Hope in God (I)

…it is such an important aspect of education to challenge the legitimacy of this widespread extension of state power. We have to begin to train the next generation to recognize that this expansion was never legitimate, and should never have been supported. There has to be a rethinking of the moral foundations of the culture with respect to the expansion of the welfare state. The next generation needs to be convinced that there are institutional alternatives to the welfare state, and these alternatives are legitimate. Not many people are involved in preaching this message of deliverance. This is why every little voice counts.[1]

Resisting the preposterous claims of the welfare state, when so much of the community is dependent on the welfare state, won’t grant you instantaneous popularity today. Those who have their snouts in the trough of government money will not love you and send you bouquets. And of those who don’t, many find the notion of a reduction, let alone an elimination in welfare to be a confusing or baffling suggestion.

But then, when the whole superstructure comes crashing down never to be re-built, it is critical there be individuals and organisations who had identified its inherent flaws, saw the cracks in the walls widening, and articulated/explained the need for massive change, and how to go about it.

The change must firstly be one of attitude. Welfarism has always promised much but provided little, unless you were a bureaucrat or politician. What has given welfarism away initially to Christians has been its consistent atheism, its hostility to marraige and the family, and the persistent gulf between its promises and its performance. Can any society deny God and survive, long-term?

We have had to trust that welfarism couldn’t survive whilst almost daily, the cracks and flaws in its superstructure seem to widen locally, nationally and internationally.

The Europeans where welfarism began under Bismarck in the 1880’s, are locked into a spiral of decline due to centralisation, massive government debt, high taxes, along with futile government attempts to manipulate the economy to health, that haven’t and cannot work.

Japan has experimented yet again with massive doses of Keynesian economic shock treatment, which have made the patient begin to lose his hair and colour, and feel more sickly than before. Now he’s saying, “Dr, I feel terrible!”

The US is mired in debts and stupid wars, and is so far into the tunnel there is clearly no light, especially at the other end. And no one at a national level has an appetite for change, or sees that the freight-train is nearing the precipice.

“Problems? What problems?”

I do not think the present ideology in favour of the welfare state can survive the demise of the finances of the welfare state.[2]

There will have to be individuals and institutions ready, when it finally goes pear-shaped. Preparation is firstly theological, spiritual and ideological, before it is anything else. Just like the Pauline epistles, we have to begin with the theological and ideological, then move onto the practical, and it all has to be fundamentally Christian in outlook.

The promise of the gospel is clear:

A bruised reed He will not break and a dimly burning wick He will not extinguish; He will faithfully bring forth justice. He will not be disheartened or crushed until He has established justice in the earth; and the coastlands will wait expectantly for His law (Isa. 42:3-4).

This is why we can be confident and have hope, because the promises of God apply today, just as they did when Matthew quoted from this passage in Matthew 12:18-21. Yes, ugliness will certainly come when the system we have known for so long in the West comes unglued.

But if we believers in Jesus Christ can understand that this has been the result of generations of rebellion against God, we may very well be able to lead the world out of the hole it has dug itself into, with Biblical solutions to the challenges of education, health and welfare, to name just a few.

This is what we have to be prepared to do, and it begins with an ideology of freedom and Biblical responsibility, something almost unheard of today, except by people of the Bible.

Are you ready for that?

 

 

[1] Gary North, “Cracked Walls and State Legitimacy,” (www.garynorth.com), 21/11/2014.

[2] Gary North, “The Setting for Serious Reform,” 17/5/2013.

A version of this column originally appeared in:

Report: Mass. not attentive to core issues behind child welfare cases

Little Jeremiah

Little Jeremiah

STATE HOUSE -- While the Department of Children and Families mishandled the case of 5-year-old Jeremiah Oliver, a new independent review of the child welfare agency absolved the department of direct responsibility for the boy's death in a report outlining systemic staffing, policy and technology shortcomings.

The Patrick administration planned on Wednesday to release the final report from the Child Welfare League of America, which the state hired to examine the embattled child welfare agency. Gov. Deval Patrick, who is traveling in Israel on a business development trade mission, asked the organization to conduct a review of the department following well-documented lapses in case management that led, in the case of the 5-year-old Oliver, to the department losing track of the boy whose body was found on the side of a highway in Sterling last month.

"While there is significant evidence that some DCF staff did not do their jobs in the Oliver case, there is not evidence that DCF's actions and failures caused Jeremiah's death. DCF and many of the adults in Jeremiah's life failed to protect him," the report's authors wrote.

The findings of the report, a summary of which was provided to the News Service, build on preliminary recommendations offered in March by CWLA including a redistricting of DCF offices to balance social worker caseloads and the need to deploy more technology for use by social workers.

Many of those suggestions are in the process of being implemented, including hiring, though caseloads remain at an all-time high for the past 20 years fueled by increased substance abuse, mental health and domestic violence concerns and increased reporting from the community and "heightened vigilance" at DCF.

The report said Jeremiah's siblings have received "excellent supports and services" since being taken into DCF custody and are being given "everything they need to overcome the trauma of their experiences and the loss of their brother."

Patrick and the Legislature have been pouring new resources into DCF this year to facilitate hiring to lower caseloads, but CWLA suggests that recommended hiring of additional managerial staff, caseworkers, and specialists in substance abuse, mental health and domestic violence counseling will require "additional funding, beyond what has been recommended in the FY15 budget proposals."

The report also recommends increased funding for substance abuse treatment.

"To prevent the deaths of children, like Jeremiah, who come to the attention of DCF because of allegations of abuse and neglect, we must look beyond DCF itself; we must address the core issues that lead children and families to need DCF's intervention and services," the report said. "For many years, Massachusetts has not been attentive enough to these issues."

The Child Welfare League recommends that DCF continue to screen in for full investigation any report alleging abuse or neglect of a child 5-years-old or younger with young parents or parents with a history of drug abuse, domestic violence or mental health issues. The practice was put into place following the disappearance of Oliver.

 

A version of this column originally appeared in:

One Breakdown Can Mean Losing Your Kid Forever

One Breakdown Can Mean Losing Your Kid Forever
State governments are permanently taking hundreds of children from their parents—under a bizarre theory that they might, in the future, be too mentally ill to care for the young.

In August 2009, Mindi, a 25-year-old struggling new parent, experienced what doctors later concluded was a psychotic episode. She had been staying in a cousin’s spare basement room in De Soto, Kansas, while trying get on her feet after an unexpected pregnancy and an abusive relationship. She’d been depressed since her daughter was born and was becoming increasingly distrustful of her relatives.

Isolated, broke and scared, one Saturday morning, she cracked. She woke to change her 5-month-old daughter’s diaper. When Mindi looked down, she believed the baby’s genitals had been torn.

Mindi’s mind raced for an explanation. The one she came to? That her baby had been raped the night before; that someone—she did not know who—had put sedatives in the air vents.

Mindi called her pediatrician’s office. A receptionist told her to take her daughter to a children’s hospital in nearby in Kansas City, Missouri. Doctors there found no evidence that the girl had been harmed or that any of what Mindi claimed had actually happened.

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Mindi rests with her son, Jace, 2, in the home of a friend of the family, where they currently reside in Lawton, Missouri. (Steve Hebert, via Propublica)

After Mindi started arguing, medical staff sent her for a psychological evaluation and notified local child welfare authorities, according to court records. (As is typical in child welfare cases, the court documents do not include the full names of anybody in the family. Mindi has asked ProPublica to use only her first name, as did other parents in the story.)

That night, authorities took emergency custody of Mindi’s daughter, who is referred to in court documents by her initials, Q.A.H. A court-appointed doctor later concluded that Mindi had experienced postpartum psychosis.

But Mindi rebounded after the episode. She began to attend therapy and to see a psychiatrist, who prescribed an antidepressant. She found a job as a shift manager at Kmart and moved into her own apartment. Each morning, she’d call the foster home where her daughter had been placed and she’d read Q.A.H. a book.

In time, her psychiatrist, therapist and even a panel of judges concluded that Mindi should get her daughter back.

Under a concept sometimes called “predictive neglect,” Missouri and about 30 other states allow courts to terminate a parent’s connection to a child if authorities conclude a mother or father has a mental illness that renders them incapable of safely raising the child.

“I found the help I needed to be healthy,” says Mindi, a wide-eyed woman with a round face and a chatty affect. “I was dealing with some mental battles at the time.”

Dr. Stanley Golan, the psychiatrist who treated Mindi, diagnosed her with a mix of post-traumatic stress disorder—likely, a therapist later said, related to abuse—depression and possibly a kind of “mild delusional disorder.” Still, the diagnoses, Golan said in court testimony, “do not interfere with her parenting and she is able to adequately care for Q.A.H.”

“You can have these diagnoses and be symptom-free,” he testified.

Indeed, in September 2011, Mindi, who was in another relationship, gave birth again, to a boy named Jace, whom she’s now raising capably on her own. Citing Mindi’s pending case over Q.A.H., Kansas authorities took Jace at birth and placed him in foster care. But they soon returned him after finding no evidence that Mindi posed any risk to her son. As a family therapist testified, Mindi has provided a “nurturing, loving environment and had met all of [Jace’s] needs.”

Yet four years later, after a protracted series of court fights, Mindi does not have her daughter back.

“I couldn’t see how they could keep one while I had the other,” said Mindi, sitting on the carpet in a living room with her son, surrounded by toy trains and a pile of books. “I don’t think I should have to fight for my own child to come home.” (Missouri and county child welfare officials declined to discuss the case.)

The question in Mindi’s case is not about what authorities did when she plunged into a mental health crisis—nearly everyone involved in the case, including Mindi’s own attorneys, agrees it was likely appropriate to remove her baby that day. Instead, the issue is whether a mental health diagnosis itself, in the absence of any harm, should be enough to keep Mindi from ever getting her daughter back.

Under a concept sometimes called “predictive neglect,” Missouri and about 30 other states allow courts to terminate a parent’s connection to a child if authorities conclude a mother or father has a mental illness that renders them incapable of safely raising the child. Officials usually must present evidence that the illness poses a threat. Most cases involve significant mental illness, not run-of-the-mill depression or anxiety. Yet there need be no evidence of actual harm or neglect, just a conclusion that there is a risk of it.

States typically do not track how many parental termination cases are related to mental illness, or how often parents have lost children based on a diagnosis. New York, one of the few states that does tally such cases, has about 200 parental terminations annually based on mental disability, a category that includes both mental illness and “mental retardation.” If there were a similar rate nationally, that would amount to several thousand cases per year. The cases are typically sealed, and there’s no way to know how many involve court overreach.

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Mindi and her son Jace, 2, play with toys in his bedroom at the home they live in in Lawton, Missouri. (Steve Hebert, via Propublica)

But if it’s impossible to know how many parents lose children unnecessarily because of the stigma of mental illness, it’s clear that the process for deciding such cases is deeply flawed.

Courts’ decisions rest on the recommendations of evaluators who often do not observe parents at home or examine their actual record of parenting. Instead, they rely on psychological tests and case notes.

Incomplete evaluations are an “endemic problem,” said Joanne Nicholson, who directed a unit that conducted parenting assessments for Massachusetts child welfare agencies and is one the country’s leading researchers on parents with mental illness.

“Parents are often evaluated without a real analysis of their supports, of the life they actually live,” said Nicholson, currently a psychiatry professor at Dartmouth College. As a result, “the diagnosis starts to speak louder than real life.”

Children can also pay a price when courts overstep. Research shows that forcing children in and out of different homes can leave lasting emotional scars.

The logic of removing kids from parents with serious mental illness is straightforward. Studies have shown that serious mental illness correlates with higher rates of child neglect and abuse. Parents who can’t take care of themselves aren’t going to be in a position to take care of a child. And delusional thinking can lead to irrational, dangerous behavior.

“You have to put protection first,” said Mary Kay O’Malley, who worked for years as a foster care caseworker, is now a professor at the University of Missouri Law School, and has dealt with many cases like Mindi’s.

When officials fail to intervene to protect children from mentally ill parents, the results can be tragic, irrevocable and front-page news. In one notorious 2008 case, a Long Island, New York, mother drowned her three children after county officials failed to respond to repeated warnings from relatives that she was dangerously unstable.

But O’Malley says she’s seen agencies and courts unnecessarily cut off parents from their children. She says that’s what happened to Mindi.

Six months after Mindi brought her daughter to the hospital, in February 2010, a parenting counselor reported that Mindi “is ready to be there for [Q.A.H.] emotionally, mentally, and [she] can support Q.A.H.”

“The parent changed in this case,” said O’Malley, who consulted for Mindi’s attorneys for free after learning about the case. “But the court didn’t.”

The laws permitting termination of parental rights were mostly written in an era when serious mental illness was assumed to disqualify patients from participation in normal life, including parenting. Parents like Mindi may have been institutionalized. In many states, the mentally ill or intellectually disabled could be sterilized. The phrasing in the law has often changed—states have removed words like “feebleminded” and “depravity”—but the same concepts echo.

Indeed, a 2012 presidential commission report found that “parents with psychiatric disabilities experience the most significant discrimination when they attempt to exercise their fundamental right to create and maintain families.”

“When [mentally disabled] people were institutionalized, they could not keep their kids. Now they’re living on their own, and they’re not allowed to keep their kids,” said Patrick Yewell, who recently retired from a career as a foster care caseworker, supervisor and administrator in Kentucky’s child welfare system.

Rudy, a 42-year-old West Indian-born man in the Bronx, New York, was also denied custody of his daughter. His chance to raise her now rests largely on a psychiatrist’s evaluation consisting of two visits and a review of Rudy’s records.

Rudy has long struggled with chronic bipolar disorder, for which he has been repeatedly hospitalized. Rudy is also intellectually delayed—an IQ test placed him at the borderline of intellectual disability.

He has no history of violence, abuse or neglect. His only child, J, who is now 3, was removed from the hospital immediately after she was born and placed in foster care. Rudy has been asking to be allowed to raise his daughter with help from his mother and sister.

Authorities first took J because of significant concerns about her mother. J’s mother, from whom Rudy had separated before J was born, had already lost three other children to foster care. One of the children removed from J’s mother and placed in foster care later died at the hands of a relative of J’s mother. And like Rudy, J’s mother suffers from mental illness and intellectual delays.

On June 28, 2010, Rudy watched as two Nassau County caseworkers and a cop walked out of the hospital with 4-day-old J. (ProPublica confirmed details of the case through court documents and multiple interviews.)

Rudy, who has closely cut hair and often dresses in baggy sports jerseys, recalls the day his daughter was taken as the saddest of his life. “I asked them why they took my daughter, and they didn’t respond,” Rudy remembered in a soft, stuttering voice with an accent left over from his childhood in St. Croix. “I asked them if I could hold her before they took her, and they wouldn’t let me hold her.”

Rudy began what would become a weekly ritual: riding two trains and a bus every Tuesday from the Bronx to Long Island to spend 75 minutes with J in a room in the county child welfare office. Some caseworkers were suspicious of Rudy. “The major concern for the family is both parents’ mental health issues,” child welfare officials wrote in a court document.

Others described him as a loving, if inexperienced, father. One caseworker note from a visit in September 2011 described Rudy as “gentle and caring,” rocking J to sleep on the couch at the county office.⁠ Two weeks later, a different worker wrote that he was “getting more adept at caring for the child.”⁠ J’s mother, meanwhile, stopped showing up for visits and failed to appear in court.

But just over a year after J was first placed in foster care, two Nassau County officials pulled Rudy into a meeting room after a visit with J and told him that the county planned for J to be adopted by her foster family, case documents show.

“They said I have a mental illness, they were trying to see if I would sign away my rights,” Rudy said as he sat one recent evening in his Bronx apartment, a pot of rice steaming on the stove. “They expected it to go smoothly, they expected me to surrender my rights.”

In New York, counties are required to appoint an attorney for parents at risk of losing their kids, but Rudy hadn’t yet been given one. Unsure of what was happening, Rudy went home and called his sister Rubeka, in Tampa, Florida.

“He sounded really upset. Not really angry, but more hurt,” said Rubeka, who works as a psychiatric nurse.

Rudy and Rubeka consulted a lawyer and came up with a plan in which Rudy would move in with his sister and mother in Florida so they could raise J together. J’s mother, who was also facing the termination of her parental rights, and whose mental health, according to case notes, was deteriorating, agreed to the plan. (J’s mother declined to discuss the case with ProPublica, except to say she supported Rudy’s effort to get custody.)

But Nassau County officials told Rudy that he should have laid out the plan months earlier and that because so much time had passed, federal child welfare law required them to request termination of his parental rights. The county’s records suggest that caseworkers had warned Rudy about this; Rudy said he did not understand he could lose his rights so rapidly and that he waited because he believed J’s mother was going to regain custody. Caseworkers also noted that visits between Rudy and J had gotten harder as she grew older—she would often cry inconsolably; she knew her father only as the man she saw on Tuesdays and considered her foster parents her real mother and father.

But these were not the reasons Nassau County authorities listed when they petitioned a county court to sever Rudy and J’s legal ties. Instead, the county filed to terminate his rights based on his mental illness. Under New York law, parents can lose their children if courts decide their mental disabilities render them incapable of parenting for the “foreseeable future.”

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Mindi says she was ordered to take specific medications by the judge in her case. (Steve Hebert, via Propublica)

The Nassau County Department of Social Services would not respond to questions from ProPublica about the case or any related policy issues. The county referred ProPublica to the New York State Office of Children and Family Services. That office declined to comment as well and referred us back to Nassau County. The foster parents’ attorney and the attorney appointed to represent J also declined to discuss the specifics of the case.

In the summer of 2012, a judge sent Rudy to Dr. Joseph Scroppo, a psychologist and attorney who has held appointments at several New York universities. Scroppo has a contract with Nassau County to perform forensic psychological evaluations and make recommendations about whether parents should keep their children.

Scroppo’s evaluation was exhaustive compared with many in other parental rights cases. He met with Rudy alone for nearly 10 hours. Then Scroppo watched Rudy interact with J for 30 minutes. He gave Rudy an IQ test, asked him to define words, stack blocks and read a few sentences.⁠ He reviewed Rudy’s mental health records, including his hospitalizations for manic episodes, and case notes from the child welfare department.

Scroppo concluded that Rudy could not be trusted to raise his daughter.

Rudy’s “score indicates that he is probably capable of semi-independent living but would experience significant problems if he were to attempt fully independent living,” Scroppo wrote. Citing Rudy’s hospitalizations, Scroppo concluded that Rudy “is now, and for the foreseeable future, unable to adequately care for the subject child.”

During a hearing in May 2013 in Rudy’s continuing parental rights case, Rudy’s lawyer, who was appointed to the case when the county filed for termination, grilled Scroppo on his evaluation.

“Your testimony … suggested that [Rudy] would have difficulty functioning fully independently; is that correct?” Rudy’s lawyer, Lauren Broderick, asked.

“Yes,” Scroppo replied.

“[But] wasn’t it your understanding that [Rudy] was cooking his own meals at the time of your evaluation?” Broderick said, looking down at her notes.

“I’m not sure whether he was cooking his meals or not,” Scroppo said.

“Did you inquire?” Broderick asked, looking up.

“No, I did not,” he said.

“Wasn’t it true at the time of your evaluation that [Rudy] was paying his bills?” she went on. “He was responsible for his own hygiene?”

“As far as I knew, yes,” Scroppo said.

Broderick continued to push Scroppo to offer evidence from Rudy’s life. Instead, Scroppo said, “I based the [categorization of] semi-independent status on the test that I administered to him.”

New York’s law allows mothers and fathers to present alternative evaluations in court, though funding is not always made available to pay for them. Rudy’s sister and brother scraped together several thousand dollars to hire an evaluator for a second opinion.

Dr. Barry Rosenfeld, a psychologist who directs clinical training at Fordham University, did not just administer tests. He spoke to the people in Rudy’s life to get a better sense of him—and pieced together a very different picture.

He discovered that in the early 2000s, Rudy shared an apartment near Tampa with Rubeka and their brother Mitchell. Mitchell had a baby boy and Rudy would take care of him. “My son was around 3 or 4. We’d go out for the night, or on the weekends, and Rudy worked less than us, so we’d leave my son with him,” Mitchell said recently over the phone from Florida. “I never had any worries about that.”

Rosenfeld learned from Norma Gonzalez, a caseworker who’d met regularly with Rudy in the apartment building where he lived when J was born, that “[Rudy] successfully manages his own day-to-day needs and has done so consistently for 3 years.”

Rosenfeld noted that Rudy’s plan to raise J with his sister indicated not incapacity, but a responsible recognition of his own need for help. “There appears to be no evidence that [Rudy] … is unable to adequately plan for care for his daughter,” he wrote.

ProPublica asked a third party to read the two evaluations and to assess the soundness of their methods. Maurice Feldman, a psychologist based at the Centre for Applied Disability Studies at Brock University in Ontario, Canada, researches parenting capacity evaluations. He said that the two evaluators relied on different methods and assumptions.

Scroppo’s evaluation didn’t take into account the help Rudy planned to have from his family; Rosenfeld’s did. “The first evaluator makes the assumption of the scenario that the parent has to parent the child totally independently,” Feldman said.

Feldman also said that even though Scroppo’s report was relatively thorough, it exhibited a common flaw: It measured mental disability in isolation from its impact on parenting.

“There is a conceptual leap that the first assessor used,” Feldman said. He concluded that because Rudy scored “low on cognitive and personality disorder measures, therefore he can’t parent,” Feldman said. “But that is a fallacy.”

“There is nothing in the first evaluator’s report, none of the materials cited, that would lead me to believe he can’t take care of his daughter.”

Scroppo declined to speak with ProPublica about Rudy’s case, citing professional obligations to confidentiality. But he did speak in broad terms about mental health evaluations in child protective cases, which make up a significant part of his practice.

“Evaluators are tasked with evaluating the specific parents, not the support system or other persons in their lives,” Scroppo explained. “It’s driven by the fact that only the parent is going to have ultimate decision making over the child. Although the parent may have—and I think it would matter if they did—a team to help them, it would hinge on their ability to be responsible. The law is for me to look at the parent in and of her self.”

Academic studies have found that mental health parenting evaluations often take this self-sufficiency view of parenting. But as Feldman argues, “Nobody raises their child in a vacuum.”

The American Psychological Association guidelines actually encourage evaluators to reach out to “extended family members and other individuals when appropriate (e.g., caretakers, grandparents, clinical and social services providers, and teachers).”

Yet often that doesn’t happen. A decade ago, DePaul University researchers reviewed 190 evaluations from Chicago’s child welfare system. Almost none of the evaluators called on family members or others besides the parents. Often, the evaluators relied on single, short interactions with parents or failed to observe them with their children. More recent studies by researchers in New York and at the University of California, Berkeley found similar patterns.

“The tests are already less than perfect at measuring what they were designed to measure—IQ or psychopathology—and they are far less than perfect at measuring parenting,” Karen Budd, the DePaul report’s lead researcher, told ProPublica.

One reason evaluations come up short is money, said Nicholson, the Dartmouth psychiatry professor who researches parents with mental illness. “Really thorough evaluation is pretty resource-intensive, and nobody wants to do them,” Nicholson said. “Nobody can actually afford that. Or they say they can’t. Taking a kid away is expensive, too.”

Even Scroppo agrees that these cases can be hard calls: “The severity of the mental illness is important in making any determination. And sometimes the line is not clear.”

When Rudy is well, he is soft-spoken and thoughtful. “I am really focusing on being a father to my daughter. My dad was a good dad—he worked hard, he took care of us, and I want to do the same thing for my daughter,” Rudy said last fall, after returning from work at the grocery store where he stocked shelves.

He also knows he would likely struggle to raise J by himself. Rudy has bouts of numbing depression and high-paced mania. At their worst, Rudy’s manic states can flare into delusions. He has believed that he’s a businessman and that YouTube videos carry secret messages. The last time he was hospitalized was in the winter of 2013. He and his sister Rubeka say the stress of the case, and the threat of losing his daughter, finally overwhelmed him.

Five states have listed mental illness as one of a few “aggravating circumstances” that exempt authorities from having to attempt to piece families back together. Among the handful of other circumstances? Murdering, torturing or sexually abusing a child.

But raising J alone, of course, hasn’t been the plan. “If he slipped into an episode, we would know it,” Rubeka says. “We would have been there to support her together.”

Rudy acknowledges there are no easy answers nor perfect endings. The case has now dragged on for nearly four years. And more hearings are scheduled for June in the Nassau County family court.

J has “been in foster care for a long time,” Rudy said. “It will be hard to take her out of foster care. [The Department of Social Services] is saying that she bonded with the foster mom. It’s a tough case, you know.”

When authorities take a child, a 1997 federal law mandates that they must provide parents with access to the programs and services they need to reunite with their children. If the issue that brought a child into foster care is homelessness, child welfare systems must find parents housing. If it’s drugs: treatment. If it’s abuse: parenting classes. Parents can be compelled to attend anger management classes, seek counseling or leave an abusive partner.

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Mindi looks through old photographs of her daughter Q.A.H., and son Jace in an album she keeps. Mindi says that since the Missouri Supreme Court ruled against her parental rights she can hardly stand to look at the images of her daughter, who she fears she may never see again. (Steve Hebert, via Propublica)

But the law does not explicitly cover disabilities, mental or physical. And in the absence of a clearly applicable federal standard, at least five states—Alaska, Arizona, California, Kentucky, and North Dakota—have listed mental illness as one of a few “aggravating circumstances” that exempt authorities from having to provide help to attempt to piece families back together. Among the handful of other circumstances? Murdering, torturing or sexually abusing a child.

In New York, courts can relieve child welfare departments of having to prove they have made efforts to reunify families if judges deem a mother or father too mentally disabled to parent. That has been Nassau County’s position regarding Rudy. “The department is not under any obligation to make reasonable efforts to return the child and to make recommendations [for services] to him,” the county’s lawyer said in a November 2013 hearing.

The rationale for denying services is often explained this way: If a parent is indeed so mentally ill that they’re never going to be able to safely raise a child, why drag that family through an extended legal case and compel taxpayers to make futile expenditures?

But without setting up supports and services, there may be very little way to know whether a parent can raise a child. Rudy was not offered parenting classes or help moving to an apartment where J could join him. No caseworker tried to help Rudy find a program that could support him to raise his daughter, though supportive-parenting programs exist in New York City.

“Nobody ever offered me any help,” Rudy says.

In Missouri, where Mindi’s case unfolded, the state’s obligation to explore support for mentally ill parents has become an issue in the courts.

In 2012, a state appellate court reversed a termination based largely on the testimony of a psychologist who’d administered tests but never actually observed the mother with her child.

“Even a mental condition that renders a parent unable to provide adequate care for a child alone does not provide a basis for termination if the parent has access to additional support because parenting is frequently ‘a group effort,’ ” the appeals court wrote. “It is because of the frequently group nature of modern parenting that [the law] does not allow for the termination of parental rights simply because a parent cannot shoulder the entire burden of raising a child on his or her own.”

While ProPublica spoke to dozens of attorneys around the country about questionable cases, few termination cases are appealed and fewer still are reversed—higher courts are typically deferential to trial court decisions. Missouri appeals courts and the state’s Supreme Court have overturned at least seven other mental-health-based terminations since 2000. We found another seven cases since 2000 in which New York appellate courts overturned mental disability terminations.

In the last decade, states including Idaho, Utah, and Vermont have added language to their child welfare statutes to protect parents with disabilities, including psychiatric disabilities. “A court may not remove a child from the parent’s or guardian’s custody on the basis of…mental illness,” the Utah law reads.

But mental health advocates say progress is too slow. They say that even in states where mental illness is not listed explicitly as a reason for terminating parental rights, parents still face bias and aren’t getting the help they need.

“People have focused on the language of disability or mental illness in the laws, and that is important,” said Jennifer Mathis, deputy legal director of the Bazelon Center, a mental health advocacy groups. “But you also need to provide supports.”

In 2011, two years after Mindi’s child was removed, Missouri’s legislature adjusted the child welfare laws to recognize the rights of disabled parents. The change came after news broke of a blind couple whose baby had been removed over concerns that their disabilities impaired their ability to raise a child.

The measure affirmed that nothing in the state’s laws should “be construed to permit discrimination on the basis of disability or disease.” Children cannot be removed, nor can parental rights be terminated, the bill maintained, “without a specific showing that there is a causal relation between the disability or disease and harm to the child.”

As it was originally introduced, the Missouri legislation noted that in making child removal and parental termination decisions, the state “shall consider the availability and use of accommodations for the disability or disease, including assistive technology and support services.” That language—the sort that advocates for parents and for people with psychiatric diagnoses say is needed to stop unnecessary family separations—was removed from the final legislation.

In Mindi’s case, her daughter’s foster parents and the state of Missouri asked the judge in 2011 to terminate Mindi’s parental rights and for Q.A.H. to be adopted. The reason her rights should be terminated? Citing state law, lawyers for Q.A.H.’s foster family wrote that Mindi has “a mental condition which is shown by competent evidence either to be permanent or such that there is no reasonable likelihood that the condition can be reversed.”

The petition rested largely on reports of the event three years earlier, when, after the delusion about her daughter’s rape, Mindi brought her daughter to the hospital.

In 2012, a Missouri trial court granted the petition to terminate Mindi’s parental rights, formally severing her connection to Q.A.H. Mindi was “unable to knowingly provide [Q.A.H.] the necessary care, custody, and control” because, the judge wrote, she “has delusions that then become her reality.”

Earlier in the case, Mindi had regained custody of Q.A.H. after eight months of separation only to lose it again after refusing to allow visits from Q.A.H.’s father, who Mindi says was abusive. Such lack of cooperation is not legally sufficient to permanently separate children from their parents, but the judge who terminated Mindi’s parental rights chalked up her claim of abuse to ongoing delusions—though no evidence was presented on this, one way or the other. Q.A.H. was placed back in foster care, this time with a new couple.

The judge also said in his opinion that Mindi had made strange faces while sitting in court, an “affect,” the judge wrote, which “is quite unusual in termination of parental rights proceeding, but is consistent with mental health diagnosis given by [the court-appointed psychiatrist].”

Mindi’s lawyers and other attorneys who represent parents like her say the judge’s reaction is common: Actions and statements that might pass without notice in people without a mental illness are pathologized in people with a diagnoses. “People who have those records at the back of their mind are looking for something to support their theory that she’s not stable,” said Sandra Wirtel, Mindi’s court-appointed attorney.

Mindi and her lawyers appealed the 2012 ruling, and the following year a Missouri appellate court sided with her. The trial court decision, a three-judge panel ruled, “utterly fails to establish that [Q.A.H.] would be harmed by a continued relationship with Mother.”

The appellate judges added that the judge’s observation of Mindi’s facial expressions “does not constitute reliable and substantial evidence on the critical question of Mother’s present mental condition.”

Mindi began preparing for Q.A.H. to return, setting up a bedroom with a pink bedspread. They had not seen each other for nearly a year, and to rebuild their relationship, Mindi and Q.A.H. were allowed to begin visits. Her daughter was bigger, more talkative, her dark blond hair now in long curls. At first, Q.A.H. was shy, feeling out her relationship with this woman she’d been separated from. But then she asked her mother to play a game Mindi had made up when Q.A.H. was younger. “She remembered that,” Mindi said.

Mindi thought her daughter would be home for Christmas. But in late 2013, Mindi’s lawyer called her to tell her the case was not over. Q.A.H.’s foster parents, joined by the state, had appealed the case to the Missouri Supreme Court. Visits were halted again. The judges heard arguments in the case two months ago.

When she’s with her son, Mindi can, for a moment, forget that for the last three years her life has been consumed by the fight for her daughter. Mindi enrolled in college again. She spends a lot of time at her Baptist church—Wednesday night Bible study and Sunday services. She now lives in the home of a family friend who is mostly away—Mindi’s father died when she was young and she’s estranged from her mother.

Late last year, she started to meet with the foster parents for monthly mediation sessions. Q.A.H. had lived with them for more than two years now.

To her attorneys, Mindi’s case still seemed like a sure win. In 2007, the Missouri Supreme Court restored the parental rights of a young mother who’d been diagnosed with bipolar disorder.

Judge Richard Teitelman sits on the Supreme Court of Missouri. Speaking broadly about such cases, he told ProPublica, “given the number of people in this world who are bipolar, or have some mental illness and who raise children very effectively, it would not seem to me that it should be a status thing—that anyone can say, if you’re mentally ill you can’t be a parent, you can’t have a child. That does not seem to comport with today’s reality.”

In the early afternoon of March 25, Mindi received a phone message from the lawyer appointed to represent her in her parental rights case. The news was what she feared. “I just lost my daughter,” Mindi wrote in a message to ProPublica.

The Missouri Supreme Court ruled, 6-to-1, that the lower court should be granted broad discretion in making decisions about the facts of a parental termination case. Though the judges noted that the state still had an obligation to prove that a parent’s mental condition poses a risk to the child, they wrote that since the trial court had believed Mindi was a danger, the Supreme Court, which did not hear testimony from witnesses, was in no position to disagree.

Judge Teitelman issued a short lone dissent. “The evidence in this case…fails to demonstrate clearly that the Mother is currently unable to adequately care for the child and that she will be unlikely to do so in the future,” he wrote, adding that the court’s decision had been “simply speculative.”

In early May, Q.A.H.’s adoption went through. Mindi has no contact with her daughter.

A version of this column originally appeared in:

House Ways and Means Committee Discusses Obama Plan on Psychotropics on Foster children

The House Ways and Means Subcommittee on Human Resources heard testimony yesterday on the disproportionate use of psychotropic medications on foster youths, and the president’s $750 million proposal to address the issue.

The hearing yesterday was spurred along by the presence of a celebrity witness, talk show host “Dr. Phil” McGraw.

“These drugs can change and even save lives,” McGraw told the committee. But with foster youths, they are “too often misused as chemical straitjackets,” prescribed to mitigate “undesirable behavior” and make foster youths “less inconvenient.”

The use of psychotropics on foster youths has received attention from several corners in both houses of Congress and the White House in recent months. President Barack Obama proposed in his fiscal 2015 budget a $750 million, 10-year plan to help states develop different ways to address mental health challenges among foster youths.

Last week, Democrats on the Senate Finance Committee said the committee plans to “play offense” on what Sen. Tom Carper (D-Del.) called “mind-bending drugs.”

Youth-Shadow-Day_0

Ways and Means leadership from both parties asserted an interest in addressing the issue. “This is a bipartisan issue,” said Subcommittee Chairman David Reichert, “We are together on this.”

A 2011 law shepherded through Ways and Means required states to share their prescription and monitoring protocols with the Administration for Children and Families (ACF), a division of the Department of Health and Human Services.

“Everyone agrees that these drugs are flowing too much,” McGraw said. “The real question is, why? Why is this happening?”

The president’s proposal is a two-pronged plan that focuses mostly on building the ability of states to treat foster youths without psychotropic drugs – or at least with less drugs – and then rewarding states for lowering reliance on the drugs.

The first part is a $50 million a year, five-year investment by the Administration for Children and Families (ACF). That mandatory spending would “encourage the use of evidence-based screening, assessment and treatment of trauma and mental health disorders” among foster youth.

The second part is a $500 million Medicaid demonstration program that would provide performance-based Medicaid incentive payments to improve care coordination and delivery of evidence-based services for foster youth.

One key element of those demonstrations would be improved collaboration between child welfare and health services agencies.

“You’d think that child welfare and mental health systems would work together a lot; you’d be very wrong,” said Dr. Michael Naylor, who helps lead a medication oversight partnership between the University of Illinois-Chicago and the Illinois Department of Children and Family Services.

ACF official Joo Yuen Chang testified that the agency found a services gap as it engaged more local systems about psychiatric medications.

“Child welfare agencies did not have access to the research-based, non-pharmacological, mental health treatments for the conditions for which many of these children were being medicated,” Chang said at the hearing.

The Dr. Phil Foundation is one of the 110 organizations to sign a letter in support of the Obama proposal, which ranking minority member Lloyd Doggett (D-Texas) introduced for the record.

But McGraw also suggested a more nefarious reason for overreliance on medications.

“It’s pay for pathology,” said McGraw, who is also a spokesman for Court Appointed Special Advocates. “More prescriptions, less treatment. More prescriptions, less treatment. These children deserve better than that.”

Read More at: House Ways and Means Committee Discusses Obama Plan on Psychotropics | The Chronicle of Social Change:

 

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Drug Firms Have Used Dangerous Tactics to Drive Sales to Treat Kids

Drug Firms Have Used Dangerous Tactics to Drive Sales to Treat Kids
  • A new investigation by the Denver Post revealed that foster children are prescribed psychotropic drugs at a rate 12 times higher than other children on Medicaid
  • The high rates of psychotropic drug use among foster children and poor children are likely a direct result of drug company tactics that targeted doctors in the Medicaid program, influencing them to prescribe more drugs to these kids
  • For foster children in the Medicaid program, nine out of the top 10 most prescribed drugs are psychotropics (compared to just one out of the top 10 drugs prescribed to non-foster children)
  • Across the US, 7.5 percent of children aged 6-17 take a prescribed medication to treat emotional or behavioral difficulties
  • Drug companies have paid billions of dollars in fines for illegally marketing psychiatric drugs to children, even when they aren’t approved for such uses

    By Dr. Mercola

    There is big money to be made in prescribing medications to kids – especially when those medications are intended to be taken for life, as many psychotropic drugs are.

    These drugs, which include stimulants, antipsychotics, and mood stabilizers, carry the risk of serious side effects, including, ironically, psychotic symptoms (like hearing voices or paranoia), aggressive behavior, hostility, seizures, heart attack, delayed puberty, and more.

    Oftentimes the side effects are far worse than the conditions, such as attention deficit hyperactivity disorder (ADHD), for which they're prescribed, and rival illegal street drugs in terms of their dangerous risks to health.

    In children, the long-term effects are often largely unknown, while in the short term, we've seen shocking increases in violent and aggressive acts committed by teens taking one or more psychotropic drugs.

    The number of prescriptions for psychotropic drugs for US children more than doubled between 1995 and 2000, but a new investigation by the Denver Post revealed that foster children are prescribed such drugs at a rate 12 times higher than other children on Medicaid.1

    This isn’t a mistake… the high rates of psychotropic drug use among foster children and poor children is likely a direct result of drug company tactics that targeted doctors in the Medicaid program, influencing them to prescribe more drugs to these kids.

    9 of the 10 Most Prescribed Drugs for Colorado Kids in Foster Care Are Psychotropics

    The Denver Post investigation revealed that for foster children in the Medicaid program, nine out of the top 10 most prescribed drugs are psychotropics (compared to just one out of the top 10 drugs prescribed to non-foster children). In 2008, drug companies spent close to $800 million for sales reps to visit health care professionals specifically for antipsychotics and antidepressants.

    Sales of antipsychotics alone topped $18 billion in 2011, which is more than sales of vaccines and triple the amount spent on such drugs in 2002, the Post reported. More than 1 million US kids now take antipsychotics each year, and tens of thousands of them are under the age of 5. According to the investigation:

    “High rates of psychotropic drug use among poor and foster children didn't occur by mistake, government investigators say. Court documents filed in health care false-claims lawsuits show that drug companies closely tracked the prescribing habits of doctors in the Medicaid program, which pays the health care of the poor, including foster children.”

    What happens to kids once they become medicated at a very young age, during some of his or her key formative years? Do these children grow up never knowing who they really are? What passions they may have had if not under the drug's influence? And will they be able to quit when they are older, or will they be turned into life-long addicts? The answers to these questions are unknown, as are the effects of most of these drugs in children.

    One in 13 US Schoolkids Takes Psychiatric Drugs

    Data from the National Health Interview Survey revealed that increasing rates of psychiatric drug use among kids is not confined to Colorado alone. Across the US, 7.5 percent of children aged 6-17 take a prescribed medication to treat emotional or behavioral difficulties.2

    Echoing the Denver Post investigation, the Health Interview Survey data also revealed that a higher percentage of children insured by Medicaid used psychiatric drugs, as did children in families whose income was below the poverty level.

    Most Antipsychotics Prescribed to Medicaid Kids Are for Off-Label Uses

    One study from Rutgers University found that at least three-quarters of children prescribed antipsychotics through Medicaid took them for off-label uses, which have not been approved by the US Food and Drug Administration (FDA).3 Among the most common conditions for which the drugs were prescribed were ADHD, conduct disorder, anxiety, and depression – none of which are FDA-approved for treatment with antipsychotics in children.

    While a doctor can legally prescribe a drug for any use, even if it hasn’t been FDA-approved, it’s illegal for a drug company to advertise off-label uses or encourage a doctor to prescribe it as such. This, however, is precisely what many of them do, and billions of dollars in fines have been paid as a result. For instance:

    • Pfizer paid $2.3 billion for marketing fraud related to Bextra, Lyrica, and other drugs. Charges included marketing drugs to doctors for uses for which they had not been approved and giving kickbacks to doctors and other health care professionals for prescribing their drugs.
    • Pfizer hired 250 child psychiatrists to market its antipsychotic Geodon, even though it wasn’t approved for use in children. This was Pfizer's fourth settlement numbering in the multimillions in less than a decade.
    • AstraZeneca settled for $520 million for trying to persuade doctors to prescribe its psychotropic drug Seroquel for unapproved uses including ADHD, sleeplessness, anxiety, and depression. Using Seroquel for improper use has been linked to an increased risk of death.
    • Johnson & Johnson paid $2.2 billion for illegal marketing of the drug Risperdal for unapproved uses in children. In addition to targeting more than 1,500 child psychiatrists, Johnson & Johnson also held a “Back to School Bash” marketing campaign that aimed to increase prescriptions of Risperdal in children via ice-cream parties and free snacks and lunches.
    • In 2012, GlaxoSmithKline (GSK) plead guilty in the largest health fraud settlement in US history. The company was fined $3 billion to resolve criminal and civil liability charges related to illegal drug marketing and withholding information about health hazards associated with its diabetes drug Avandia and others, including the antidepressant Paxil, which was illegally marketed to children and adolescents for everything from depression to shyness.
    • Eli Lilly paid $1.4 billion for promoting its antipsychotic Zyprexa for off-label uses, often to children.

    Why Are So Many Children Being Drugged?

    The American Academy of Child & Adolescent Psychiatry (AACAP) states that up to 85 percent of children in the child welfare system meet the criteria for a psychiatric diagnosis.4  But the diagnosis of mental illness in children is far from an exact science. Modern psychiatry has expanded its reach to the point that even the most normal of emotions and mental states now fall under one labeled "disorder" or another.

    They have been able to cleverly redefine mental illness with the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM). This book is created by members of the American Psychiatric Association. You would think that diseases are put in this book after evaluating carefully executed scientific trials, but nothing could be further from the truth. Additions and changes to this manual are determined by votes by its members. This categorization is NOT based on science at all!

    It is well-documented that psychiatric drugs in general, and atypical antipsychotics specifically, are misused across the board. Children as young as 18 months are now receiving antipsychotic drugs, despite the fact that the diseases they're designed to treat rarely develop before adolescence. So why are toddlers receiving these potent drugs? Sadly, one of the key reasons these drugs are used is their sedative effect. They're typically prescribed to control "disruptive" behavior – not to treat severe mental illness.

    It's also come to light recently that the Harvard psychiatrists who invented the pediatric bipolar diagnosis were disciplined for conflicts of interest after it was revealed they'd all received millions of dollars in undeclared drug company monies.5  Even the AACAP admits “in many states there is a disproportionate number of children in foster care who receive psychotropic medication.” Indeed, according to a 2010 study, an estimated 20 percent of children diagnosed with ADHD are actually misdiagnosed.6

    Has Your Doctor Been Paid by Drug Companies?

    Beginning in Fall 2014, you will be able to determine if a health care provider you trust is actually on the drug industry's payroll, thanks to a new federal law that entails the following:

    • Drug and medical device companies will be required to report and disclose all payments (including stock options, research grants, knickknacks, consulting fees, travel expenses, and more) to physicians. Unfortunately, payments to nurses, physician assistants, and other medical professionals will not have to be disclosed
    • The information will be displayed in an online government database that you will be able to search

    In the meantime, you can search ProPublica's database to see the disclosed payments made to physicians in your state. Many of the most prestigious universities, including Harvard, are now banning their staff from receiving money from drug companies for speaking, and this new disclosure requirement will hopefully push more institutions in that direction.

    Breaking the drug industry's stranglehold on the conventional medical industry will not be easy -- after all, the drug industry spends nearly twice as much on promotion as it does on research and development7 -- but the tide is beginning to turn. Increasing numbers of people are now waking up to these harsh realities, and you, being among those who are informed, can help share this knowledge with others. More than 1.5 million people receive this newsletter, and together, we can make a huge difference.

    The ultimate goal is to have a critical mass of people refuse the unnecessarily dangerous and counterproductive solutions currently offered by conventional medicine, as this will be the powerful stimulus to generate authentic change. You can also act now, on a personal level, by making the necessary lifestyle changes that will allow you to take control of your health, instead of leaving it in the hands of the drug industry – especially when it comes to your kids.

    Alternatives to Drugs for Behavioral and Emotional Challenges in Children

    If your child is suffering from an emotional or mental challenge, please seek help, but do so from someone who does not regard psychotropic drugs as a first line of defense. Please understand that behavioral problems in children – including what might appear to be serious mental disorders – are very frequently related to improper diet, emotional upset, and exposure to toxins.

    Increasingly, scientific evidence shows that nourishing your gut flora with the beneficial bacteria found in traditionally fermented foods (or a probiotic supplement) is extremely important for proper brain function, and that includes psychological well-being and mood control. Dr. Natasha Campbell-McBride has successfully demonstrated the power and effectiveness of this theory. In her Cambridge, England clinic, she successfully treats children and adults with a wide range of conditions, including autism, ADD/ADHD, neurological disorders, psychiatric disorders, immune disorders, and digestive problems using the GAPS (Gut and Psychology Syndrome) Nutritional Program, which she developed.

    Her GAPS theory – which is fully explained in her excellent book, Gut and Psychology Syndrome – is an elegant description of how such conditions can develop as a direct result of gastrointestinal toxicity. Another helpful tool is my three-part interview with a renowned children's health expert, the late Dr. Lendon Smith, on Non-Drug Treatment of ADD/ADHD. Here are a few additional guidelines to help you address underlying toxins in your child, without, or at least BEFORE, agreeing to any kind of drug therapy:

    Additionally, whole and even sprouted wheat contains physiologically significant amounts of wheat germ agglutinin (WGA), which can have adverse effects on mental health due to its neurotoxic actions. Wheat can also interfere with the production of serotonin, the largest concentration of which can, again, be found in your intestines, not your brain. Try eliminating all gluten-containing grains first for 1-2 weeks and see if you don't notice a significant improvement in your child's behavior.

    1. Severely limit or eliminate fructose from your child's diet, as sugar/fructose has been linked to mental health problems such as depression and schizophrenia.
    2. Avoid giving your child ANY processed foods, especially those containing artificial colors, flavors, and preservatives. This includes lunchmeats and hot dogs, which are common food staples in many households.
    3. Replace soft drinks, fruit juices, and pasteurized milk with pure water. This is HUGE since high fructose corn syrup is a primary source of calories in children.
    4. Make sure your child is getting large regular doses of healthy bacteria, either with high-quality fermented organic foods and/or high-quality probiotic supplements.
    5. Give your child plenty of high-quality, animal-based omega-3 fats like krill oil. Also, make sure to balance your child's intake of omega-3 and omega-6 fats, by simultaneously limiting their intake of vegetable oils.
    6. Include as many whole organic foods as possible in your child's diet, both to reduce chemical exposure and increase nutrient content of each meal. See my nutrition plan for a comprehensive guide to healthful eating.
    7. Also reduce or eliminate grains from your child's diet, especially wheat. Beyond the fact that even healthy organic whole grains can cause problems as they, too, break down into sugars, gluten-containing grains have pharmacologically active peptides that can contribute to cognitive and behavioral issues in susceptible children.
    8. Avoid artificial sweeteners and colors of all kinds.
    9. Make sure your child gets plenty of exercise and outdoor playtime, remembering that midday sunlight provides the UVB wavelengths necessary to produce vitamin D3.
    10. Get them out into the sun to help maintain optimal vitamin D levels. Scientists are now beginning to realize vitamin D is involved in maintaining the health of your brain, as they've recently discovered vitamin D receptors in the brain, spinal cord, and central nervous system. There's even evidence indicating vitamin D improves your brain's detoxification process. For children and pregnant women, getting enough vitamin D is especially crucial, as it may play a major role in protecting infants from autism. If natural sun exposure is not feasible, for whatever reason, you can use either a safe tanning bed or an oral vitamin D3 supplement.
    11. Give your child a way to address his or her emotion health. Even children can benefit from the Emotional Freedom Technique (EFT), which you or an EFT practitioner can teach them to use.
    12. Be sure you are also providing positive praise to your child. Dr. Smith believed parents should be able to say nice things to their child twice as often as they give commands or ask questions. If you are shouting and scolding more than you are complimenting and rewarding your child, it could be contributing to psychiatric problems.
    13. Prevent exposure to toxic metals and chemicals by replacing personal care products, detergents, and household cleaners with all-natural varieties. Metals like aluminum, cadmium, lead, and mercury are commonly found in thousands of different food products, household products, personal products, and untold numbers of industrial products and chemicals. Also be aware of exposure to metals from vaccinations and dental fillings. The presence of toxic metals in your child's body is highly significant, as they are capable of causing serious health problems by interfering with normal biological functioning. The health effects range from minor physical ailments to chronic diseases, and altered mood and behavior.

    mercola.com

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