Category: Dear Luise

Psychiatric care in Denmark linked to “a severely increased risk of dying.”

University of Copenhagen researchers led a nationwide study in Denmark comparing individuals who died from suicide to matched controls between the years 1996 and 2009. Essentially, the researchers found that increasing levels of psychiatric care are associated with “a severely increased risk of dying.” They concluded, “The public health significance of this finding may be considerable.” You would think the press and public would be outraged. The study was totally ignored.

The researchers found that taking psychiatric medications during the previous year made a person 5.8 times more likely to have killed themselves. If a person had made contact with a psychiatric outpatient clinic, they were 8.2 times more likely to have killed themselves. Visiting a psychiatric emergency room was linked to a 27.9 times greater likelihood of committing suicide. And if someone had actually been admitted to a psychiatric hospital, they were 44.3 times more likely to have committed suicide within the year.
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Foreword to Dear Luise

“Mom, won’t you tell the world how we’re treated?” This was Luise’s last request to her mother, Dorrit Cato Christensen. She wanted her to describe the treatment she had received in the Danish mental health care system. With this book Dorrit fulfills her daughter’s wish.

What follows is a heartrending account of a life in our psychiatric care system, a life cut tragically short – the same fate suffered by many vulnerable people being treated for mental health problems. Every year more at-risk psychiatric patients end up like Luise – we know that this population’s lifespan averages 15 to 20 years less than others in their age group. This is a clear sign that we have to change the way we treat psychiatric patients.

We must improve conditions by offering quality time, attentiveness, compassion, evenhandedness and respect to every patient, so we can design the best treatment solution for each person. We need to talk openly about mental health issues and strengthen our networks of patients, families and friends. To this end I have set up a virtual meeting place, the website Psykisksaarbar.dk, now consulted by a growing population in Denmark. In 2009 I took the initiative to found an association called Det Sociale Netværk af 2009 (The Social Network of 2009), bringing together a wide range of national voluntary mental health organizations in a joint effort to improve conditions in Denmark for the mentally ill and their relatives. The organization of which Dorrit Cato Christensen is president, Død i Psykiatrien (Death in Psychiatric Treatment), is now part of our network.

I come in contact with many people who have been, or currently are, admitted to a psychiatric ward. Most have inside experience of various facilities and all agree that there are significant differences in approach from one institution to the next. A young girl said to me: “As soon as you set foot in the ward you know what kind of hospital stay you’re in for. Whether the mind-set is caring and responsive, or whether the place is ruled by coercion, constant evaluation and a staff that ignores you.”

We should not, in all conscience, allow sub-standard treatment in a country like Denmark, yet it happens all the time. I have often heard patients say: “You must be strong to be psychologically vulnerable.” When studies show that psychiatric caregivers harbor more negative expectations and prejudices about the mentally vulnerable than the general population, it means there is a problem inherent in our mental health care system. This is exacerbated by a dreadful lack of resources in psychiatric treatment wards.

The most important thing to remember is that first and foremost we are all human beings. We must not forget this for one second, before any incapacity or vulnerability is analyzed, defined and written down. This is why it is so important to see behind the facade of a diagnosis. A diagnosis is like an overcoat – the real person is found underneath it. This is one part of her daughter’s life story that Dorrit describes so movingly for us – her personhood, her humor, her compassion and her zest for life.

When I meet people who support The Social Network, who form networks on our website Psykisksårbar.dk, or participate in our regular Sunday get-togethers, it strikes me how similar we humans really are and how much we have in common. There is basically no real difference between you and me and a person who happens to have been given a psychiatric diagnosis. It is not a question of these people being completely different, but more that sometimes they may experience so much inner noise that they are thrown off-balance and become vulnerable.

The most important thing we can do for psychiatric patients is not to keep them isolated. Loneliness is their worst enemy. And it is crucial that we nurture hope, that we hope and believe we can find the best in each other, and that we make room for the individual. Hope is the vital life-giving elixir for the soul, mind and body – to be able to sense that the people around you believe in you, that you are valued, that you are needed. We become whole when others believe in us. And we’re most likely to find this when we feel the solidarity of good fellowship.

I would like to thank Dorrit Cato Christensen for her work with mental health patients and their families and friends, and for the very important work she is doing as president of the association Død i Psykiatrien. Her book is a poignant contribution to the debate, in which she openly and candidly tells the story of her daughter’s sad fate and gives us a glimpse of our mental health care system groping for the right treatment. Luise’s hospital records show that she told her caregivers she felt she could not tolerate the drug treatment they prescribed and wanted them to phase it out. But instead of less medication, she got more. This turned out to be fatal.

Many patients and relatives will already be familiar with the situations and events Dorrit portrays here. Many will see their own lives reflected in this story and perhaps even find the energy to fight for a dignified life. I also hope that mental health practitioners will read the book, then stop and think carefully about how they can deepen their professional skills through respect for the individual. We can be certain of one thing – pills are not and never will be enough. We must constantly listen to our patients and think carefully about whether we are giving the right medicine to the right person. The “medicine” that always works for the psychologically vulnerable is to approach them with compassion, nurturing, trust and calmness.

Poul Nyrup Rasmussen
Danish Prime Minister 1993-2001
Member of European Parliament 2004-2009

Read more about Poul Nyrup

Psychiatric care in Denmark linked to “a severely increased risk of dying.”

University of Copenhagen researchers led a nationwide study in Denmark comparing individuals who died from suicide to matched controls between the years 1996 and 2009. Essentially, the researchers found that increasing levels of psychiatric care are associated with “a severely increased risk of dying.” They concluded, “The public health significance of this finding may be considerable.” You would think the press and public would be outraged. The study was totally ignored.

The researchers found that taking psychiatric medications during the previous year made a person 5.8 times more likely to have killed themselves. If a person had made contact with a psychiatric outpatient clinic, they were 8.2 times more likely to have killed themselves. Visiting a psychiatric emergency room was linked to a 27.9 times greater likelihood of committing suicide. And if someone had actually been admitted to a psychiatric hospital, they were 44.3 times more likely to have committed suicide within the year.
Read more

Foreword to Dear Luise

“Mom, won’t you tell the world how we’re treated?” This was Luise’s last request to her mother, Dorrit Cato Christensen. She wanted her to describe the treatment she had received in the Danish mental health care system. With this book Dorrit fulfills her daughter’s wish.

What follows is a heartrending account of a life in our psychiatric care system, a life cut tragically short – the same fate suffered by many vulnerable people being treated for mental health problems. Every year more at-risk psychiatric patients end up like Luise – we know that this population’s lifespan averages 15 to 20 years less than others in their age group. This is a clear sign that we have to change the way we treat psychiatric patients.

We must improve conditions by offering quality time, attentiveness, compassion, evenhandedness and respect to every patient, so we can design the best treatment solution for each person. We need to talk openly about mental health issues and strengthen our networks of patients, families and friends. To this end I have set up a virtual meeting place, the website Psykisksaarbar.dk, now consulted by a growing population in Denmark. In 2009 I took the initiative to found an association called Det Sociale Netværk af 2009 (The Social Network of 2009), bringing together a wide range of national voluntary mental health organizations in a joint effort to improve conditions in Denmark for the mentally ill and their relatives. The organization of which Dorrit Cato Christensen is president, Død i Psykiatrien (Death in Psychiatric Treatment), is now part of our network.

I come in contact with many people who have been, or currently are, admitted to a psychiatric ward. Most have inside experience of various facilities and all agree that there are significant differences in approach from one institution to the next. A young girl said to me: “As soon as you set foot in the ward you know what kind of hospital stay you’re in for. Whether the mind-set is caring and responsive, or whether the place is ruled by coercion, constant evaluation and a staff that ignores you.”

We should not, in all conscience, allow sub-standard treatment in a country like Denmark, yet it happens all the time. I have often heard patients say: “You must be strong to be psychologically vulnerable.” When studies show that psychiatric caregivers harbor more negative expectations and prejudices about the mentally vulnerable than the general population, it means there is a problem inherent in our mental health care system. This is exacerbated by a dreadful lack of resources in psychiatric treatment wards.

The most important thing to remember is that first and foremost we are all human beings. We must not forget this for one second, before any incapacity or vulnerability is analyzed, defined and written down. This is why it is so important to see behind the facade of a diagnosis. A diagnosis is like an overcoat – the real person is found underneath it. This is one part of her daughter’s life story that Dorrit describes so movingly for us – her personhood, her humor, her compassion and her zest for life.

When I meet people who support The Social Network, who form networks on our website Psykisksårbar.dk, or participate in our regular Sunday get-togethers, it strikes me how similar we humans really are and how much we have in common. There is basically no real difference between you and me and a person who happens to have been given a psychiatric diagnosis. It is not a question of these people being completely different, but more that sometimes they may experience so much inner noise that they are thrown off-balance and become vulnerable.

The most important thing we can do for psychiatric patients is not to keep them isolated. Loneliness is their worst enemy. And it is crucial that we nurture hope, that we hope and believe we can find the best in each other, and that we make room for the individual. Hope is the vital life-giving elixir for the soul, mind and body – to be able to sense that the people around you believe in you, that you are valued, that you are needed. We become whole when others believe in us. And we’re most likely to find this when we feel the solidarity of good fellowship.

I would like to thank Dorrit Cato Christensen for her work with mental health patients and their families and friends, and for the very important work she is doing as president of the association Død i Psykiatrien. Her book is a poignant contribution to the debate, in which she openly and candidly tells the story of her daughter’s sad fate and gives us a glimpse of our mental health care system groping for the right treatment. Luise’s hospital records show that she told her caregivers she felt she could not tolerate the drug treatment they prescribed and wanted them to phase it out. But instead of less medication, she got more. This turned out to be fatal.

Many patients and relatives will already be familiar with the situations and events Dorrit portrays here. Many will see their own lives reflected in this story and perhaps even find the energy to fight for a dignified life. I also hope that mental health practitioners will read the book, then stop and think carefully about how they can deepen their professional skills through respect for the individual. We can be certain of one thing – pills are not and never will be enough. We must constantly listen to our patients and think carefully about whether we are giving the right medicine to the right person. The “medicine” that always works for the psychologically vulnerable is to approach them with compassion, nurturing, trust and calmness.

Poul Nyrup Rasmussen
Danish Prime Minister 1993-2001
Member of European Parliament 2004-2009

Read more about Poul Nyrup

Dear Luise

Dear Luise

An unintended event. This was the bland phrase used to describe Luise’s sudden death in the psychiatric ward at Amager Hospital in Copenhagen, Denmark. She was 32. Dear Luise is a mother’s deeply personal account of her struggle to ensure her daughter’s survival through 20 years of treatment in the Danish mental health system. It is an alarming – and thoroughly documented – exposé of the abject failure of the medication-based treatment regimen routinely imposed on vulnerable psychiatric patients. This book is also a poignant tale of love and hope, brimming with tender memories of the creativity, originality and wry humor of a very capable, intelligent young woman.

Behind Luise’s ultimate fate we see the smug certainty of mental health professionals, both doctors and caregivers, and the concomitant dehumanization of their patients through indifference, harassment, coercion and the use of force. In this tragic case, the mother’s investigation also reveals a shocking trail of incompetence and dishonesty – repeated misdiagnosis, professional collusion, “missing” official records, falsified hospital charts, victim-blaming, and a complete lack of accountability.

Her mother’s ill-fated trust in Denmark’s healthcare system led an 11-year-old girl with misunderstood adjustment problems into a doctor-mandated drug hell. First she was wrongly diagnosed and dosed with powerful anti-epilepsy medicine. Then the severe side-effects were treated with antipsychotics that caused even more serious adverse reactions, both mental and physical. Complaints from mother and daughter ran into a stone wall, and all meaningful dialogue was cut short. The system had only one response – increase the medication.

Luise’s tragedy is far from unique in Denmark – or indeed any other “advanced” industrialized country. Towards the end of her life she knew what was happening to her. Luise told her mother: On my gravestone I want it to say that it was the medicine that killed me.

‘Happy pills’ from Denmark

cartoonThis cartoon was posted on Facebook by the Silje Benedikte Foundation, named for a young Norwegian woman who took her own life at 20 after two years of treatment with 20 different psychotropic drugs. The joke seems to be that, since a big debate is finally raging in neighboring Denmark over their health system’s misuse and overuse of psychotropic medications, there’s now a surplus available for export! We see a Norwegian dad emptying a mega-jar of antidepressants down his kid’s throat, saying, “Just got these in from Denmark earlier today.”

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Psychiatry Gone Astray

Here’s an English translation of “Psychiatry Gone Astray,” an op-ed piece by Prof. Peter Gøtzsche in the Copenhagen daily Politiken that has caused quite a stir in Denmark. His book, Deadly Medicines and Organised Crime: How Big Pharma has Corrupted Healthcare, came out last year. The article is posted on the website of Dr. David Healy, a professor of Psychiatry in Wales and an internationally respected psychiatrist and psychopharmacologist. His book Pharmageddon tells how pharmaceutical companies have hijacked healthcare in America – with life-threatening results.

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Death in Psychiatry – Dorrit Cato, author of “Dear Luise”

“For the first time ever the Danish mental health system has been found guilty of causing the death of one of its patients,’ writes Dorrit Cato Christensen, author of Dear Luise. “This is important news. One hopes that far more psychiatric healthcare providers will be found guilty of causing death with their dangerous treatment. The psychiatric ward where this patient was treated I know very well. My daughter Luise died there from overmedication.

“After the verdict the Clinic Manager claimed that they have learned from the sad story so treatment will be safer, with less medication. I don’t believe them at all,” says Dorrit. “They said exactly the same eight years ago when my beloved Luise died in their care. In our organization Death in Psychiatric Care we see how bad psychiatric treatment really is. People contact us constantly to tell us how a beloved relative who sought psychiatric help suddenly ends up as a dangerously ill zombie. Many report that a relative has died from overmedication.”

Translation of a January 9, 2014 article in Politiken, a leading Copenhagen-based daily newspaper, covering the ruling on Adel’s suicide:

Gross medical negligence led to suicide

Psychiatric Hospital in Amager harshly criticized for overmedicating 26-year-old man. Clinical Manager claims that incidents involving medicine in large doses have led to ‘cultural change’ in psychiatric treatment.

Overmedicinering

MANIC DEPRESSIVE. His brother says psychotropic drugs changed Adel from a vigorous 26-year-old to looking like “a 90-year-old patient in a hospice.” – Photo: PRIVATE PHOTO

By HANS DRACHMANN

A 26 -year-old psychiatric patient who committed suicide by throwing himself in front of a subway train in June 2011 had been so heavily medicated at the Psychiatric Center in Amager that the side effects were ‘unbearable.’

After two years of deliberations, the Patient Safety Commission has severely criticized the psychiatric hospital for providing treatment to the patient, Adel Saidane, which ‘did not meet generally accepted professional standards.’

Upheld all complaints

‘My older brother suffered so many side effects that were so unbearable that any human being might commit suicide in that situation.’ said the patient’s brother, Hafed Amin Saidane , who brought the case before the Patient Safety Commission.

The report criticized the Psychiatric Center on five specific points. The 26-year-old was overdosed with medication. The doctors did not given any reason for the high doses, as they should have. They failed to take proper care of the patient and were not sufficiently focused on side effects. The hospital ward should have provided Adel Saidane with an individual caretaker so he could not leave the center unaccompanied.

‘All our complaints have been upheld. We were in no doubt that he committed suicide because of the medication’s side effects,’ says Hafed Saidane.

His brother was bipolar but had not been hospitalized for two and a half years. Then in May 2011 he felt distressed and checked himself into the hospital. Over the next four weeks he was treated with several antipsychotics combined with sedatives in amounts that, in his brother’s words, changed him from a vigorous 26-year-old to looking like ‘a 90-year-old patient in a hospice.’

The case has consequences

At Copenhagen Metro Mental Health Services they’re deeply apologetic over the incident. ‘I take this very personally. We are so sorry and my heart goes out to the relatives. It’s a terrible thing and I feel awful about it,’ says Inger Merete Terp, Clinical Manager at Amager Psychiatric Center.

The case is an example of the wide-ranging practice of overmedicating psychiatric patients, which was prevalent in the Copenhagen area until mid-2012, when Politiken began covering the situation.

Overmedication, among other things, led to the dismissal of a Clinical Manager in Glostrup and a reprimand to a deputy director of Copenhagen Metro Mental Health, prompting the adoption of an action plan mandating close monitoring of medication to prevent overdoses.

Subsequently the proportion of patients treated with heavy doses of the antipsychotic Zyprexa was reduced from almost 25 percent to about 5 percent.

‘I think we’ve got a good grip on it and we’ve now ensured that action can be taken on the same day if any mental health center starts prescribing excessive doses,’ says Svend Hartling , vice president of Metro Mental Health.

He describes the Amager incident as ‘highly irregular’ and will now ask the executive board of Metro Mental Health whether enough has been done to prevent this from happening again.

Paradigm shift

The Patient Safety Commission’s report is also being sent to the National Board of Health and to chief medical officers in Copenhagen, who will address the issues at a meeting next week.

‘We are discussing whether there should be consequences, so other patients are not put at risk,’ said National Health Board oversight manager Anne Mette Dons. She is generally satisfied that the Metro region has taken effective action against overmedication. ‘There really a has been a paradigm shift.’

Clinic Manager Inger Merete Terp says that the overmedication case has resulted in a ‘culture change.’

‘We need to focus not only on medication but also on patients’ daily lives. We must look at patients’ daily life, see that they can wash dishes or take a walk and do things that contribute to quality of life,’ she says.

The Commission’s ruling will now be taken up with doctors at Amager Psychiatric Center and with other mental health center managers in the Metro Area.

Death in Psychiatry – Dorrit Cato, author of “Dear Luise”