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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/

public health resources

Parity is an industry issue.  Isn't it a treatment issue rather than a prevention one? 

National high school debates material

 

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