Resolved: That the United States federal government should substantially increase public health services for mental health care in the United States.
Definitions federal government, substantial, mental health
Affirmative:
"About one in five Americans experiences a mental disorder in the course of a year. Approximately 15 percent of all adults who have a mental disorder in one year also experience a co-occurring substance (alcohol or other drug) use disorder, which complicates treatment." http://www.surgeongeneral.gov/library/mentalhealth/summary.html
"Mental and behavioural disorders are common, affecting more than 25% of all
people at some time during their lives. They are also universal, affecting people of all
countries and societies, individuals at all ages, women and men, the rich and the poor,
from urban and rural environments. They have an economic impact on societies and on the
quality of life of individuals and families. Mental and behavioural disorders are present
at any point in time in about 10% of the adult population. Around 20% of all patients seen
by primary health care professionals have one or more mental disorders. One in four
families is likely to have at least one member with a behavioural or mental
disorder." http://www.who.int/whr/2001/main/en/chapter2/index.htm
Unequal health insurance benefits: http://www.fmhi.usf.edu/parity/parityhome.html
; health care not a right
Schizophrenia is a brain disease http://www.nimh.nih.gov/events/locschiz.cfm
Employment and accommodations http://www.jan.wvu.edu/kinder/pages/psychiatric.html
- the majority of people with disabilities who don't have jobs want to be working
special populations - children, seniors, people with disabilities, non-English speakers,
... ; lack of access to wanted/voluntary services for people living in rural areas, people
without private insurance
prevention.....
cost-effectiveness - housing costs less than crisis, ...
inadequate rule-out of other health issues
Negative:
primum non nocere
www.ect.org
medical model; treatment must include ongoing medical work-ups and rule-outs
professionalizes caring/compassion, weakens community
one size fits all
pre-symptomatic interventions
rise in diagnosis, rise in ADD
pharmaceutical ads, profits
prevention
cost-effectiveness - housing costs less than crisis, ...
stories
Advocates concerns::
Alternatives: a new paradigm; complementary medicine and holistic alternatives must be part of any services package
Coercion
Laurence Gostin, Public health law: power, duty, restraint, 2000, Berkeley: University
of California Press
institutionalization v community integration (Olmstead)
outpatient
commitment
Housing
http://www.sciam.com/news/050301/1.html
On homelessness
Mischaracterizations
violence
Human rights
From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for
Themselves http://www.ncd.gov/newsroom/publications/00publications.html
discrimination
stereotyping
Anti-psychiatry
www.mindfreedom.org
Citizens Commission on Human Rights (Church of Scientology)
Whose voice?
families speak first www.nami.org
"Nothing About Me Without Me"
Recovery:
The concept of recovery must be embedded in all policies and direct service users must be respected by including their primary voice in meaningful and significant ways in all aspects of policy setting, from planning through implementation to evaluation. Not part of medical model: http://www.nimh.nih.gov/research/prevfg3.htm
Values:
beneficence (decisionally impaired) v autonomy (self-determination)
duty to step aside v duty to assist
Models:
Perspective of the Disability
Community
Language:
http://www.peoplewho.org/documents/wordsmatter.htm
Evidence:
consensus (best practice) v truth (real science)
medications tested for short times in control situations that don't replicate how they are
actually used; data on adverse effects and deaths inadequately noted
Robert Whitaker, Mad in America: bad science, bad medicine, and the enduring
mistreatment of the mentally ill, 2002. Cambridge: Perseus
Contingencies:
you must take drugs to get work placement assistance and
advocacy; you must accept treatment to get housing
alternatives to drug treatment not readily available
services are one-size-fits-all; people are not
Survivors:
are angry, want acceptance, inclusion, choice
Prevalence:
"I am uncomfortable with the presentation of incidence and prevalence data
without sources which dispute the conventional wisdom that such a vast proportion
of the population has mental illness. Incidence and prevalence could be
one of the critical debate issues. Debaters need to be aware of the how incidence
and prevalence data are created and manipulated to support an industry, a market. I
think the entire methodology is specious. Do they follow standard epidemiological
processes? I think they make huge assumptions about undiagnosed illness."
Costs and profits:
Info on the number of prescriptions written, some economic info about the proportion of
drug company profits that come from psychotropics. Economics of prevention
compared to treatment.
"The pharmaceutical industry continues to be the most profitable industry in America with profit margins in 2000 nearly four times the average of Fortune 500 companies. ["Fortune 500", Fortune Magazine, April 2001. See www.fortune.com and "Pay, Profits and Spending in Drug Companies, July 2001, at www.familiesusa.org.] A 1999 study by the Congressional Research Service found pharmaceutical companies the most lightly taxed of major industries - they pay taxes at a 16.2 percent rate compared to an average effective tax rate of 27.3 percent for all other industries. [See www.house.gov/berry/prescriptiondrugs/Resources/crs_pharm_tax_memo.PDF ]"
http://www.biopsychiatry.com/drugcompanies/
More:
www.peoplewho.org/lists including actmad (do
identify yourself and your purpose and ask for permission to participate; don't lurk)
http://www.peoplewho.org/readingroom/
Parity is an industry issue. Isn't it a treatment issue rather than a prevention one?
National high school debates material
Home: www.peoplewho.org