I saw this drug marketing ad from Johnson and Johnson posted on Twitter today. Johnson & Johnson is marketing their sustained release version of paliperidone called Sustenna as a way to keep people with schizophrenia out of jail! I have not been able to find an updated package insert from the FDA at this point but this is from a release on the J&J web site as an indication for the drug.
"The time to first psychiatric hospitalization or arrest and/or incarceration was significantly longer for people treated with INVEGA SUSTENNA® versus these same commonly prescribed oral antipsychotics."
I have been posting here for years about the fact that health care businesses and governments have actively worked together to eliminate psychiatric and mental health resources. That is just a proven fact. I have posted that psychiatrists have been taken out of the loop so that these same politicians and business leaders can accomplish these goals. I have posted that the resulting pricing strategies divert any existing resources away from physicians and patients and into the pockets of the managed care, pharmaceutical benefit manager industry, and pharmaceutical companies leaving some patients with very little to live on. I have posted about how psychiatric beds have been rationed until they are practically non-existent and the admission and discharge criteria altered so that very little treatment occurs there. And as a final result, I have documented the widespread diversion of patients with severe psychiatric problems to jails. The largest psychiatric hospitals in the USA are county jails. I have pointed out how there is a tendency to blame psychiatrists for the mythical shortage of their own specialty and mental health services when any real shortage was planned that way by the same people who have rationed mental health services to the bone.
There are probably just a few people (usually psychiatrists and the families of patients) who know about what happens when the bar is lowered from hospital admissions to arrests and incarcerations. I have observed first hand what occurs. The risk to the patient increases exponentially. Every time there is a confrontation between the police and a mentally ill person the odds are greater that there will be misunderstanding, injury, and possibly death. I have received many of these beaten up people on my inpatient service when they were brought to the hospital and admitted because they were obviously mentally ill. The only reason they were brought to the hospital was because of the physical injury. Otherwise they were on their way to jail. Once in jail they can get no care or very little care. It is common that people with mental disorders or addictions are taken off of their usual medications. They do not receive them in jail most of the time and that can impair their ability to cooperate with law enforcement or work with an attorney to get released.
So jail has become a treatment endpoint on par with hospitalization. Somebody somewhere must have a number that shows it is much more likely that a person with a serious mental disorder ends up in jail rather than a psychiatric hospital. I could suggest a number of surrogate endpoints for the next study. Number of people dead on the street. Number of people dead because they did not get their insulin or needed medical care for heart or lung disease. The possibilities become numerous when humane treatment in a safe medical setting drops farther down the list.
There are probably just a few people (usually psychiatrists and the families of patients) who know about what happens when the bar is lowered from hospital admissions to arrests and incarcerations. I have observed first hand what occurs. The risk to the patient increases exponentially. Every time there is a confrontation between the police and a mentally ill person the odds are greater that there will be misunderstanding, injury, and possibly death. I have received many of these beaten up people on my inpatient service when they were brought to the hospital and admitted because they were obviously mentally ill. The only reason they were brought to the hospital was because of the physical injury. Otherwise they were on their way to jail. Once in jail they can get no care or very little care. It is common that people with mental disorders or addictions are taken off of their usual medications. They do not receive them in jail most of the time and that can impair their ability to cooperate with law enforcement or work with an attorney to get released.
So jail has become a treatment endpoint on par with hospitalization. Somebody somewhere must have a number that shows it is much more likely that a person with a serious mental disorder ends up in jail rather than a psychiatric hospital. I could suggest a number of surrogate endpoints for the next study. Number of people dead on the street. Number of people dead because they did not get their insulin or needed medical care for heart or lung disease. The possibilities become numerous when humane treatment in a safe medical setting drops farther down the list.
This ad and study as well as the FDA approval marks a new low water mark in psychiatric care in the USA. I think we can safely say that we are now in a post psychiatric era of care. An era where the quality measure is keeping patients out of a place that they should never have been put in the first place - the county jail. The is a palpable new low in the nonsystem of care for the mentally ill. That new low has been endorsed by a federal agency - the FDA and a pharmaceutical company. It will probably result in other pharmaceutical companies trying to get the same indication.
At this point there is no doubt that businessmen and politicians have a stranglehold on psychiatric care. It has morphed into a landscape that is unrecognizable to this psychiatrist.
God save our patients and God save us all.
George Dawson, MD, DFAPA
Supplementary: I intentionally kept this brief. I have thoroughly covered all of this on the blog. I just wanted to clearly mark this dark day.
