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Introduction
Some Background on Kaiser Permanente and Behavioral Health
Historical Articles of Interest Listing
Special Articles of Interest
Some Background on Kaiser Permanente and Behavioral Health
Historical Articles of Interest Listing
Special Articles of Interest
You
need to understand the current climate we are living in.
It seems
everyone is clinically diagnosed as depressed or anxious. On
medication.
Perhaps Paxil, Zoloft or Ritalin. It seems you don't get to
talk
to your counselor much. One visit to the psychiatrist usually
means
time to be drugged, then back to the same counselor who sent you there
in the first place.
Interestingly enough, I don't have Kaiser Permanente insurance. Never have. Never will. A loved one of mine did, now she no longer has Kaiser Permanente, does not go through the Kaiser Permanente Behavioral health team based approach. Thank goodness. And today, after a gradual withdrawal process, she is Paxil free. She is able to be a normal teenager, able to deal with life's everyday ups and downs without the emotional numbing aid of an anti depressant.
Interestingly enough, I don't have Kaiser Permanente insurance. Never have. Never will. A loved one of mine did, now she no longer has Kaiser Permanente, does not go through the Kaiser Permanente Behavioral health team based approach. Thank goodness. And today, after a gradual withdrawal process, she is Paxil free. She is able to be a normal teenager, able to deal with life's everyday ups and downs without the emotional numbing aid of an anti depressant.
I
had the opportunity to scour the mental health
progress
notes and other documents from her former Kaiser Permanente
counselor
and
psychiatrist for many, many, many - hours. I was
mortified.
Mortified at many things.
The month-long gap in time between sessions, thus why a psyche consult with subsequent medication? Therapy is a relationship, and from what I gather the Kaiser Permanente Behavioral Health experience is not one based on weekly sessions to feel better about oneself, utilize all options before a last resort of medication.
The month-long gap in time between sessions, thus why a psyche consult with subsequent medication? Therapy is a relationship, and from what I gather the Kaiser Permanente Behavioral Health experience is not one based on weekly sessions to feel better about oneself, utilize all options before a last resort of medication.
What
I
would like to see happen is have all Kaiser
Permanente
patients who were diagnosed too quickly as depressed, thus
given
medication,
all Kaiser Permanente patients who found themselves stuck with
the
same
counselor, Kaiser Permanente patients who needed weekly
sessions,
but
were
granted only a limited number of sessions per benefit year,
Kaiser
Permanente patients who felt all therapy options were not
exhausted before being
put on medication, and all those concerned about their loved
ones
who have gone through Kaiser Permanente Behavioral Health and
want
to complain -to please contact me.
I
am putting together a data base. I
would like
to see everyone who has had a poor experience with Kaiser
Permanente
Behavioral
Health to not only provide me with a summary of the unpleasant
experience,
but seriously think about filing a Complaint against the
counselor with
The National Association of Social Workers, along with a
Complaint
against
the psychiatrist who was too quick with the anti depressant
prescription,
to not only the Medical Board in your state, but with any
professional
associations he belongs to who are willing to hear a ethics
complaint
from
you.
Folks,
we are in a crisis as far as the state of
mental
health
is concerned in this country. Our counselors and
psychiatrists are
not actually talking to us nearly enough. We are too
quickly
told
we are depressed and here - take this anti
depressant.
We,
especially those affected by
and associated
with,
Kaiser Permanente Behavioral Health, need to listen more and
also speak
up.
| Historic Articles of Interest | Special Articles of Interest |
| Some Background on Kaiser Permanente
and Behavioral Health First before browsing the following list of informative information on how the behavioral health system is often taking advantage of the patient, here is some really important background on Kaiser Behavioral Health: The following is from "Nicholas A. Cummings Collected Papers Vol. I" - Page 128 - 129 Note: Nicolas A. Cummings led the Behavioral Health Division and worked it into a money making enterprise. He also is the person that made sure psychiatric services were provided by HMO's. That sounds good doesn't it? Read the following to learn the motives behind the actions: The Beginning of the Kaiser Permanente Mental Health Benefit "Kaiser Permanente soon found, to its dismay, that once a health system makes it easy and free to see a physician, there occurs an alarming inundation of medical utilization by seemingly physically health persons. In private practice the physician's fee has served as a partial deterrent to over-utilization, until the recent growth of third party payment for health care services. The financial base at Kaiser Permanente is one of per capitation, and neither the physician nor the Health Plan derives an additional fee for seeing the patient. Rather than becoming wealthy from imagined physical ills, the system could be bankrupted by what was regarded as abuse by the hypochondriac. Early in its history, Kaiser Permanente added psychotherapy to its list of services, first on a courtesy reduced fee of five dollars per visit and eventually as a prepaid benefit. This was initially motivated not by a belief in the efficacy of psychotherapy, but by the urgent need to get the so-called hypochondriac out of the doctor's office. From this initial perception of mental health as a dumping ground for bothersome patients, twenty years of research has led to the conclusion that no comprehensive prepaid health system can survive that does not provide a psychotherapy benefit. Early investigations confirmed physicians fears they were being inundated, for it was found that 60% of all visits were by patients who had nothing physically wrong with them. Add to this the medical visits by patients whose physical illnesses are stress related (peptic ulcer, ulcerative colitis, hypertension, etc.), and the total approaches a staggering 80 to 90% of all physician visits. Surprisingly as these findings were 25 years ago, nationally accepted estimates today range from 50 to 80% (Shapiro, 1971) Interestingly, over 2,000 years ago Galen pointed out that 60% of all persons visiting a doctor suffered from symptoms that were caused emotionally, rather than physically (Shapiro, 1971).  Timothy Leary was the Director of the Kaiser Foundation Psychological Research from 1952 to 1958. He did a lot of research on how to control and manipulate a population. He led a wild lifestyle up at Kaiser where - "In the
mid-1950s Leary worked as
director of Psychological Research
at the Kaiser Foundation and taught at Berkeley University. There he
and
his wife were involved in heavy drinking and adulterous wife swapping.
In early 1960, he joined the Harvard Center for Personality Research.
That
same year Leary took his first dosage of hallucinogenic mushrooms, and
he was permanently changed. Believing that psilocybin mushrooms created
mystical perception that could reprogram the brain, Leary persuaded the
school authorities to allow him to devise and administer the "Harvard
Drug
Research Program."
http://behavioral.kaiserpapers.info/tleary.htmlPlease read: There are several variations of why Tim Leary was fired from Kaiser. Most of the explanations sound petty. Only one sounds logical and provides a reasonable explanation. The following version is from Nicholas A. Cummings who replaced Timothy Leary. Quotes are from: "The Entrepreneur of Psychology: The Collected Papers of Nicholas A. Cummings" pages 5 and 6 - The Role of the Somatizer inb the Development of the Health Plan Early in the 1950's, the Permanente physicians discovered that 60% of all visits to physicians were by patients who either had no physical illness, or had a physical illness that was being exacerbated by psychological factors. Today, this is a nationally recognized phenomenon, and the American Medical Association (AMA) accepts 60% to 70% as the national figure. The reason it was first discovered at Kaiser Permanente was the nature of the health plan itself. See: http://behavioral.kaiserpapers.info/tleary.html#leary1 The Leary material is very important as it sources all that has followed while providing somewhat of a road map for understanding what in the world these people are really doing. http://govinfo.library.unt.edu/whccamp/meetings/transcript _9_8_00_s3_4_5.html "Targeting the insurance companies of the nation is important to identify the idea that upstream intervention is going to save the insurance dollar. There is cost savings and the business department of Kaiser has data to support that. As long as the outcomes are behaviorally based, we can measure the outcomes in terms of reduced medical visits and reduced medical visits translates to dollars, savings. " mirrored at: http://behavioral.kaiserpapers.info/cam1.html Now Learn how this branch of medicine is used to control, bribe and sometimes treat people. A Letter from Douglas Beech, M.D. While reading about the outcome of Dr. Thomas Jensen’s suit against Kaiser Permanente’s San Diego HMO in the October 6 issue, I was painfully reminded just how far the collective mentality of psychiatry has plunged into a managed care paradigm of minimalism.Dr. Jensen protested the policy of the HMO that "required" psychiatrists to prescribe without personal examination of a patient. Physicians who participate in such a practice do not have the HMO policy to blame, but the outcry suggested that the policy was responsible for physicians’ not performing their required duty. Please read: http://behavioral.kaiserpapers.info/beechy.html Kaiser Defends Mental Health Coverage As 'team-Based' Kaiser Permanente, under investigation in California for requiring psychiatrists to write drug prescriptions for mental health patients whom they have not seen, on Thursday defended its practice as "team-based."http://behavioral.kaiserpapers.info/team.html LEADER'S MANUAL FOR ADOLESCENT GROUPS ADOLESCENT COPING WITH DEPRESSION COURSE Gregory Clarke, Ph.D. Peter Lewinsohn, PhD ... In short - Kaiser realizes that there is big money to be made in kid's being labeled as depressed. It is a great excuse for another study that leads to many new government funded contracts. http://www.kpchr.org/public/acwd/CWDA_manual.pdf Kaiser Mid Atlantic States caring for mental health of adolescents. Development of KP Services for Adolescents "In 1955, KP San Francisco opened one of the first teen clinics in the country (Charles Wibbelsman, MD, personal communication).a In 1986, KP expanded that care by opening a comprehensive teen center in Panorama City, California. The center is staffed by a multidisciplinary team that includes nurses, physicians specializing in adolescent medicine, a health educator, and a social worker. The center maintains a collaborative relationship with the department of obstetrics and gynecology and monitors pregnant and high-risk teens to assure compliance with established standards of health care delivery and confidentiality. " http://xnet.kp.org/permanentejournal/winter02/westeast.html regarding the above article please again review the top listed article about Dr. Leary Phantom
Mental
Health Services at Kaiser Permanente? April
28,
2004 - Kaiser Papers Hawaii
received
the
following
press release from Dr.
Russell M. Holstein regarding Kaiser
Permanente's
failure to deliver quality mental
health care services.
HIDDEN
LIMIT
ON MENTAL HEALTH TREATMENT AT KAISERhttp://www.kaiserpapershawaii.org/ Articles related to the over medicating of patients Teen Screening - The Truth There is An 84 - 94% Chance Your Child Will Incorrectly Be Determined to Have a Mental Illness http://www.teenscreentruth.com/ Is your child being "mentally screened" at school without your knowledge or permission? Students have been lured into taking the "test" by being given free movie tickets and food. From what I understand, TeenScreen is now in place in over 12 states, and in over 450 schools. To see if your state is supporting TeenScreen, check out this web site. http://www.ifeminists.net/introduction/editorials/2006/0524zizza.html Alliance for Human Research Protection GAO Report "Two million people are injured annually from prescribed pharmaceuticals--106,000 die from adverse prescription drug effects--in addition to 98,000 drug related deaths in hospitals due to errors." http://www.ahrp.org/cms/content/view/148/28/ Drip Drip Drip - Paxil Info Leaks Out April 25, 2006. By Evelyn Pringle Secrecy agreements in litigation hide information about defective products or a company's negligence, and sometimes go so far as to prohibit the parties from discussing that there ever was a lawsuit. Such is the case with Paxil and as a result, unwitting patients continued to take the drug long after its dangers were known to GlaxoSmithKline. Many lawsuits filed against Glaxo have been settled out of court, with confidential agreements that prevent the public from knowing about the harmful effects of the Paxil. http://www.lawyersandsettlements.com/articles/paxil.html Treatment for Depression More Than Triples in the US in the Last 10 Years Children Should Not Be Over Medicated Like many mental health reform advocates, I was thrown into the fire via a deeply personal life experience.When I carefully "weaned/tapered" a child off 20mg of the powerful antidepressant Paxil, little did I know that the personal can be quite political. Families in this great country of ours, if not throughout the entire world, are much safer and happier as children live their lives again without antidepressants and psychotropic drugs. http://behavioral.kaiserpapers.info/druggedkids.html Prescribing Practices BY DANIEL B. BORENSTEIN, M.D The patients were evaluated by other mental health professionals or trainees, following which the Kaiser psychiatrists were asked to prescribe psychotropic medications without a comprehensive or any other face-to-face evaluation. Apparently, this practice had been going on for more than 10 years and had never caught the attention of either the licensing authorities or the psychiatric society. http://behavioral.kaiserpapers.info/frompresident.html Kaiser therapists stage one-day strike Kaiser’s requirement that they take on 10 new patients a week—in addition to their regular caseload—so overloads the system that it takes about two weeks for a new patient to get an initial appointment with a counselor, and sometimes three to four weeks for a follow-up visit. http://www.apa.org/monitor/sep98/strike.html Health care system plays mind games with emotionally ill, critics say Kaiser sent her to a psychiatrist who put her on Prozac and suggested that she attend group therapy, neither of which, she said, helped her with the insomnia, anger and depression she was suffering from a childhood trauma. "It seemed like the psychiatrist's primary job was dispensing Prozac," Ann said. "There was no mention of psychotherapy. I was sent to a group and listened to other women's horror stories. It was really of no help." http://www.nomanagedcare.org/mindgmesa.htm From Frontline - Is the FDA Hazardous to your health? More than a dozen prescriptions drugs have been pulled off the market...... http://www.pbs.org/wgbh/pages/frontline/shows/prescription/ Teens and depression Some experts contend that deep feelings are part of growing up and that, in any case, drugging kids isn't the sole answer In only six minutes according to Kaiser Permanente they can diagnosis your psychiatric condition. Amazing! http://behavioral.kaiserpapers.info/povs.html The
Citizens Commission on Human Rights
- Commissioner's
Fraud Report Written for law enforcement agencies, insurance companies and others concerned with bringing escalating mental health fraud under the law, this report from CCHR provides information on criminal and civil fraud prosecutions in the mental health industry. Understanding
the Opportunities of Integrated
Primary Care Integrated delivery systems such as Kaiser Permanente currently have an advantage for successfully implementing IPCs because the financial incentives are more easily aligned than is usually the case. "Three tenets are important to recognize as being inherent in this shift: Healthcare design is best done from a population management point of view. Resources need to be allocated to fit the composite of healthcare needs of members, viewed from a population management perspective. | Behavioral Health Quality Improvement Committee Description of the various programs in Kaiser Permanente Behavioral Health, the various job functions of the the Committe members, physicians,etc., ease of patient self referral without approval, inpatient, outpatient, drugs, division descriptions of the sections and subsections of this department. http://behavioral.kaiserpapers.info/bhq.html Are We Too Quick To Medicate Children? Los Angeles Times Report by Melissa Healy November 5, 2007 http://www.latimes.com/features/la-he-psychkids5nov05,0,5905395,full.story?coll=la-tot-features mirrored for historical purposes at: http://behavioral.kaiserpapers.info/quicktomedicatechildren.html Kaiser Behavioral Health Hacks provided the teen patient data for TeenScreen. Please Read: "In a study of a screening program implemented by Kaiser Permanente in Hawaii, research analyzing feedback from over 5,000 youth showed that computer-based screening was very inexpensive when compared to traditional clinical services. A cost analysis showed a total cost of $70 per visit for a standard preventive visit compared to $15 per visit for a computer-assisted health visit (Paperny, D.M. et. al., 1997, 1999)." See: http://tinyurl.com/23qvte and mirrored for historical purposes at: http://behavioral.kaiserpapers.info/pdfs/Comprende.pdf "When Stepdad Becomes The Odd Man Out" by: Tony Zizza With the arrival of Father's Day this month, seems like it's just another day for stepdads to hear (and feel) they aren't "real." This is incredibly interesting, but it does nothing to shed the sadness off the daily situation for the true American heroes on June 20th - stepdads. http://behavioral.kaiserpapers.info/stepdad.html Daniel E. Troy, Chief Counsel Food and Drug Administration Amicus Brief, September 3, 2002 ; See also: Gary Young,FDA legal strategy would preempt tort suits National Law Journal March, 2004, vol. 128; Pg. 3 www.law.com/jsp/nlj/PubArticleNLJ.jsp?id=1076428430132 On August 6, Harris portrayed the changes - such as label warnings - through the prism of FDA officials who consistently side with industry, not drug safety. Dr. Scott Gottlieb, for example planted the view that the agency's advisory committees "are vulnerable to a growing chorus of criticism," implying they are not persuaded by evidence. He then planted the insidious suggestion (which Harris dutifully reported as fact): "Now, instead of waiting for proof, the agency has promised to issue public health alerts about drug risks even when problems are only suspected. And over the last year, it has demanded that pharmaceutical companies add tough warnings for drugs as diverse as the antidepressant Zoloft, because it might lead a small number of teenagers to become suicidal, and the popular pain pill Advil, because it might in rare cases cause heart attacks. " Gardiner Harris was badly misled by FDA officials whose concern is clearly with business interests when he wrote that proof was needed. In point of fact�,� the Food Drug and Cosmetics Act (21 CFR 201.57(e) ) REQUIRES warnings when there is reason to suspect a hazard: "the labeling shall be revised to include a warning as soon as there is reasonable evidence of an association of a serious hazard with a drug; a causal relationship need not have been proved." See: http://www.ahrp.org/infomail/05/09/30.php Irving Kirsch, Alan Scoboria, Thomas J. Moore, Antidepressants and Placebos: Secrets, Revelations, and Unanswered Questions, Prevention & Treatment, Volume 5, Article 33, posted July 15, 2002 there is now unanimous agreement among commentators that the mean difference between response to antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only by gaining access to US Food and Drug Administration (FDA) documents. The small difference between the drug response and the placebo response has been a "dirty little secret," known to researchers who conduct clinical trials, FDA reviewers, and a small group of critics who analyzed the published data and reached conclusions similar to that of the authors. It was not known to the general public, depressed patients, or even their physicians. http://journals.apa.org/prevention/volume5/pre0050033r.htm Dr. Mosholder's embargoed report and the accompanying Suppressed FDA memos are posted on the AHRP website at: http://www.ahrp.org/risks/SSRImosholder/index.php ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP) ... paid lobbying efforts on behalf of industry are carried out under the pretext of advocacy in the public interest. The Boston Globe reports that "little attention has been paid to smaller nonprofits, especially patient groups that are largely funded by the drug industry." Much as doctors are on the take, a lot of so-called patient "advocacy" groups are pimping for the drug and medical device industry. http://www.ahrp.org/cms/ GlaxoSmithKline (GSK) has submitted documents to the FDA and other regulatory agencies, contradicting its decade long denial that its antidepressant drug,paroxetine (Paxil / Seroxat) increased the risk of suicidal behavior in the company’s controlled clinical trials,. http://www.gsk.com/media/paroxetine_adult.htm In a letter to healthcare professionals this week, GSK warned about the increased suicide risk stating: "There is a possibility of an increased risk of suicide related behavior in young adults ages 18-29" -- whether the drug is prescribed for depression or for other conditions not associated with suicide. http://www.gsk.com/media/paroxetine/adult_hcp letter.pdf Despite the acknowledged suicide risk, GSK attempts to persuade physicians (in the letter to healthcare professionals) to continue to prescribe their drug, offering the company's faith-based "belief" in the drug's benefit: "GSK continues to believe that the overall risk-benefit of paroxetine in the treatment of patients with MDD and other non-depressive disorders remains positive…" http://www.gsk.com/media/paroxetine/adult_hcp_letter.pdf Read the complete MedWatch 2006 Safety Summary, including links to the Dear Healthcare Professional Letter and the revised approved product labeling at: http://www.fda.gov/medwatch/safety/2006/safety06.htm#paxil "GlaxoSmithKline (GSK) and FDA notified healthcare professionals of changes to the Clinical Worsening and Suicide Risk subsection of the WARNINGS section in the prescribing Information for Paxil and Paxil CR. These labeling changes relate to adult patients, particularly those who are younger adults." Study: ADHD drugs send thousands to ERs By LINDA A. JOHNSON, Associated Press Writer Wed May 24, 7:42 PM ET DEAR PHARMACIST SUZY COHEN ADHD DRUGS NOT A CURE http://behavioral.kaiserpapers.info/dearsuzyletter.html By: Suzy Cohen, a registered pharmacist, syndicated writer for the Tribune Media Services SOME OF PSYCHIATRY’S & PSYCHOLOGY’S RECENTLY CONVICTED SEX CRIMINALS PSYCHIATRISTS & PSYCHOLOGISTS: PROFESSIONAL RAPISTS, PERVERTS AND PEDOPHILES PSYCHIATRISTS WHO MUST REGISTER AS SEX OFFENDERS http://www.psychcrime.org/rape/index.html ...more than 100 cases of psychotherapist sexual activity with a patient to the State’s Attorney for prosecution. Florida law presumes that patients being treated for mental or emotional troubles are vulnerable and specifically forbids psychotherapists from engaging in sexual activity with them. Paxil
Protest Long Overdue by
Tony Zizza My fellow
Americans, brace yourself for the first annual Paxil Protest. Sponsored
by the cutting edge non-profit organization, SSRI Citizen, this long
overdue protest takes place September 26th through September 28th,
2005, at 200 North 16th Street in Philadelphia, Pennsylvania. This is
one of the many key sites where Paxil's manufacturer GlaxoSmithKline is
stationed. Paxil is an extremely powerful and dangerous antidepressant
that has created havoc for millions of people and their families
worldwide. It's worth noting that Paxil isn't even allowed to be given
to children under the age of 18 in GSK's home country of Great Britain.
http://www.ifeminists.net/introduction/editorials/2005/0928zizza.html GPs
under fire for Prozac prescriptions to children Around 40,000 children are prescribed anti-depressant medication when they should be offered 'talking' therapy first, a Government watchdog has warned. New national guidelines tell doctors not to prescribe pills as a 'first line' defense against depression. Instead GPs should offer three months of 'talking' therapy first, according to the National Institute for Health and Clinical Excellence (NICE). The recommendations come after the revelation that half of children and teenagers on anti-depressants receive no psychological support. http://www.dailymail.co.uk/pages/live/articles/health/healthmain.html?in_article_id=363698&in_page_id=1774 Kaiser
Permanente's Behavioral Health Patient Rights
& Responsibilities -
Hawaii Region http://improvehealthcare.netfirms.com/KaiserRights.htm http://improvehealthcare.netfirms.com/ New
Warnings Sought on Antidepressants By GARDINER HARRIS Published: September 12, 2004 For anyone taking an
antidepressant please read
these
facts. Used appropriately with a true medical reason
they can
be
be good medicine but
prescribed inappropriately to treat
any and
everything
is not right. They must be used exactly as instructed by the company that manufactures them. They not only can harm your body creating disease but flippantly using them ages your skin and other parts of the body, often dramatically. The latter statement is my personal observation on what is visibly happening to people. http://behavioral.kaiserpapers.info/warnsought.html http://www.antidepressantsfacts.com/ PsychCrime
- Database
of convicted mental health practitioners reported to CCHR International
since 1990. It is, by far, an incomplete list and does not include all
cases reported to law enforcement agencies or the courts.
Citizens
Commission on Human Rights July
2004 Health
care system plays mind games with emotionally ill, critics
say More
family doctors prescribe antipsychotic drugs http://behavioral.kaiserpapers.info/July%202004%20Fraud%20Report.doc Depression
fastest-growing diagnosis, report
says Nearly 350,000 visits by young Canadians to family physicians last year resulted in recommendations that they take antidepressant drugs that are not clinically indicated for people under 20 and that research suggests may actually increase their likelihood of suicide. http://behavioral.kaiserpapers.info/growdiagnosis.html Often,
Time Beats Therapy for Treating
Grief - By JANE E. BRODY http://behavioral.kaiserpapers.info/timegrief.html Study
Advises Against Drugs for Children in Depression Pediatricians and family physicians should not prescribe antidepressants for depressed children and adolescents because the drugs barely work and their side effects are often significant, Australian researchers have concluded. http://behavioral.kaiserpapers.info/nodopeforchildren.html Top
10 Reasons for Not taking Anti Depressants
unless you truly have a
proven
medical reason
to
do so http://behavioral.kaiserpapers.info/donttakeit.html "When
Step dad Becomes The Odd Man Out" Article of the perils of being a step parent by Tony Zizza http://behavioral.kaiserpapers.info/stepdad.html Before
you switch insurance companies make
sure you are off any and all
anti-depressants!
-
When Amy M. left her steady job to become a freelance advertising copywriter,she had no idea the antidepressant she took to combat depression would have an unexpected side effect. She couldn't get health insurance. "I
was turned down by Blue Cross, Blue Shield and Kaiser," said the
35-year-old Oakland resident, who has been taking the antidepressant
Celexa for several years. "My rejection letters from the insurance
companies stated the reason for the denial:
antidepressants."
Coordination of resources is a vital, albeit challenging goal, given
the current fragmentary nature of healthcare funding. "
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