Yes, Let's Talk About Mental Health Care and What's Not Being Said

By Jennifer Maurer

Let's be careful what we ask for.

Lord help our children if all this talk about guns and violence and mental health gets us more of the same broken mental health system with its ever-growing list of childhood diagnoses, traumatic hospitalizations, and the "slew of antipsychotic and mood altering pharmaceuticals" (1) that often follow them.

Let's make sure we talk about the 40-fold increase in bipolar diagnosis in children and adolescents in the span of just one decade (2) - a diagnosis that earns children powerful psychiatric prescriptions despite the fact that "few studies have looked at the safety and effectiveness of psychiatric medications for treating children and adolescents with the disorder." (3)

Let's make sure we talk about the fact that these adult prescriptions, most of which are untested for use in children, have turned up in far too many school shootings over the past 14 years, including those involving Kip Kinkle in Oregon, Eric Harris at Columbine, Jeff Weise at Red Lake Indian Reservation, Cho Seung-Hui at Virginia Tech,Steven Kazmirerczak at Northern Illinois University and now, it appears, Adam Lanza in Newtown, CT.

These widely publicized shootings left 96 children and adults dead and an additional 95 wounded. And this is far from a complete accounting.

This is sufficiently sobering, I think, to start a conversation about the role of psychiatric medications and their use with children.

Let's talk about antidepressant research "showing unacceptable risk of serious adverse effects, including hostility and suicidality" prompting some manufacturers to discourage their use in patients under 18 years of age. Research findings that led to mandatory black box labeling by the FDA and a ban in the UK on the use of antidepressants in children under 18, with the exception of Prozac. (4)

In my own fumbling attempts to support my children through distress, I have often wished that there were some magic pill that could make it all better. At times, I've thought I would settle for something that could make it even a little better.

No parent wants to see his or her child suffer. It is unbearable. It is often hard to tell who is suffering more: the parent or child. This is an important question to ask. And to answer.

Unfortunately, there isn't enough evidence that these powerful psychiatric medications do make it better for our children. In fact, there is a growing body of evidence that they can make it worse. Much worse. (5)

There is so much we don't know about our children's emotional growth and brain development and the impact of labeling and medicating our children's suffering.

We do know that research is showing brain shrinkage (read "damage") associated with the use of psychiatric medications that are increasingly being employed as mood stabilizers in adolescents and even young children. (6)

We do know that the rates of children who are so disabled by mental health disorders they qualify for federal assistance has increased 35 fold from 1987 to 2007, despite the wide availability of a staggering array of new-and-improved antidepressants, stimulants and mood-stabilizing medications (that aren't actually stabilizing moods, as noted in Liza Long's impassioned blog).

Mental illness is now the leading cause of disability in children. (7)

We do know those who are diagnosed with a serious mental illness are dying 25 years younger than the rest of us. (8)

We do have research that shows exposing children to psychiatric medications is associated with an increase in serious mental illness diagnoses such as juvenile bipolar disorder.(9)(10)

We do know, from a large-scale National Institute of Mental Health study, that pre-adult onset of bipolar illness is "associated with greater rates of comorbid anxiety disorders and substance abuse, more recurrences, shorter periods of euthymia, and greater likelihood of suicide attempts and violence." (11)

If our children are being diagnosed with disabling mental illnesses at an alarming rate, and early-onset diagnoses are associated with worse outcomes, and adults diagnosed with serious mental illnesses are already dying 25 years younger, then we have a much bigger tragedy on our hands. Do the math.

Right now, we are talking a lot about violence, gun control and mental illness. These are important conversations. But they aren't the only ones we should be having.

Children don't have enough support for the hard work of growing up. Families don't have enough support for their children's or their own emotional pain. Our currently underfunded and overtaxed mental health care system isn't up to the challenge.

There are no easy answers and no quick fixes. But there is tremendous potential for healing and transformation when we stop looking for magic pills and potions and start looking for meaning and purpose, community, compassion and connection.

We do need to have a conversation about mental health. One that is unflinching in its demand for solutions that are better, safer, more compassionate and more effective for our children and our families.

Solutions that don't fit neatly inside a bottle.

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Jennifer Maurer is a mother of two school-aged children and the managing director of the Mother Bear Community Action Network, a family-led mental health network dedicated to supporting families experiencing mental health challenges. Mother Bear provides families with mental health recovery education, peer support and access to resources that help families recover and thrive.

References:

1. Long, Liza. I Am Adam Lanza's Mother': A Mom's Perspective On The Mental Illness Conversation In America. Huffington Post online, Dec. 16, 2012.

2. Moreno C, Laje G, Blanco C, Jiang H, Schmidt AB, Olfson M. National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Arch Gen Psychiatry. 2007 Sep;64(9).

3. Rates of Bipolar Diagnosis in Youth Rapidly Climbing, Treatment Patterns Similar to Adults. National Institutes of Health Press Release, September 3, 2007.

4. Jureidini, J. et al. Efficacy and safety of antidepressants for children and adolescents. British Medical Journal 328 (2004):879-83.

5. Whitaker, R. Anatomy of an Epidemic. Crown Publishing. 2010.

6. Ho, B., Andreasen, N. et al. Long-term Antipsychotic Treatment and Brain Volumes. Arch Gen Psych 68 (2011):128-37.

7. Angell, M. The Epidemic of Mental Illness: Why? New York Review of Books online, June 23, 2011.

8. Morbidity and Mortality in People with Serious Mental Illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, October 2006.

9. Faedda, G. et al. Pediatric bipolar disorder: phenomenology and course of illness. Bipolar Disorders 6 (2004):305-13.

10.Cicero, D. et al.  Antidepressant exposure in bipolar children. Psychiatry 66 (2003):317-22.

11. Perlis, R. et al. Long-term implications of early onset in bipolar disorder. Biological Psychiatry 55 (2002):875-81.

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Media inquiries may be directed to Jennifer Maurer at jennifer@motherbearcan.org.