Wrong Way Mental Health

Too little, too late, wrong workforce, wrong places - this is the story of health care workforce in the United States. Mental health is a primary example.

To have real solutions in mental health or in health care, there must be investment at the very start of health care problems - infancy or before. Unfortunately we expend national resources in health and education at the end of life, on few people, in few locations, on highly technical areas, with little result for the expenditure involved. Better children make better students and have better behaviors as children and adults. They have better jobs and make better decisions - including health care decisions. 

We must begin change at the beginning and avoid Wrong Way Mental Health.

Why Bring This Up

Advocacy is needed to change what our nation does, but sometimes advocacy groups distract people from the proper focus. The very start of mental health is the beginning of life.

The point of any article intent on changing mental health should be emphasis upon child development, parenting skills, and counseling from the earliest ages. A recent article attempts to dramatically attract attention by mentioning the use of powerful adult psych drugs on infants. This article should not have used the term infant as this is birth to age 1. The term infant was used for dramatic impact. The terrible 2s does result in inappropriate and unsanctioned use of major psych drugs - but a focus upon this is not helping our nation with needed change.

Even the title of this article indicate the distraction. More Infants Prescribed Psychatric Drugs To Address Behavior

Infants - really? Drugs to address behavior - really?

What Is Needed To Address Mental Health 
It is tragic that we do not have the child development/parenting skills training and counseling that we need, especially inside entire homes at risk. One of the great challenges in mental health is that the impact spreads to families and classrooms. It impacts multiple generations. Common sense dictates that the important areas to address must involve home and classroom. In fact, a primary solution if not the primary solution for education, health, and societal cost controls (such as depopulating prisons) is about earliest impact upon life.

There is no excuse for overprescribing,
but dramatic statements have consequences.

Advocates and advocacy groups can gain attention by many methods but may not progress their causes by some choices. A really good advocate takes an opportunity, such as overprescribing, and bridges to the real needs to impact mental health. Sadly this attention gathering fails to get to the need for counseling or cognitive behavioral training. 

We do know in older ages that non-drug approaches are as good and can be better than drug approaches. But not surprisingly the studies on children and youngest children are few - making this unsupported experimentation.

What Can Happen with Unsupported Experimentation? 

Most of all, we do not know what will happen. We do know that Paxil ended up being used for depression treatment in adolescents with tragic results. This has become another classic example of what is wrong in American health care. A study on Paxil was done to answer certain research questions, it did not find positive results in these questions. The research was rewritten to fit other questions. Millions of dollars was made via this experimentation and teens died that should not have died. Perhaps the real villain is desperation as it is difficult to find something that works fast and it is difficult to find those willing to work hard at behavioral and other changes.

Speaking of distraction - Should primary care or mental health professional associations focus on any area except more support for those who deliver primary care or mental health? I get very tired of association claims of success when there is even less support where it matters as cuts have occurred in overall funding plus more types of costs are added with more dollars distracted to these costs - leaving fewer dollars to pay for the team members that deliver the care - or at least attempt to do so. 

Robert C. Bowman, M.D.
SMART Basic Health Access


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