Skip to content
  • About
  • Contact
  • Contribute
  • What Physicians Say
  • My Book
  • Careers
  • Podcast
  • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
KevinMD.com — Social media's leading physician voice
  • All
  • Physician
  • Burnout
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
    • All
    • Physician
    • Burnout
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • About
    • Contact
    • Contribute
    • What Physicians Say
    • My Book
    • Careers
    • Podcast
    • Speaking
  • About Kevin Pho, MD, Founder of KevinMD
  • Aging and dementia: what physicians say, in their own words
  • Artificial intelligence: what physicians say, in their own words
  • Be heard on social media’s leading physician voice
  • Cancer: what physicians say, in their own words
  • Children’s health: what pediatricians say, in their own words
  • Contact Kevin
  • COVID-19: what physicians wrote as it happened
  • Custom enhanced author page pricing
  • Diabetes and obesity: what physicians say, in their own words
  • Direct primary care: what physicians say, in their own words
  • DMCA Policy
  • End of life: what physicians say, in their own words
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • GLP-1 drugs: what physicians say about Ozempic and its successors, in their own words
  • Heart disease: what physicians say, in their own words
  • Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words
  • KevinMD influencer opportunities
  • Medical errors: what physicians say, in their own words
  • Medical ethics: what physicians say, in their own words
  • Medical malpractice: what physicians say, in their own words
  • Medical school: what students and physicians say, in their own words
  • Mental health: what psychiatrists and physicians say, in their own words
  • Nursing: what nurses and physicians say, in their own words
  • Opinion and commentary by KevinMD
  • Opioids: what physicians and pain patients say, in their own words
  • Physician burnout speakers to keynote your conference
  • Physician burnout: what physicians say, in their own words
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician personal finance: what physicians say about their own money, in their own words
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Physician suicide: what physicians say, in their own words
  • Physicians and administrators: what physicians say about who runs medicine, in their own words
  • Primary care physician in Nashua, NH | Kevin Pho, MD
  • Primary care: what physicians say, in their own words
  • Prior authorization: what physicians say, in their own words
  • Privacy Policy
  • Private equity and corporate medicine: what physicians say, in their own words
  • Race and medicine: what physicians say, in their own words
  • Recommended services by KevinMD
  • Residency: what residents and attendings say, in their own words
  • Scope of practice: what physicians, nurse practitioners, and PAs say, in their own words
  • Subscribe to the KevinMD enhanced author page
  • Subscribe to the newsletter
  • Surgeons and surgery: what surgeons say, in their own words
  • Take-home messages: what physicians say when asked to leave one
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The electronic health record: what physicians say, in their own words
  • Vaccines: what physicians say, in their own words
  • Violence against health care workers: what physicians and nurses say, in their own words
  • What physicians say: the KevinMD records
  • Women in medicine: what women physicians say, in their own words
  • Women’s health: what physicians say, in their own words

Why Congress should be responsible to fix mental health

Allen Frances, MD
Physician
July 25, 2013
Share
Tweet
Share

The past months have been disastrous for mental health. One embarrassment has followed another — leading to a crisis of confidence that is potentially dangerous for those who rely on psychiatric care.

Most damaging were the negative reviews of DSM-5, the new diagnostic manual. It was justly panned for introducing many unsafe and scientifically unsound diagnoses that will worsen the already existing over-treatment of the worried well and the shameful neglect of the really sick.

The National Institute of Mental Health then piled on with a misleading press release that seemed to reject all of current clinical practice in order to pump up support for its expanded budget request for brain research. NIMH failed to admit that it will probably take decades to translate any of its basic science findings into tangible benefits for patients who are suffering now. The exclusive NIMH focus on biology has blinded it to the desperate needs of the one million psychiatric patients now languishing in prison for nuisance crimes that could have been prevented if only they had access to adequate community treatment and decent housing.

Sometimes bad mistakes turn out to be a blessing in disguise — you realize how far off proper course you have been drifting and can make a needed course correction. The bad mistakes made by DSM-5 and NIMH are a loud wake up call to the current mess in mental health and the compelling need for change.

So, what’s next? I am no fan of the U.S. Congress — it seems to be perpetually paralyzed by foolish partisanship, unable to meet obvious challenges or even debate them rationally. It is a sign of my desperation to suggest that only Congressional hearings can begin to cure the deep-seated disorders that plague our mental health non-system. I suggest that Congress undertake an eight item agenda:

First, the diagnostic system in psychiatry is broken and can’t be fixed internally by the American Psychiatric Association — which currently holds the monopoly. DSM-5 has fanned the flames of diagnostic inflation with definitions that turn everyday life problems into mental disorder — harming the misidentified ‘patients’ and costing the economy billions of dollars. Psychiatric diagnosis has become too important (in decisions determining workman’s comp, disability, VA benefits, school services, custody, criminal responsibility, preventive detention, and the ability to adopt a child, fly a plane, or buy a gun) to be left to one small professional association

Psychiatric diagnosis is too much a part of public policy to be left exclusively in the hands of the psychiatrists. Experts in psychiatry have no expertise in how their diagnostic decisions will affect public health, public welfare, the allocation of resources, and the health of the economy. Congress should set up an agency to ensure much more careful vetting of risks and benefits.

Second, Congress should also investigate why one million psychiatric patients are occupying expensive prison beds instead of being treated more humanely and economically in the community. Because state budgets for psychiatric care have been slashed dramatically, prisons have inadvertently become the mental health provider of last resort and are now the biggest system of mental health care in the country. This foolish misallocation of resources results in the barbaric mistreatment of the mentally ill — a practice the rest of the developed world abandoned two centuries ago.

Third, Big Pharma needs to be tamed — just as twenty years ago, Congress tamed Big Tobacco. Drug company marketing consists of nothing more than misleading disease mongering — selling diagnoses to peddle pills to people who don’t need them. If it has the political will to take the following steps, Congress can easily end Pharma’s hijacking of medical care. No more direct-to-consumer advertising of drugs — a privilege Pharma enjoys only in the US. No more misleading marketing to doctors cloaked in the sheep’s clothing of ‘education’. No more financial contributions turning consumer advocacy groups into extenders of company lobbying. No more ‘research’ guided by the marketing efforts to enhance patent life and stretch indications, rather than aiming for real breakthroughs. No more ghost written papers by thought leaders who mouth party line. No more monopoly pricing power because government is prohibited from bargaining. And no more revolving door politicians drifting back and forth from government to cushy Pharma jobs.

Fourth, Congress should provide more teeth and funding for an under-resourced FDA that is almost by necessity too drug industry friendly — willing to passively accept costly me-too drugs, ill-equipped to monitor adverse effects, and unable to sunset drugs (like Xanax) that are widely prescribed despite having questionable indications and unquestionable harmful effects.

Fifth, Congress should investigate the research mandate of the NIMH. Is it really meant to be exclusively a brain institute making grand and probably unrealistic promises for the distant future, while completely ignoring the really desperate needs of the mentally ill in the present? If not NIMH, who is charged with studying and improving our current sad state of mental health care?

Sixth, Congress should investigate the CDC’s fatally flawed method for determining rates of mental disorder. CDC has a systematic bias toward over-estimating the disorder rates in the healthy and ignoring the needs of the really sick. Its data gathering relies on telephone contacts conducted by lay interviewers who cannot possibly distinguish clinically significant mental disorder from everyday symptoms that are part of the human condition. The wild instability and elasticity of the reported prevalences is proof positive they should be discounted; not taken as credible indication our society is getting sicker. Epidemiological attention should focus instead on the extent and correlates of the more severe mental disorders currently being neglected.

Seventh, Congress should attend to the catastrophe that more people now die from overdoses of prescription than street drugs. High flying prescribers need to be brought to ground with strict monitoring, professional discipline, and public shaming. And real-time computerized control could contain loose drug dispensing. If Visa can put an advance stop on a suspicious $100 purchase, we can develop a proactive check that a prescription makes sense before filling it. Cooperative FDA and DEA scrutiny of drug company marketing practices and distribution methods would reduce the current free availability of lethal narcotics. We are fighting a drug war against the cartels that we cannot possibly win and haven’t yet begun a war against the inappropriate use of prescription drugs that we could not possibly lose.

ADVERTISEMENT

Finally, Congress should expand its existing concern about suicide in the military to discuss the over-prescription of medication to active duty troops (10 percent), the rampant polypharmacy, and the lack of transitional supports between active duty service and civilian life that results in the excessive diagnosis of PTSD and unnecessary disability from it.

Why Congress? With all its obvious flaws, there is no other place to turn. The related problems of out-of-control diagnosis and out-of-control prescription drugs and out of control imprisonment of psychiatric patients are all facilitated by institutions that have proven to be immune to self correction — the American Psychiatric Association, Big Pharma, state governments, the Center For Disease Control, and the Food and Drug Administration.

Unless Congress does its part, soon most of us will have a fake mental disorder (or a few) and we will live in a Brave New World where nearly everyone uses medicine. Meanwhile, people with real mental illness are treated more shabbily in the U.S. than in any other developed country in the world.

If all this doesn’t warrant investigation, what does?

Allen Frances is a psychiatrist and professor emeritus, Duke University.  He blogs at the Huffington Post.

Prev

The primary care physician is being slowly picked to the bone

July 25, 2013 Kevin 31
…
Next

The wacky world of prescription prior authorizations

July 26, 2013 Kevin 14
…

Tagged as: Physician Burnout and Mental Health

< Previous Post
The primary care physician is being slowly picked to the bone
Next Post >
The wacky world of prescription prior authorizations

 

ADVERTISEMENT

More by Allen Frances, MD

  • #MeToo shows why women must learn sexual self-defense

    Allen Frances, MD
  • The problem of polypharmacy in psychiatry

    Allen Frances, MD
  • Pay primary care doctors what they’re worth

    Allen Frances, MD

Related Posts

  • Physician burnout: the impact of social media on mental health and the urgent need for change

    Aaron Morgenstein, MD & Amy Bissada, DO & Jen Barna, MD
  • How the happiest countries protect mental health

    Alyssa Sterner
  • The physician mental health crisis in the ER

    Ronke Lawal, MBA
  • Physician advocacy is a duty, not a political choice

    Sean Gallagher, MD
  • Navigating mental health challenges in medical education

    Carter Do
  • Mental health issues and the African American community

    Lashawnda Thornton, MSW

More in Physician

  • 3 reforms to counter wellness influencers in practice

    Farid Sabet-Sharghi, MD
  • Choosing a limb lengthening surgeon requires accountability

    Hrayr Basmajian, MD
  • How to reassure patients: 5 steps beyond normal tests

    Devina Maya Wadhwa, MD
  • Setting boundaries as a physician doesn’t mean caring less

    Jerina Gani, MD, MPH
  • How emergency medicine decision making works under pressure

    Geoffrey Mount Varner, MD, MPH
  • Why I stay in emergency medicine: a dancer at nearly 100

    Howie Mell, MD, MPH
  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • The conflict of interest that discloses as nothing

      Martha Rosenberg | Medications
    • 4 fibromyalgia myths the current evidence doesn’t support

      Kayvan Haddadan, MD | Conditions and Diseases
    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • AI governance in health care has to reach the exam room

      Amanda Heidemann, MD | Health Technology
    • The Pennsylvania measles outbreak and the cost of forgetting

      Christine King, CRNA | Conditions and Diseases
  • Past 6 Months

    • Why CDC opioid guidelines get the overdose data wrong

      Richard A. Lawhern, PhD | Conditions and Diseases
    • Retirement isn’t the end of medicine, it’s a second act [PODCAST]

      The Podcast by KevinMD | Podcast
    • Sensory processing in autism and the brain’s volume control

      Josette Pelatan, PhD | Conditions and Diseases
    • What maternity care deserts cost a town

      Manisha Kaliaperumal | Health Policy
    • Why medicine needs a national physician license now

      Vaishali Popat, MD, MPH | Physician
    • A cold cost $945. The cost of primary care is broken.

      Susan Newman, MD | Physician
  • Recent Posts

    • Why exhaustion can make you see things that aren’t there [PODCAST]

      The Podcast by KevinMD | Podcast
    • 3 reforms to counter wellness influencers in practice

      Farid Sabet-Sharghi, MD | Physician
    • Shift work and circadian rhythms shape the 24/7 workplace

      Deepak Gupta, MD | Conditions and Diseases
    • Paid for twice

      Physicians paid for G2211 twice. Most never bill it.

      Michael Duben, MD | Physician Finance
    • The next child

      Medicaid managed care and the case for mutual stewardship

      Steven Merahn, MD | Health Policy
    • Choosing a limb lengthening surgeon requires accountability

      Hrayr Basmajian, MD | Physician

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use Agreement
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why Congress should be responsible to fix mental health
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...