;5- 6
Burrell  S The human impact of crowding in juvenile detention. J Juv Justice Detention 1998;13 (1) 43- 51
Legislature  F Justification Review: Juvenile Detention Program's Performance Improved; Staffing Needs to Be Revisited.  Tallahassee, FL Office of Program Policy Analysis & Government Accountability2000;Report 99-45
Grisso  TUnderwood  LA Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System.  Washington, DC Office of Juvenile Justice & Delinquency Prevention, US Dept of Justice2004;

Saturday 23 November 2013

Friday 22 November 2013

Anti-depressants warning by experts - Courtesy of the Guardian Network - October 2013

Anti-depressants warning by experts

12:38am Monday 14th October 2013 in National News 

 A study commissioned by a healthcare charity suggests the UK is becoming a nation of pill poppers with GPs prescribing anti-depressants too quickly

The UK is becoming a nation of pill poppers, with GPs too quick to prescribe anti-depressants, mental health experts warn.

New research suggests GPs are 46 times more likely to prescribe medication for depression and other mental illnesses instead of other medically proven alternatives like psychological therapy, exercise or meditation.

The reliance on prescription medication comes as the study, commissioned by healthcare charity Nuffield Health, indicates mental illness is also on the rise.

A survey of 2,000 people showed 44% experienced anxiety symptoms regularly, up 33% when the recession hit five years ago.

The research suggests the number of people experiencing low mood, an early indicator of depression, has also increased, jumping from 31% to 39%.

It showed only 1% of those who visited their GP were told to exercise to alleviate low mood or anxiety, compared with 46% who were prescribed anti-depressants.

Nuffield Health medical director Dr Davina Deniszczyc said the trend indicated a "ticking mental health time bomb in the UK".

"The compelling evidence that physical activity can play an important role in both treating and alleviating early symptoms of mental ill health isn't sufficiently filtering through to front line and primary care services," she said.

"Nuffield Health is calling for all GPs to treat mental health as they would any other condition that can benefit from treatment with exercise - like chronic heart disease, diabetes and obesity for example."

The push for less reliance on anti-depressants is supported by those surveyed, with only 4% saying they would prefer to be prescribed medication over exercise, if given the choice.

The study also showed 76% thought exercise lifted their mood and 72% were aware it was clinically proven to manage moderate anxiety or low mood.

Beth Murphy, Head of Information at the mental health charity Mind, said prescription drugs were often used because there were long waits for talking therapies.

"Mind has found that people who do regular exercise or take part in ecotherapy activities such as gardening can improve their mental well-being and reduce feelings of depression," she said.

"We urge health professionals to take alternatives such as exercise seriously and consider a range of treatments that offer more choice for individuals."

Almost half (46%) of those surveyed said financial worries were a key contributor to low mood, 43% identified family issues and 36% said problems at work played a role.

Only 8% said ill health affected their mood.

GPs to stop prescribing antidepressants blamed for suicidal feelings in under-18s Courtesy of the Guardian Newspaper 2005

GPs to stop prescribing antidepressants blamed for suicidal feelings in under-18s

· Pills to be phased out for up to 40,000 children
· New treatments to include exercise and counselling the preferred methods across the Channel in France.

Sarah Boseley, health editor
Wednesday September 28, 2005

Doctors were yesterday told to stop giving antidepressants to children and people under 18, because of the risks that the pills will make them feel suicidal.

The new NHS guidance marks a watershed in the treatment of children's mental health. It shifts the focus sharply away from the psychiatric drugs that around 40,000 children are thought to be taking for depression, anxiety and other problems. Children with mild depression should be given advice on diet and exercise, the guidance tells GPs. Those with moderate and even severe depression should be offered a three-month course of counselling.

The guidance is likely to cause consternation among GPs who do not have enough counsellors and therapists available to treat all the children who will need help. "The very significant shortage of practitioners able to deliver these therapies is a cause for concern," said Dinah Morley, the deputy director of the charity Young Minds, which applauds the new emphasis on therapy.

The government's National Institute for Clinical Excellence (Nice), which has produced the guidance, says only one drug - Prozac - may help children, and even that carries risks. Only if the "talking therapies" do not work can children be prescribed antidepressants - and even then, only in combination with other forms of counselling and close monitoring for side- effects.

Until recently, most under-18s diagnosed with depression have been treated by their GP and most will have been given a prescription. But in response to growing concern at the potential of the modern antidepressants to make young people feel suicidal - highlighted over several years by the Guardian - Nice has said pills should never again be the treatment of first resort.

In June 2003 the drug licensing body in the UK warned doctors of the risks in prescribing any of the modern antidepressants known as the SSRIs (selective serotonin reuptake inhibitors) for anybody under 18, with the exception of Prozac. All of them had a tendency to increase suicidal thinking, but only Prozac showed any benefit in children to counterbalance the dangerous side-effects.

A study in the Lancet in April last year, which looked not only at trial results the drug companies had published but also those they had not, confirmed the risks to children.

From the mid-90s until two years ago, more and more children who were diagnosed with depression were given tablets by their doctors. The SSRIs were much better tolerated than older antidepressants and were thought very safe for GPs to prescribe. The annual number of prescriptions to those under 18 soared from 13,227 in 1995 up to 27,658 in 2003.

But then the few clinical trials carried out in children had shown that the drugs had serious risks. Some children felt suicidal. That was the case with adults too, but significant numbers of adults appeared to recover from their depression. In children, there was not significant evidence, except for Prozac, that the SSRIs had any benefit to set against the risk. This only came to light because GlaxoSmithKline, British manufacturer of the bestselling SSRI, Seroxat, applied for a licence for the drug to be used in depressed children. It submitted the trial evidence it had to the Medicines and Healthcare Regulatory Authority (MHRA), which regulates drugs.

The data showed that 3.4% of children experienced mood changes, tried to harm themselves or thought of suicide, compared with 1.2% who took a dummy pill in the trials. At the time, there were 8,000 children on Seroxat. In June 2003 the MHRA put out a warning to doctors that they should no longer prescribe it to under-18s. In September they issued a similar warning for a second drug, Efexor. On December 11 the MHRA told doctors all the drugs, except for Prozac, were unsuitable for children, although it left it up to doctors to decide whether or not to continue using them, and many are thought to have done so.

Tim Kendall, joint director of the National Collaborating Centre for Mental Health, who was one of the authors of the Lancet study and also led the formulation of the Nice guidelines, said they were even more clear now about the risks. "No child, however severe the depression, should have their firstline treatment with a drug," he said.

He and his colleagues are concerned about the numbers of children with depression, which is sometimes triggered by a sad event like a death, but is often linked to poverty, deprivation, abuse and family breakups. "Our view is that we should be targeting these children as best we can," he said. "Out of 1,200 kids in a comprehensive, at least 40 would be expected to suffer a diagnosis of depressive illness and only 10 are getting any help."

The new guidance for doctors says GPs should advise children with mild to moderate depression on ways they can help themselves through exercise and diet. "But then if there is any significant risk, we should be offering individual cognitive behaviour therapy or family therapy, depending on their needs," he said. "We're really serious that we don't think these drugs should be used lightly."

Even when a young person is severely depressed, the first step should be psychotherapy for around three months. Only if there has been no improvement after four or five sessions should the doctor - and by this stage it would be a psychiatrist - consider prescribing Prozac.

Andrew Dillon, chief executive of Nice, said the guideline "makes it clear that psychological treatments are the most effective way to treat depression in children and young people." Children taking pills should talk to their GP about phasing them out.

At present, there are not enough counsellors and therapists to help all the children who may need it. Yesterday Louis Appleby, the national director for mental health, said: "We know that not everyone who needs treatment is able to access it easily or quickly and expertise and services are not equally distributed around the country." He added that the government was "considering ways of increasing numbers of staff" trained in cognitive behaviour therapy, which is usually the preferred treatment for depression. More than £300m had gone into child and adolescent mental health services.

Mind, the mental health association, urged the government to give the NHS the support and resources it would need to ensure children have proper access to psychological treatments. Research on antidepressants "has shown many to be totally unsuitable for young people. They must be provided with effective alternatives," said a policy officer, Alison Cobb.

"These guidelines are a welcome step in the right direction: the onus is now on the government to provide the means to make them happen," said Liz Nightingale of the mental health charity Rethink.

Danger signs

In 2003, under-18s in England were given 27, 658 prescriptions for antidepressants

40,000 children and young people are thought to be on psychiatric drugs, including antidepressants

Doctors were warned in 2003 of the risks of using Seroxat, Efexor, Lustral, Cipramil, Cipralex and Faverin in children and young people

A survey of GPs in March 2004 found 80% thought they were prescribing SSRIs to too many adults and children

Wednesday 20 November 2013

DANSK TRANSLATION - "Langt fra Rotten i staten Danmark." (Far from Rotten in the State of Denmark) by Dave Traxson, Chartered Educational Psychologist -Courtesy of : dxsummit - Den globale topmøde om Diagnostiske Alternativer

CLICK ON HYPERLINK : http://dxsummit.org/archives/1709

Den globale topmøde om Diagnostiske Alternativer: En online platform for Rethinking Mental Health

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Langt fra Rotten i staten Danmark

Dave Traxson 19 nov 2013 kulturelle emner, aktuelle status Dx, trykker spørgsmål, sociopolitiske Issues    

psykofarmaka og deres anvendelse som midler til social kontrol og alternative filosofier i nogle vestlige Societies

Mange internationale undersøgelser, som den, der udføres af WHO i 2009, viser Danmark i en meget positivedenmark lys i form af dens Velfærd State og behandling af udsatte grupper i samfundet. Kendt som et land med et levende og progressivt samfund med en gradueret skattesystem at den skal finansiere det, Danmark jævnligt kommer ud som det lykkeligste land at støtte et barns udvikling, og hvor man lever og noget overraskende et land, hvis borgere gør ikke modsætte sig disse skattesatser. Det er også interessant, har en af de laveste satser for brug af psykofarmaka til børn i den vestlige verden, er det en tilfældighed? Psykiske indeks er også meget stærk i Danmark, med 89% af befolkningen rapporteret som havende flere positive erfaringer i en gennemsnitlig dag (følelser af hvile, stolthed i realisering, nydelse, osv.) end negative (smerte, bekymring, sorg, kedsomhed osv. ). Dette tal er det højeste i OECD, hvor gennemsnittet er 80%, hvilket i sig selv er meget betydelig. Sikkert vi alle ønsker at efterligne sådanne fundamentale konstateringer og lære at forbedre vores øjeblikket stadigt mere opdelte samfund. Danmark har investeret kraftigt i en banebrydende metode, der kaldes social pædagogik for de mest udsatte gruppe af børn i samfundet, hvad vi kalder 'passet børn.' Dette er baseret på at bruge »Sociale pædagogernes der arbejder intensivt med omkring 5 unge hver og holde disse tilfælde lang sigt. Denne intervention får gode liv udfald fx seks ud af ti sådanne børn i Danmark komme ind Higher Education i forhold til seks promille i UK Social pædagogik er en akademisk disciplin beskæftiger sig med teori og praksis for holistisk uddannelse og omsorg. Udtrykket »pædagogik 'stammer fra det græske Pais (barn) og agein (at opdrage, eller bly), med præfikset" social "understrege, at opdragelsen er ikke kun forældrenes ansvar, men et fælles ansvar for samfundet. Som et resultat, er social pædagogik en funktion af samfundet "det afspejler, hvordan et givet samfund på et givet tidspunkt tænker uddannelse og opdragelse, om forholdet mellem individ og samfund, og omkring social velfærd for sin marginaliserede medlemmer. Derfor sociale pædagoger arbejder inden for en række forskellige indstillinger, fra tidlige år gennem voksenalderen til at arbejde med dårligt stillede voksne grupper såvel som ældre. For at opnå et holistisk perspektiv inden for hver af disse indstillinger, social pædagogik samler teorier og begreber fra beslægtede discipliner som primært psykologi, så også sociologi, uddannelse, filosofi, lægevidenskab og socialt arbejde.     

Som sociale væsener, vi lever med vores øjne på vores refleksion, men har ingen garanti for ro i de farvande, hvor vi ser det.     Charles Horton Cooley 

Social pædagogik bygger på humanistiske værdier understregede menneskelig værdighed, gensidig respekt, tillid, ubetinget påskønnelse, og lighed, for at nævne et par stykker. Den understøttes af et grundlæggende begreb børn, unge og voksne som ligeværdige mennesker med rige og ekstraordinære potentiale og anser dem ansvarlige, ressourcestærke og aktive agenter i deres egen udvikling og liv planlægning. Samlet, social pædagogik har til formål at opnå følgende:     Holistisk uddannelse - indlæring af hovedet (kognitiv viden), hjerte (følelsesmæssige og åndelige læring), og hænder (praktiske og fysiske færdigheder),         Holistisk velvære - styrkelse sundhed-opretholde faktorer og yde støtte for folk at nyde en lang varig følelse af lykke,         at aktivere børn, unge såvel som voksne til at give sig selv og være selv-ansvarlige personer, der tager ansvar for deres samfund         . At fremme menneskelig velfærd og forebygge eller mindske sociale problemer . Petrie m.fl. (2006) identificerer ni principper social pædagogik:     "Et fokus på barnet som et helt menneske, og støtte til barnets generelle udvikling,     Den praktiserende læge ser sig selv / sig selv som en person, i forhold til barnet eller den unge,     børn og personale ses som bebor det samme liv rummet, ikke som eksisterende i separate hierarkiske domæner,     som professionelle, er pædagoger opfordres til stadighed at reflektere over deres praksis og til at anvende både teoretiske forståelser og selvforståelse til de til tider udfordrende krav, som de konfronteres,     Pædagoger er også praktiske, så deres uddannelse forbereder dem til at dele i mange aspekter af børns dagligdag og aktiviteter,     Børn s foreningsliv ses som en vigtig ressource: arbejdstagere bør fremme og gøre brug af gruppen,     pædagogik bygger på en forståelse af børns rettigheder, der er ikke begrænset til procedurespørgsmål eller lovgivet krav:     Der lægges vægt på teamwork og om værdiansættelse bidrag andre i 'opdragelse' børn: andre fagfolk, der er medlemmer af lokalsamfundet og ikke mindst forældre,     det centrale i en terapeutisk sammenhæng . og allieret til dette, vigtigheden af at lytte og kommunikere " Samlet set en meget dygtig social pædagog praksis er en holistisk og menneskelig proces at skabe en balance mellem:     den professionelle: (teori og begreber, reflekterende praktiker = hovedet)     det personlige: (ved hjælp af ens personlighed, positiv attitude, opbygge personlige relationer, men at holde det private ud = HJERTET)     det praktiske: (ved hjælp af visse metoder og kreative aktiviteter = hænderne) Alle tre elementer er lige og supplerer hinanden, og dermed skabe synergi med delt formål. På grund af denne filosofi er det måske ikke overraskende, at receptpligtig satser for psykofarmaka er lavere end mange andre lande med en tilsvarende økonomisk og kulturel profil, men at manglen denne filosofiske fundament for humanistiske værdier og co-konstruerede muligheder. at sætte disse observationer til en international kontekst, Constantine Berbatis og associerede fra Ausralia sammenfattet deres resultater i en undersøgelse med titlen 'legale psykostimulanser forbrug i Australien, 1984-2000: internationalt og kompetencemæssige sammenligning ", at" For de 10 lande fra 1994 til 2000, i alt psykostimulanser forbrug steg med gennemsnitligt 12% om året, med den højeste stigning fra 1998 til 2000. Australien og New Zealand rangeret som den tredje i alt psykostimulanser brug efter USA og Canada, hvor det gennemsnit 8% af skolens befolkning. Australien, hvor 1984-2000 er antallet af forbruget af lovlige psykostimulerende steg med 26% om året, med en 8,46-dobling 1994-2000, forbruges betydeligt mere end Det Forenede Kongerige, Sverige, Spanien, Holland, som til gengæld var mere end Frankrig eller Danmark, der begge har satser på under 0,2% på grund af særlige anvendte metoder. Frankrig mener i brugen af psykoterapi og sport til at reducere angst niveauer og adfærdsmæssige vanskeligheder. For det europæiske perspektiv, 'The Spirit Level "(2009) forudsat fremragende bevis på den ulighed, splittelse i samfund, og hvordan det påvirker trivsel. Forskningen tyder på, at forfatterne Wilkinson og Pickett konstatering at der er en stærk sammenhæng mellem omfanget af indkomstforskelle i et land og sværhedsgraden af multiple, diskrete sundhed, psykisk velvære og sociale problemer, og det er også relevant for kulturel aktivitet . Undersøgelsen viste, at blandt de 22 europæiske analyserede lande, var der en stærk sammenhæng mellem indkomstforskel inden for et land, og den kulturelle aktivitet af sine borgere. Psykiske velbefindende og kulturel aktivitet fandtes at være væsentligt højere i egalitære lande såsom Sverige og Danmark, end i stærkt lagdelte lande, herunder Portugal, Polen og Grækenland. De seneste ændringer i de mest almindeligt anvendte diagnostiske statistisk manual blev indført som led i revisionen at producere den American Psychiatric Association nye DSM-5, offentliggjort i maj 2013. Dette er nu den aktuelle bibel for moderne psykiatri. DSM har været igennem en række ændringer i de sidste halvtreds år, og har givet en meget stor årlig indtægt fra salget til APA, især når revisionerne, denne gang produceret af lukkede medic eneste grupper, "er først udgivet. Børn, der er alt for trist er blevet relanceret med "social angst, '(SAD) af den diagnostiske manual revision, kunne de, der jævnligt vise raserianfald blive diagnosticeret med' temperament dysregulering med dysfori, '(TDD) - OR' periodisk eksplosiv forstyrrelse '(IED ), og teenagere, der er særligt excentrisk kunne være porescribed lægemidler til behandling af 'psykose risiko syndrom. " (PRS) Som vi alle intuitivt ved nogen af os er i risikogruppen for en forbigående episode af mental ustabilitet og smerter på grund af mange faktorer såsom dødsfald, arbejdsløshed, mobning, fordomme og udsættelse for en ufølsom samfund. Det mest skandaløse bevidst ændring er fjernelsen af 'dødsfald udstødelse ", som forhindrede anti-depressiva at blive ordineret i mindst to måneder. Nu, er blevet fjernet børn og andre sårbare grupper kan og bliver ordineret disse uprøvede psykofarmaka inden for fjorten dage for at miste en "elsket". De meget omtalte risici for en øget selvmordstanker og selvskadende adfærd i denne tidlige tilpasningsperiode kan nemt forværre den ene tragedie med en anden. Et stort antal mentale sundhedspersonale i hele verden frygter nye diagnoser kan unødigt stigmatisere mange børn og føre til unødig brug af psykofarmaka, der ofte kan producere en lang række alvorlige bivirkninger. Disse kan omfatte neurologiske skælven eller 'Parkinsonianisms', tardiv Dyskenesia, signifikant vægttab, psykotiske episoder, selvskadende adfærd og ironisk store søvnforstyrrelser, når vi alle ved, at en "god nats søvn 'er en nødvendig forudsætning for trivsel / god mental sundhed og adfærd i vores børn, den følgende dag og på længere sigt. 

Ved massivt pathologizing mennesker under disse kategorier, du har tendens til at sætte dem på en automatisk vej til medicin, selv om de oplever normal nød, hedder Jerome Wakefield 2012 , der er professor i socialt arbejde og psykiatri ved New York University. 

Vi som et progressivt samfund må ikke fjerne normale og forbigående menneskelige reaktioner fra repertoire af acceptable menneskelige reaktioner på traumatiske og vedvarende stressfaktorer for børn og unge. Snarere end at diagnosticere tvivlsomme lidelser mange mentale sundhedspersonale mener, det er mere vigtigt at forstå de væsentlige stressende livsbegivenheder, der er opstået i en individuel og til at forme op mestringsstrategier og støttemekanismer, der naturalistisk opstår i et sundt samfund.  

 Det vigtigste er ikke at diagnosticere, hvad der er galt med nogen, men for at finde ud af, hvad der er sket med dem.     Jacqui Dillon 

 Baroness Susan Greenfield, professor i farmakologi ved Oxford University og tidligere direktør for Royal Institution sagde i en Times Educational Supplement interview i 2007,

 er der klart en voksende vilje til at tilbyde unge lægemidler, der har dybtgående virkninger på den måde, de tænker og opfører sig, og også     bør vi lægge mere tanke at ændre formen på vores klasseværelser til at passe vores børn, snarere end at forsøge at medicinere vore børn til at passe klasseværelset! Adfærdsmæssige og mentale sundhedsproblemer, som vi nu ved, har mange potentielle og interagere årsagsfaktorer involveret i deres debut, og derfor kræver et varieret repertoire af kreative og omsorgsfulde svar på at opfylde behovene hos en ung person, der oplever følelsesmæssige og fysiske lidelser .     -Dave Traxson 2013 

 Blandt de alvorligste bekymringer disse sundhedspersonale er oprettelsen af "risiko syndromer" i håb om at tidlig diagnosticering af unge og behandling vil forhindre de altfavnende forhold senere i livet. For eksempel opretter den nye håndbog et "psykose risiko syndrom" for unge, der har milde symptomer findes i psykotiske lidelser, såsom paranoia, vrangforestillinger, indre stemmer og uorganiseret tale eller adfærd. "Der vil være unge, der er lidt underligt og har sjove idéer, og det vil mærke dem som pre-psykotisk," sagde Robert Spitzer, professor i psykiatri ved Columbia University, som har været en af de mest højrøstede kritikere af DSM revision. Dette kunne stigmatisere de unge for en betydelig del af deres liv skade beskæftigelsesudsigterne og uddannelsesmuligheder. 

give et barn en etiket af en psykisk sygdom er stigmatisering IKKE diagnose.     Professor Thomas Szasz - 1968 

 Mange kommentatorer deler de bekymringer, som forfatter til " Generthed: Hvor normal adfærd Blev en Sygdom, "(2010), der blev nomineret til en større skrift i medicin præmie, der hedder,   
de er tæt på at behandle børnene som forsøgskaniner. Jeg tror, ​​det er rystende og oprørende "og også" APA-aftalen skal være i bevægelse for at forhindre sådanne kontroversielle praksis ikke opmuntre dem, som det gør her.     Professor Christopher Lane 2010 

jeg personligt enig med Lane og føler, at denne stigende tendens til pathologise og medicate tusindvis af udsatte børn og unge er en form for Psycho-Økonomisk imperialisme, som er den biokemiske kolonisering af børns 'udvikle sind for stor kommerciel gevinst og til at foretage direkte eller indirekte en større form for social kontrol. Det sørgeligste element i denne lukrative og syge enogtyvende århundrede 'handel trekant' dannet mellem Big Pharma, psykiatri, medicin og familier er, at forældrene ofte bliver forført af rationaler, der tilbydes af fagfolk. Dette gælder især, hvis de er socialt dårligt stillede og får at vide eller oplev fra hjemmesider, som de kan drage økonomisk fordel af en af de to niveauer af invalidepension betalinger kr. (300 £ eller £ 600 per måned), som derefter godkendes af de samme fagfolk der foreslog diagnosen. Slaveri var drevet af et væld generere "forretningsplan", og der er meget få konjunkturerne i den moderne verden, hvor alle deltagere kan så gavmildt belønnet, end levering af psykofarmaceutiske produkter til børn, som efter min opfattelse er en form for kemisk slaveri . Vi må ikke glemme, at den vigtigste drivkraft i denne proces er den forbedrede rentabilitet og markedsmæssig ekspansion af medicinalfirmaerne på bekostning af nogle af de svageste i samfundet. For udsatte børn i særdeleshed, øger slavebindes og skabe langvarig afhængighed eller »kunder« på en plethera af lægemiddelkandidater behandlinger i sving de massive overskud af lægemidlet producenter og så profitcyklussen slår uendeligt videre. Hvorfor er Amerika så fokuseret på sygdommen model forskel? Thomas Szasz gik så vidt som at hævde, at fremtrædende af 'medicinske model' er en væsentlig årsag til nedgangen af demokrati i det amerikanske samfund (2001). Szasz hævdede vi er blevet en pharmacracy, et samfund styret af medicin forståelse af menneskeheden, hvor "folk opfatter alle mulige menneskelige problemer som medicinsk i naturen, der er modtagelige for medicinske løsninger." Som medicin blev en dominerende dommer i sandheder om, og løsninger til , den menneskelige tilstand, blev værdierne også forvandlet. Szasz foreslog, at en etik er opstået som understøtter ansvarlighed for vore gode gerninger, mens undskylde vores dårlige gerninger (og mindre end ønskeligt træk), der forestiller sidstnævnte som følge af sygdomme og lidelser. Resultatet, Szasz gældende, er en nation af mennesker, der unddrager sig ansvar for deres handlinger, skyder skylden sygdomme, genetiske arv og andre, for adfærd, der på én gang ville have afspejlet dårlig karakter eller uansvarlighed. I realiteten Szasz argumenterede, medicin undergraver borgere tager personligt ansvar, og dermed skader den meget struktur i samfundet.    

 Jeg kan beregne bevægelsen af himmellegemerne, men ikke den vanvittige mennesker.     -Isaac Newton 

 Mange kritikere og medlemmer af offentligheden føler disse retrograd ændringer i vores diagnostiske bureaukrati er symptomatiske også en samfundsmæssig drev for øget social kontrol i nogle lande over unge. Jeg har tidligere bragt på bane en samfundsmæssig model for social kontrol, som består af et gradueret respons hierarki af sundhedsmyndighederne og juridiske systemer i nogle vestlige lande. Det begynder med den meget forhøjede niveauer af ordination psykofarmaka til børn og unge, der er blevet skitseret hidtil i dette indlæg. Derefter udvikler sig til teenagere og unge voksne, der placeres eller sektioneret på psykiatriske afdelinger, hvor de kan ofte gives psykofarmaka mod deres vilje, eller endnu værre ECT. Nogle 'udviklede lande' har enormt uforholdsmæssige niveauer af disse to første niveauer af interventioner i forhold til andre mere progressive dem, og denne tendens fortsætter til næste lag af de massivt differentierede indespærring som ofte involverer også psykiatrisk diagnose og ordination af psykofarmaka. USA for eksempel incarcerates 28 gange per 100.000 af befolkningen mere end Danmark resulterer i 2,3 millioner indsatte, hvoraf er en million hævdede at have psykiatriske lidelser, der kræver medicin. Sommetider forværres af unge mennesker, der bliver sat i isolationsfængsel hvilket naturligvis er ot vil hjælpe dem med at løse deres sociale problemer. Dette er undertiden forekommer i voksne fængsler med udsatte børn yngre end seksten blive låst op "ude af øje og ude af sind 'fra fællesskabet, som de vil i sidste ende nødt til at lære at håndtere inden for. at være fair udleveret nogle af de ændringer i DSM -5, såsom at fjerne bi-polar etiket som en diagnose for ethvert barn, og erstattes af stemningen dysregulering uorden kategori er muligvis preferrable uden 'uorden' tag, men dette resultat stadig stigmatiserer og sandsynligvis vil medicinerer et barn, der isn 't overensstemmelse med sociale normer. Forhold som Trodsforstyrrelser (ODD) synes bevidst designet til at trække flere og flere børn ind i meget indbringende 'business planlægning "af den farmaceutiske industri, der ser barndommen som en" marked ekspansion muligheder. " Når symptom tjeklister læses af enhver lægmand de kan tænke på en bred udsnit af unge i deres omgangskreds, som kunne være "monteret up 'for disse nyudviklede pseudovidenskabelige lidelser. Selve processen i sig selv er uorganiseret og dysfunktionelle. Den systematiske over-diagnose og pathologisation af brede dele af børn og udvikle voksne er observeret ved mange sociale kommentatorer, at være mere risikabelt at den langsigtede psykiske velbefindende af individuelle børn og samfundet som helhed end den angiveligt unormale adfærdsmønstre disse kategorier er designet til at afgøre.     

 Når formodede "helbrede" er potentielt mere skadeligt og systematisk toksisk end »udstedelse« til bekymring ved at blive undersøgt, så har vi en etisk pligt til at hæve vores hoveder over de brystværn i et samfund, der er lykkeligt uvidende om konsekvenserne af sådanne drakoniske praksis.     -Dave Traxson 2013 

Mange barn rapporterede tilfælde af kolleger har i deres mening klart meget høj, hvis ikke kliniske, niveauer af angst, som ifølge National Institute of Clinical Excellence ( NICE) retningslinjer, er en kontraindikation indikator for behandling med Ritalin. Dette skyldes Ritalin i sine mange forskellige former er en psyko-stimulerende og kan forårsage overstimulering eller i nogen rapporteret, heldigvis begrænset antal tilfælde pludselig død ved hjertesvigt. Svær vægttab er blevet rapporteret i mange tilfælde som når de ikke behandles som en hastesag, har ført til en yderligere forværring af barnets helbred og kan kompromittere deres fine immunforsvar i nogle få tragiske tilfælde. Nogle meget bekymrende rapporter fra forældre fortæller om flere recepter eller 'drug cocktails "af høje niveauer af Ritalin, SRI anti-depressiva og anti-psykotiske medicin for at hjælpe afslapning. Når der i et tilfælde blev recepten taget til apoteket efter høring han nægtede at udstede recepten, sagde det var en potentielt "livstruende" kombination af lægemidler. Den forælder blev rådet til at gå tilbage til den ordinerende børnepsykiater og få det ændret, som hun gjorde behørigt. Heldigvis giftige mix var signifikant ændret, men ikke alle apotekere er lige opmærksomme på at de involverede risici. En række fagfolk har alvorlige bekymringer om princippet om informeret samtykke vedrørende medicinering, med nogle forældre sige ord om, at de ikke forstår, hvordan de arbejder, især den påståede 'paradoksal virkning «, men de får deres barn til at tage det, fordi de har tillid til den ordinerende læge. Dette resonerer med den berømte Milgram eksperiment, hvor forsøgspersoner sagde Milgram skelsættende bog "autoritetstro - En eksperimentel View '" Jeg gjorde det, fordi manden i den hvide pels fortalte mig at. "(1974), støttede denne stærke socio-psykologiske fænomen. Denne situation er ikke nogle forvrænget konspirationsteori, men den aktuelle virkelighed som anerkendt af sådanne ærværdige organisationer som USFDA Drug Safety udvalg, hvis formand Peter Gross i Hackensack University Medical Center udtalte i 2006: "Det er blevet klart, at narkotika bliver overused med børn. "Ja én eminent amerikanske psykiater Leon Eisenberg, født i 1922, som var den" videnskabelige fader ADHD ", og som i en alder af 87, syv måneder før sin død i sit sidste interview udtrykte beklagelse over universelt voksende tilstand hans navn var forbundet med, med angivelse,     

ADHD er et godt eksempel på en fiktiv sygdom. 
at afslutte, da vi begyndte med en litterær tema, den nuværende sløve påvirker tusindvis af unge ved 'drug cocktails' er redolant brugen af daglige soma i Orwells gribende '1984 'og siligism,     

kontrollerer han, som kontrollerer fortiden fremtiden. Han, der kontrollerer nutiden kontrollerer fortiden. Hovedpersonen, Winston, gik på,     

Deres værste fjende, reflekterede han var dit nervesystem. På ethvert tidspunkt spændingen inde i dig var ansvarlig for at omsætte sig ind i nogle synlige symptom.

Pas på!

George Orwell fra 1984 " Måske samfundet nu opfatter manifestation af symptomer "af høj energi og vitalitet som en udfordring og dermed ADHD blev født, eller gennemslagskraft og udfordrende voksne synspunkter i et konformt samfund blev set som ODD (Oppostional Defiant Disorder), som begge skal undertrykkes kemisk fører til triste og socialt ængstelige individer, der også Neeed medicinering. Hvis så vi kollektivt har fået ind i en af RDLaing berømte "knob", og vi er dømt til et kedsommeligt fremtid ensartethed og den globale opvarmning både er forårsaget af tilsvarende drivere. Jeg er glad for at have boet i en æra, hvor selvsikkerhed og energi er højt værdsat og Jeg stadig lidenskabeligt hold for en vision, hvor vores vidunderlige unge mennesker får lov til nysgerrigt at strejfe, kanalisere deres kreative energier ind i en delt foretrukket fremtid, der er bedre ikke værre vores nuværende virkelighed. Lande som Danmark, hvis lykke og psykiske velbefindende ratings er væsentligt højere end vores egen skal ses som modeller, som vi alle kan lære af som en interaktiv læring samfund. Gladere børn er automatisk mindre tilbøjelige til at blive givet sind ændre narkotika ved ethvert samfund, forhåbentlig.     Hvis det at være energisk, individualistisk, kreativ, rastløs og nysgerrig stigmatiseres som psykiske lidelser så civilisation og videnskab som vi kender det er i fare for at bryde sammen, da alle pionerer besidder nogle af disse meget egenskaber.     Traxson 2013-Dave Så for at slutte, hvor vi begyndte i et nordeuropæisk Demokrati - forældrene i Danmark tilstand kollektivt af deres handlinger, "Vi har ikke brug for en recept for vores børns lykke og trivsel. Vi har de personlige ressourcer til at gøre det selv med hjælp fra vores fremragende pædiatriske support teams. " Sådanne kollaborative teamwork er et budskab, vi har brug for at lytte, i UK   

Det er op til dig (og samfundet vil jeg tilføje) i dag for at begynde at gøre sunde valg. Ikke valg, der er lige sundt for din krop, men sundt for dit sind.     Steve Maraboli  

Min påskønnelse til Todd Krohn nylige artikel om "Power Elite" Website for nogle af ideerne og citater der findes på dette indlæg, og til artiklen "Inventor af ADHD dødslejetilståelse: ADHD er en fiktiv sygdom, "af Moritz Nestor, på den nuværende bekymringer Website. .. Også til Wikipedia for definitionen af social pædagogik Og selvfølgelig til mine forældre, bedsteforældre, hustru og børn for at gøre mig til at tro på disse tidløse væsentlige værdier

 jeg også rose det følgende elektroniske ressource for dig - "Arbejde med børn i pleje: Europa perspektiver, "Pat Petrie et al. (2006) Alle andre nævnte arbejde kan nemt søges.