Two-day conference looks at psychotropic medication and the law
-By Gilien Silsby
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| Kitty Dukakis and Elyn Saks |
Kitty Dukakis, the former first lady of Massachusetts, vividly recalls the first time she received electroshock therapy for her crippling depression and alcoholism. It was her 38th wedding anniversary, and she had little hope the treatment would help.
“On our drive home from the hospital, I turned to my husband (Michael Dukakis, former Massachusetts governor and 1988 Democratic presidential nominee), and suggested we go out to dinner,” she recalled. “He was so surprised, I think he almost ran the car off the road. But the effect was immediate – I felt like a different person.”
Dukakis shared her story at the recent two-day conference, "Psychotropic Medication and the Law,” sponsored by the Saks Institute for Mental Health Law, Policy, and Ethics; the USC Gould School of Law; and the Burton Blatt Institute at Syracuse University.
Dukakis was the final speaker at the conference, which was moderated by Rosie Mestel, Los Angeles Times health and science editor, and Peter Blanck of the Burton Blatt Institute.
In addition to Dukakis, scholars from around the country made presentations on several topics, including forced medication and medicating youths in the juvenile justice system. Several consumers of psychotropic drugs gave first-hand accounts of how they were affected by medication and other treatments.
“We are hearing from people on every side of this issue,” said USC Law Prof. Elyn Saks, who organized the event and is the recipient of a 2009 MacArthur Foundation “genius grant” and founder of the Saks Institute. “Our goal is to look at a single topic each year that impacts the entire mental health community – from scholars to consumers.”
Dukakis said she began regaining control of her life after her first electroconvulsive therapy treatment in 2001. It is now become her mission to let people know that ECT is not scary.
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| Michael Dukakis |
ECT often conjures up images of abuse and suffering as depicted in movies such as “Frances,” “Requiem for a Dream” and “One Flew Over the Cuckoo’s Nest,” she said. “But for me, it has been a miracle, and truly changed my life.”
Dukakis is especially susceptible to depression at certain times of the year, and plans her treatment accordingly. The most noticeable side effect is some memory loss, but she said the payoff is worth it. “I feel good -- I feel alive,” she said.
She pointed out that depression and mental illness impact people from across the spectrum – from students to law professors to politicians. “It does not discriminate,” Dukakis said.
“Kitty really offers hope to people who may be struggling with similar issues,” said Saks, who has struggled with schizophrenia for several decades, and is helped by a combination of psychotropic drugs and talk therapy. “I too had to find the right treatment that worked for me. That’s really the trick.”
Other highlights from the two-day symposium included presentations on military mental health, developing new drugs for treatment and conflicts of interest in medical research.
Kathleen West with the Center for Innovation and Research on Veterans and Military Families at USC School of Social Work spoke about challenges in the systems of care for active-duty service members, recently returned personnel, and veterans - especially with regard to the management of psychotropic medications.
She said that the public health implications of tens-of-thousands of troops returning stateside are just beginning to be recognized. Most mental health problems are addressed and psychotropic medications are prescribed and managed in the field.
“The military is paying attention to its increased psychotropic medication formulary and requesting guidance on how to improve in-theatre management,” West said. “Because service members are trained to deal with battle, the diagnoses of ‘Depressive Disorder –Other’ or ‘Anxiety State- Unspecified,’ which were in the top three most common ‘Mental Health Encounter’ diagnoses in the OEF/OIF theatres from 2008 to 2010, reflect that which is beyond normal for most service members in setting."
Herbert Meltzer, a professor at Northwestern School of Medicine, spoke about developing drugs for treating psychotic disorders. He said that many of the legal issues affecting people with psychotic disorders as well as their families and society could be solved with more effective and tolerable drug treatments.
“Research is essential to discover these treatments and to effectively introduce them to clinical practice,” Meltzer said. “… Many of the medical and legal issues that adversely affect those with psychotic disorders, such as involuntary hospitalization, incarceration rather than hospitalization, substance abuse, inadequate support for needed services, would be lessened by optimal utilization of current medications and development of more effective treatments.”
Laws and policies at the federal, state, and local levels, along with underfunding of services and research have “limited the prospects for discovering novel mechanisms and developing more effective and safer drugs,” he said.
“A well-directed and fully funded basic, translational, and service-based research effort focused on antipsychotic and cognitive-enhancing drugs, on a world-wide scale, could dramatically cut the illness and societal burdens from psychotic disorders,” Meltzer said.
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| Stephen Morse, Elyn Saks and Howard Zonana |
Stephen Marder, UCLA professor and director of the Section on Psychosis Semel Institute at UCLA, spoke about potential conflicts of interest in medical research.
“The concerns about financial conflicts of interest in medical research are a serious problem because they undermine the public's confidence in research findings,” he said, adding that if better pharmacological agents are developed for treating serious mental illnesses, it will be necessary for scientists from academia to work closely with industry.
Although financial disclosure is a necessary component of any management plan, it is insufficient. “Management strategies that are based on an understanding of the ways in which conscious and unconscious bias can influence research have the potential for addressing this problem,” Marder said.
Presentations were also made by Christopher Thompson of the Los Angeles County Department of Mental Health, Christopher Slobogin of Vanderbilt Law School, Howard Zonana of Yale University, Coni Kalinowski of University of Nevada School of Medicine, Robert Burt of Yale Law School, and Stephen Morse of University of Pennsylvania. Pat Risser, Frank Baron and Sanjeet Sihota spoke from a consumer’s perspective.
To watch presentations and view power point presentations, please go to: http://weblaw.usc.edu/centers/saks/psychotropic_medication.cfm
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