York state psychiatric institute, and author of shrinks, the untold story of psychology. Host hello. Im dr. Jeffrey lieberman here with art levine, a noted journalist and author and we are going to today his book Mental Health, inc. Its great to be with you, first let me thank you for your interest in Mental Illness in Mental Health care to few of your colleagues in the Fourth Estate have seen this is an area to really focus on and provide a public and interested parties with the information that is really needed, and the priority that it should have and you certainly seem to have recognized it. Its also take a gratifying for me to be interviewing you, art, because your a columbia alum having gone to the Journalism School which is not of the best schools of journalism in the country. Of course thats where i am faculty and currently employed. So the book guest thank you, doctor. Host please, call me jeffrey. Guest okay. Host when someone calls the doctor makes you feel old and stodgy. But the book is really a welltimed saving indictment of the Mental Health care system in this country, and overall im in complete agreement with you. At the same time let me give you a heads up, just for full disclosure and also for the purposes of a lively discussion, im going to challenge a little bit on the points you make in the book as a practicing psychiatrist and head of the largest, what are the largest psychiatry departments in the world. I knew something about the subject matter, but please know i do this in the best of intentions and in the interest of clarity and accuracy in the belief we are both soldiers in this very important, if historically neglected mission. Im going to orient my questions along three themes. First your background, second, substantive issues that you address in the book, and in third, what are the steps Going Forward that we can sort of advocate or aim for in order to provide some corrective measures and what you will be doing Going Forward in that regard. So to begin let me just ask, you are trained as a journalist. You come from one of the best schools in the country. You couldve picked anything as your area of interest. Why did you get into Mental Health care . Guest well, it started when i was a journalist for an alternative weekly called cd link run by the south florida sun sentinel, and i and Investigative Reporter and and a future writer. It was my only eight interest. And what happened in my case is i had three separate awakenings about what the scope of the problems were. It started in the early 2000s when i was working for city link and because i did reporting im about to describe i was honored as 2001 Florida National alliance of Mental Illness journalist of the year. Those looking at the criminalization of people with Mental Illness in south florida which was among the worst in the country, which is a a problem across the country. My interest started in, first, it was a raft of shootings of people with Mental Illness in both the city of miami and Miamidade County. This is still an ongoing host by the police . Guest by the police, right, by the police. So there was that host who are not trained to be First Responders to mental patients trying to write. Later on i began exploring the Crisis Intervention Team training work devised by the Memphis Police department, and either a section of my chapter, one of the chapters in the book describing that. But i had three separate arenas that sort of raise my awareness. From the very beginning i viewed it as a social justice issue. So the issue for me as a journalist who had covered other abusive arenas of misconduct, this struck me as something calling out to the tools of Investigative Journalism and future writing. So first with the shootings. Then there were the tragedies of people who had completely inept care or no care at all, every minority of them, but some people with untreated schizophrenia were in fact, killing loved ones. And i opened my initial story with a person who was let out of a facility over the objection of the psychiatrist but the facility wanted to save money, then he had a dream that he wanted to send his father to heaven by killing him with a baseball bat. And i profiled this example of the untreated. Then i learned, this is all in the same timeframe. And then i learned through the good offices of one of the countries great reformers, judge Stephen Lightman who has really changed host i know him well. Guest so the judge gave me a tour of a modernday hell, which is the ninth floor of the Miamidade County jail. It is, my original article at the photos, but the photos and even narrative feature writing simply does not do justice to the horror of what you saw. So its my view its not even 19th century Mental Health, its a bedlam circa the 1700s. So the were mostly minorities, mostly untreated and refusing the medication or not treated properly who were naked, surrounded by blue synthetic cloth that they couldnt use to rip or kill themselves, and they were spouting gibberish or they were locked behind these dungeon like cells and the only places for them to sleep on this rusted metal beds. And the judge told me at the time, it makes you wonder who is crazy. I we crazy or is a system crazy that this is existing . And even developed over the years of Reform Program that led literally like 15 years later to the closing of the facility and some, diverting people away from the Mental Health system. So then about the same time, o this is a threepart answer to explain why uncovering these issues in this book. The second was my great interest in learning what works. Thats where i get interest in the work of dr. Robert drake and others in the early 2000s, there was a program being rolled out by the Substance Abuse and Mental Health services administration, nicknamed samhsa, that was looking at how to find out programs that of wr the most seriously mentally ill, and i get interested in covering that. I wrote a paper on it as a fellow with the progressive policy institute. And that was host what years which are explained in south florida and then with samhsa . Guest so i basically, i was in south florida from 942004, and when i returned, so i broke my stories in south florida, but then i wanted to understand what works and how can we do better. And thats right get interested in things like in terms of police, the Crisis Intervention Team training. I learned about family psychoeducation from doctor macfarlane. I learned about support employment to call these very valuable programs that, particularly in the psychosocial programs that are still unused by and large across america foe most seriously mentally ill people, and thats one of my big talking points and stresses in my book. So that was that, and at that time i had not yet become fully aware of the role of dangers over medication and offlabel medication. And that awareness came about because of the report i found i really dug into, which had to do circa 20092010 concerns the veterans were being heavily overmedicated for ptsd with antipsychotics in common is with antidepressants and tranquilizers. And just this barrage of chemicals as opposed to actually providing thoughtful, compassionate care, let alone evidencebased cognitive treatments. So those are three arenas that i stood with me since then. And then i began researching my book about 2013. So this is a very longwinded answer but i but i want to expe context of why uncovering all that. Then theres a fourth element which is the abusive troubled teen facilities which exists for parents who dont know how to deal with kids who are misbehaving or drug users. And i expose what amounts to teen torture facilities across the country that focus telling the story primarily of a program in alabama. These abusive facilities and inept residential Treatment Facilities flourish because Community Care is so awful, and families and people struggling with Mental Illness and families just talking with kids were misbehaving and experimenting with drugs, which probably does require them to be sent to some inhouse facility, they are all being victimized by a system that a president ial commission years ago rightly called is in a shambles. So thats obviously this is a lot of areas to cover and unpack, but that is the range of issues im thinking of covering in this book. Host all i i can say is god bless you. Buy your own journalistic curiosity, you stumbled into an area which obviously is assented to ive been doing my whole professional life, and you hit the nail, several nails in terms of what are the sort of glaring and egregious problems that exist in the fact that they can continue uncorrected, and attended for song because youre right it is a social justice issue. There are terms that are used in Public Health care, Public Health such as unmet clinical needs. When you dont have treatment for something like, lets say memory improvement in alzheimers disease, or healthcare disparities with certain segments of the population dont get the attention because of discrimination or whatever, like women historically were neglected, the children, pediatric pharmacology or underrepresented minorities whether its racial or ethnic, but Mental Health care or the lack of it, all of those but it is much worse like to say. I consider it to be a civil rights violation. Why there is no legal action is another matter, but this is just basically to concur with what you have been saying. I think youre struck paydirt. And then there is guest can i make one point . There is one area of legal action thats the Justice Department suing the jail systems, particularly in places like Los Angeles County that are notorious, 22 people been been sent to prison for brutalizing host but you have to be careful because the thing is society has to manage some out either in a humane or brutal way its constituents and the fact that we havent embraced the need to provide as good of Mental Health care as a general medical care has led to displacement, as you point out in your book, of these individuals to Nursing Homes, to prisons or to homeless shelters try to i agree with your points. This area is basically largely untouched and it is a National Disgrace and a national scandal. Youre absolutely right. The Broad Strokes of your sort of thesis and your argument are right on target. Im going to help you in the course of this interview and thereafter if youd like to really sharpen the fine points and to establish the scholarly evidence to support these points. So just to continue, excuse me for making these comparisons. You will correct me if there inappropriate. It seems like the territory you are covering it with Mental Health inc. Sort of relates to come on the one hand, what has been done in writing, particularly in american psychosis, and also on the other hand, what maybe Robert Whitaker is done with matt in america and psychiatry under the influence. Would you take umbrage or agree . Guest i agree with that. Im a centrist who goes with the facts are and i dont like ideology. Essentially what i found is doctor torre downplays to a certain degree the impact of rampant over medication with antipsychotics because he favors a wider use of involuntary outpatient commitment. And in many cases whitaker doesnt pay as much attention on his side, and hes one of the endorsers of my book, but he doesnt pay as much attention as dr. Torre does to the side effects societally of mismanaged and poorly treated Mental Illness in terms of the homelessness, j lings and police encounters. I basically took in many cases the best of both of their arguments and im advancing what may appear to be opposite points of view in which of course they just opposite, but i see the wisdom in each of the points of view and thats what im trying to address as reporter, and i dont have an ideological agenda. Host im not religious but i had to say god bless you again. You really i think ive taken a very studious but also enlightened sort of approach to this allimportant topic. So just diving into the substance of the book, whats the implication of your title . By Mental Health, inc. , tht was maybe your publishers title but it connotes something kind of conspiratorial like eisenhower is militaryindustrial complex. Guest it was inspired by a book coauthored by their great investigative journalist morton minced called america inc. Which was come he was a guy who broke the scandals over unsafe auto and hes a famous Investigative Reporter, and it seems to me that the corporatization and dollar oriented orientation of companies has corrupted both for profit and even nonprofit Mental Health care in this country. In particular the pharmaceutical industry. So the subtitle of my book is how corruption, lax oversight and failed reforms in danger are most vulnerable citizens. So i am trying to paint what some of called the shock doctrine type approach to the arena of Mental Health care. Im trying to use as many vivid examples as i can about things have gone off the rails and thats it most of the book is about. And i look at of the department any lawsuits to explore the different schemes used a Drug Companies to promote offlabel and improper uses of these medications, look at the corrupting effect of the drug industry, of the fda and sort of pushing out for really risky uses that dont meet a real costbenefit analysis. These medications, and it extends to an arena doesnt get as much attention but i think his very, very central, and that has to do what the department of health and Human Services and the program that the agency that runs medicare and medicaid, they pay for dangerous offlabel use, thats the center for medicare and medicaid services. So regardless of the Justice Department getting over the years, the last 25 years, 35 billion in penalties and payments from Drug Companies for illegal marketing, it doesnt affect what hhs which oversees this agency does if they continue to pay for fraudulent uses that the Justice Department spent years building cases over the illegal marketing. Thats one side. And even less that is the fact that these Companies Sign what are called corporate integrity agreement with the Inspector Generals Office of the department of health and Human Services. What happens as a result of that is they violate one agreement. They pay lets say i have my dollars in a settlement. They agree to never go forth and do no wrong anymore and then according to settle lawsuits allegations he continued to violate those agreements. Host can interject here . I like to make a corrective statement if i could. Guest sure. Host so you are like an explorer who is trying to map my world, and you have hit on so many of the third rail issues that really constrain and vent Mental Health care providers that think they know what the right thing to do is and want to do it but cant. And youre trying to bring these to light to precipitate action in our country. What you are doing is so important and so on track, but ive got to tell you, the pharmaceutical industry, its cordial relationship with the fda, cms, thats a red herring. Those are red herrings. Those are not good. They are not laudable. They are in many cases prosecutable, but thats not the central, the biggest problem. Were going to get to that in a few minutes, in the course of the way i have laid out the questions i would ask you. I just want to interject to say you are on the track of this and will get you a Pulitzer Prize one of these days for sort of exposing the whole thing, but i just want to say that from the standpoint of pharma marketing schemes, cozying up to researchers, relationships with the fda, cms not having price restrictions, offlabel use, thats not where the actions, its like the deep throat, follow the money or follow whatever, the term was hit on going to have to do that and guest okay. One thing is im a report and aye where the facts go and an openminded to learn new things. I go. Host good. Just getting back to the more substantive issues, you break down the Mental Health system to kind of three coexisting systems, a Public Sector which the state and municipal finance care, private sector including academic, forprofit, everything nongovernment, within the va system. Then theres a shadow Mental Health system you identify which is your Nursing Homes, the prisons and homeless shelters.