January 28, 2016 - News of the Week
Why You Should Never Use The Term 'The Mentally Ill'
By Jeff Grabmeier MedicalXpress.com January 26, 2016
Even subtle differences in how you refer to people with mental illness can affect levels of tolerance, a new study has found.
In a first-of-its-kind study, researchers found that participants
showed less tolerance toward people who were referred to as "the
mentally ill" when compared to those referred to as "people with mental
For example, participants were more likely to agree with the statement
"the mentally ill should be isolated from the community" than the
almost identical statement "people with mental illnesses should be
isolated from the community."
These results were found among college students and non-student adults
- and even professional counselors who took part in the study.
The findings suggest that language choice should not be viewed just as
an issue of "political correctness," said Darcy Haag Granello,
co-author of the study and professor of educational studies at The Ohio
"This isn't just about saying the right thing for appearances," she
said. "The language we use has real effects on our levels of tolerance
for people with mental illness."
conducted the study with Todd Gibbs, a graduate student in educational
studies at Ohio State. Their results appear in the January 2016 issue
of The Journal of Counseling and Development.
The push to change how society refers to people with mental illness
began in the 1990s when several professional publications proposed the
use of what they called "person-first" language when talking about
people with disabilities or chronic conditions.
"Person-first language is a way to honor the personhood of an
individual by separating their identity from any disability or
diagnosis he or she might have," Gibbs said.
you say 'people with a mental illness,' you are emphasizing that they
aren't defined solely by their disability. But when you talk about 'the
mentally ill' the disability is the entire definition of the person,"
Although the use of person-first language was first proposed more than
20 years ago, this is the first study examining how the use of such
language could affect tolerance toward people with mental illness,
"It is shocking to me that there hasn't been research on this before.
It is such a simple study. But the results show that our intuition
about the importance of person-first language was valid."
research involved three groups of people: 221 undergraduate students,
211 non-student adults and 269 professional counselors and
counselors-in-training who were attending a meeting of the American
The design of the study was very simple. All participants completed a
standard, often-used survey instrument created in 1979 called the
Community Attitudes Toward the Mentally Ill.
CAMI is a 40-item survey designed to measure people's attitudes toward
people with diagnosable mental illness. Participants indicated the
degree to which they agreed with the statements on a five-point scale
from 1(strongly disagree) to 5 (strongly agree).
The questionnaires were identical in all ways except one: Half the
people received a survey where all references were to "the mentally
ill" and half received a survey where all references were to "people
with mental illnesses."
The questionnaires had four subscales looking at different aspects of
how people view those with mental illnesses. The four subscales (and
sample questions) are:
"The mentally ill (or "People with mental illness") need the same kind
of control and discipline as a young child."
- Benevolence: "The mentally ill (or "People with mental illness") have for too long been the subject of ridicule."
- Social restrictiveness: "The mentally ill (or "People with mental illness") should be isolated from the rest of the community."
mental health ideology: "Having the mentally ill (or "people with
mental illness") living within residential neighborhoods might be good
therapy, but the risks to residents are too great."
Results showed that each of the three groups studied (college students,
other adults, counselors) showed less tolerance when their surveys
referred to "the mentally ill," but in slightly different ways.
College students showed less tolerance on the authoritarianism and
social restrictiveness scales; other adults showed less tolerance on
benevolence and community mental health ideology subscales; and
counselors and counselors-in-training showed less tolerance on the
authoritarianism and social restrictiveness subscales.
However, because this was an exploratory study, Granello said it is too
early to draw conclusions about the differences in how each group
responded on the four subscales.
important point to take away is that no one, at least in our study, was
immune," Granello said. "All showed some evidence of being affected by
the language used to describe people with mental illness."
One surprising finding was that the counselors - although they showed
more tolerance overall than the other two groups - showed the largest
difference in tolerance levels depending on the language they read.
"Even counselors who work every day with people who have mental illness
can be affected by language. They need to be aware of how language
might influence their decision-making when they work with clients," she
Granello said the overall message of the study is that everyone -
including the media, policymakers and the general public - needs to
change how they refer to people with mental illness.
understand why people use the term 'the mentally ill.' It is shorter
and less cumbersome than saying 'people with mental illness," she said.
"But I think people with mental illness deserve to have us change our language. Even if it is more awkward for us, it helps change our perception, which ultimately may lead us to treat all people with the respect and understanding they deserve."
January 4, 2016 - News of the Week
(changes made by Jean Arnold on 1/8/16)
A DUBIOUS DIAGNOSIS, ANOSOGNOSIA, AND A FEAR-FOCUSED CAMPAIGN
Has "anosognosia" tripled in ten years?
The diagnostic term "anosognosia," was
created in 1914 by Joseph Babinski, a French-Polish
neurologist. The diagnosis is primarily given to stroke patients
who have lost awareness of a body part, a condition attributed to brain
In 2000, intense lobbying by Dr. E. Fuller Torrey and Dr. Xavier
Amador convinced psychiatrists to add anosogosia to the psychiatrists'
diagnostic bible, the DSM-IV. Anosognosia can be used to justify
coercive treatment; this and the uncertainty of its
relevance to mental illnesses raises moral and ethical concerns among
Before "ansognosia" became a psychiatric diagnosis, psychiatrists had
relied on a "lack of insight" concept that allowed patients at
least some voice concerning their treatment and
medications. Now, the Treatment Advocacy Center in Arlington, Va
reportedly conflated "lack of insight" with anosognosia.
It's worth noting that in 2004, Anthony S. David and Dr. Amador
estimated that 15% of people with schizophrenia were affected by
anosognosia (source: Wikipedia) That estimate has increased
alarmingly. According to TAC, the 15% has grown to 50% for people diagnosed with
schizophrenia, 40% of those with bipolar disorder. TAC and other
supporters also consider potential violence to be a hallmark of
An even further escalation of anosogosia has come from promoters of Congressional bill #HR 2646. When asked by a radio host
if mentally ill people are more likely to be violent, Rep.Tim Murphy prefaced his circuitous answer by noting that
"we're dealing with 60 million folks..." (10 million is the
typical estimate of people diagosed with schizophrenia and bipolar
disorder.) The Murphy statement suggests a flexible approach to
diagnosing anosognosia. http://whyy.org/cms/radiotimes/2015/12/01/mental-illness-and-the-law/
How times have changed since 2000. In Dr. Amador's book. "I'm not
sick, I don't need help," he considered coercive treatment to be
counter-productive. The book makes a convincing case that a treatment
partnership is more effective than coercion and its results are more
"Psychiatrists Raise Doubts on Brain Scan Studies" http://www.madinamerica.com/2016/01/psychiatrists-raise-doubts-on-brain-scan-studies/#comments
Use this link for an illuminating blog "Anosognosia: How Conjecture
Becomes Medical Fact" by Sandra Steingard, MD, concerning the rise of
the term "anosognosia" in psychiatry
Read more about insightul awareness in "The Issue of Insight" by Larry Davidson, Yale University Medical School,
Here's a brief description of the source of the word "anosognosia"
June 11, 1914. In a brief communication presented to the Neurological
Society of Paris, Joseph Babinski (1857-1932), a prominent
French-Polish neurologist, former student of Charcot and contemporary
of Freud, described two patients with “left severe hemiplegia” – a
complete paralysis of the left side of the body – left side of the
face, left side of the trunk, left leg, left foot. Plus, an
extraordinary detail. These patients didn’t know they were paralyzed.
To describe their condition, Babinski coined the term anosognosia –
taken from the Greek agnosia, lack of knowledge, and nosos, disease.
Check out a new blog titled "IS AN OMINOUS NEW ERA OF DIAGNOSING PSYCHOSIS BY BIOTYPE ON THE HORIZON?"
December 1, 2015 - News of the Week
SHOULD KENDRA'S LAW GO NATIONWIDE ?
Three questions need answers. Has Kendra's Law reduced violence?
Does the law alienate people who need help? Does a fear-focused strategy distort public understanding of the
It took 6 years of "imminent-danger" marketing by determined activists
to launch Kendra's Law (KL), a compulsory treatment law intended for
people with serious mental illnesses. Marketed as a public safety
necessity, Kendra's Law was approved with unheard-of speed by New
York's legislature and Governor George Pataki, and began
operation in November 1999. The framers' ultimate goal -- a
nationwide expansion of compulsory treatment -- has become a mainstay
of HR 2646 now under discussion in the House. HR 2646 is one of
several healthcare laws under consideration.
A tabloid editorial, "All right, let's turn back the clock" (NY Post
(10/15/93), was an early sign that fear tactics would dominate the
campaign for involuntary outpatient commitment (now called "assisted
outpatient treatment" or AOT). Dr. E. Fuller Torrey launched the
campaign at an APA conference in Baltimore with an unsubstantiated
assertion: "The public stereotype that llinks mental illness to violence
is based on reality, and not merely a stigma."
Next came opinion pieces, interviews, television features, and books by Kendra's Law's creators : Help
the Ill Before They Kill - Armed and Dangerous - Imminent Danger
- Why Deinstitutionalization Turned Deadly, - Mental Illness, Public
Safety - Deadly Madmen - The Insanity Offense: How America's Failure to
Treat The Seriously Mentally Ill Endangers Its Citizens - to name a few.
Critics say KL's marketing strategy has reduced community
willingness to accept supportive services. They contend that fear
of coercion turns away people in need. HR 2646's remedies
-- coercion and institutions -- are unacceptable to ex-inpatient
activists who want to expand existing programs that engage people who
need help in non-threatening, non-stigmatizing community settings.
Supporters of HR 2646 proclaim KL's success by quoting numbers.
Oddly, the outcome figures most quoted are based on data gathered not
by outsiders but by the program's staff in 2005. At the time, 85
percent of Kendra's Law participants had no history of violence to
others during the 3 years prior to entering the program. A
later "first-ten-year report" simply repeats the 2005 outcome figures.
The public needs to know the 10-year outcomes for KL participants who
had committed violent acts toward others before enterng the program.
The law's expansion seems unjustified without an independent evaluation
of the target population's long-term outcomes.
It is disappointing that the media madness leading up to the passage of
Kendra's Law missed a timely opportunity to protest Gov. Pataki's
drastic cutbacks to New York's struggling mental-health system.
Instead, the fear-focused publicity transformed patients into imminent
threats to every New Yorker.
It's been twenty-two years since the New York Post's "Let's Turn Back
the Clock" editorial, and HR 2646 would make it happen.
Links to the largest studies of Kendra's Law's effectiveness are posted
1st independent evaluation of Assisted Outpatient
New York State Assisted Outpatient Treatment Program Evaluation
2009. This evaluation,
led by Marvin S. Swartz et. al,
required by the New York State Legislature when it
extended the law in 2005. (The "Duke Report")
Phelan et. al, published in
Psychiatric Services 2010
Effectiveness and Outcomes
Outpatient Treatment in New York State
This evaluation was
published in February 2010 after its
initial presentation at the annual conference of the Internationals
Association for Forensic Mental Health Services, Vienna, Austria, July
3rd independent evaluation by Pamela Clark
Robbins, et.al, published in Psychiatric
Outpatient Treatment in New York: Regional Differences in New York's
This independent report
includes several charts to illustrate
the uneven implementation of Kendra's Law from 1999-2006 .
August 14, 2015 - News of the Week
ANNOUNCES A CRISIS AND STABILIZATION CENTER
highly respected and successful 100% peer-run program in
Poughkeepsie NY, PEOPLe, Inc., helps people whose lives have been derailed by
mental health diagnoses. Opening soon, a crisis
and stabilization center will expand PEOPLe Inc's recovery-oriented treatment options.
the leadership of executive director Steve Miccio, PEOPLe,
brings hope and renewal to New Yorkers diagnosed with mental
illnesses and to those whose conditions are complicated by
mind-altering substance use. The program has been acclaimed and
copied by activists here and abroad, despite derision of its
user-friendly approach from advocates of forced treatment.
READ MORE ABOUT PEOPLE, INC.
READ MORE ABOUT STEVE MICCIO in
article that is also about the recovery movement.
July 1, 2015 - News of the Week
WILL THE MURPHY-JOHNSON BILL, HR2646, HELP STRUGGLING FAMILIES
Or will it arrest progress and turn back the clock on mental healthcare
Congressman Tim Murphy (R-PA) has vowed to conquer a thorny
national disgrace: the public's neglect -- many would say abandonment
-- of psychiatrically-labeled Americans and their families.
Rep. Murphy and Rep. Eddie Bernice Johnson (D-TX) have proposed a bill,
HR 2646, titled "Helping Families in Mental Health Crisis Act of 2015," to rescue
suffering families with psychiatrically-labeled members who are unable
to find appropriate treatment and housing.
(Link to text of HR 2646 introduced June 4, 2015)
But the 173-page bill goes far beyond helping families in crisis.
It proposes a massive restructuring of a system that distributes billions of federal mental health dollars to states and
federal agencies. The question is whether HR 2646 would
replace an unmanageable system with a worse one.
1) The bill does not
address the negative public attitudes that have
derailed attempts to establish community housing and
supports. For forty years, essential housing and supportive
programs have been rejected by communities, leaving only a small
percentage of families able to find crucial community
support. This serious impedimentt to community inclusion has
caused untold pain and jeopardized the well-being of all concerned.
2) The bill has impressive support from pharmaceutical companies.
It's now become clear, however, that countless lives were damaged by
over-diagnosis and over-medication while families were assured by
trusted experts that neuroleptics were completely safe. Many of
us see the bill's overwhelming support by big pharma as an ominous
sign. Provisions in HR 2646 assure that forced meds will be
expanded. And progress toward treatments using less medication
will be curtailed or defunded.
3) Another concern is the Murphy bill's disabling of SAMHSA, a federal
overseer of mental health and substance abuse programs. HR 2646
culminates an ongoing attack on SAMHSA led by Dr. E. F. Torrey and D.
J. Jaffe who have for years disparaged SAMHSA's encouragement of
former patients who favor recovery-oriented practices. Just
as the rise of experienced ex-patient voices is beginning to
shape positive changes in mental healthcare, the bill's dismantling of
SAMHSA would make client activism more difficult.
4) Beyond the "disable SAMHSA" provisions, HR 2646 curtails the ability
of patients and their advocates to seek social justice. It
strips Protection & Advocacy agencies of their ability to assist
their clients beyond "abuse and neglect." This gratuitous
restriction prevents advocacy for better services.
MORE about the bill....
The Murphy-Johnson bill overlooks a main reason millions of people with
psychiatric labels are destitute. Advocates have for 40 years
sought the effective community treatments, safe housing,
programs and services that were promised when psychiatric
institutions were emptied into unprepared communities. Yet the
public has consistently and effectively blocked community housing and
support. Why? There is an unreasonable amount of fear and
rejection of people with psychiatric labels. This fact was stated
most strongly by former Surgeon General David Satcher in his
groundbreaking mental health report of 1999: "Because most people
should have little reason to fear violence from those with mental
illness, even in its most severe forms, why is fear of violence so
entrenched?" At least some of that unwarranted fear was
deliberately spawned by supporters of forced outpatient medication to
promote their controversial agenda.
Using a twisted but effective strategy, suppporters of compulsory
medication chose to "capitalize on the fear of violence" (their words)
for 20 years to win public support for involuntary outpatient treatment
and re-institutionalization. How will Rep. Murphy and Rep. Johnson convince the
public that psychiatrically-labeled people are not to be feared
as neighbors and co-workers? Will they even try, since they
need a fearful public's support for HR 2646's restrictive provisions.
At worst, the exhaustively complex Murphy-Johnson bill may be raising
false hope among families, proposing programs that alienate the people
most in need of help, and reinforcing the public's misguided view that the
nation's excessive violence is linked to mental illness. At least
$130 billion federal dollars are spread among eight federal
departments and agencies (SAMHSA gets a mere $3-4
billion). The devil is in the details of HR
2646. And in
the priorties of its authors.
!! NEWS ALERT !!
A U.S. Senate bill will be introduced later this summer by Senator Chris Murphy (D-CT)
AN ACTIVIST STATES GOALS
Why We Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!
Mother, storyteller, mental health advocate, and coordinator of the Recovery Now! campaign.
June 12, 2015
"May is Mental Health Month" has come and gone, and it is time to build
on years of awareness campaigns and move into action to promote whole
health and recovery. People with serious mental health conditions are
dying on average 25 years earlier than
the general population, largely due to preventable physical health
conditions, so why do we still focus on mental health separately from
physical health? And when we know that people with serious mental
health conditions face an 80 percent unemployment rate,
why do we largely ignore the role of poverty, economic and social
inequality, and other environmental factors in mainstream discussions
about mental health?
Decades of public health research have
clearly shown that access to the social determinants of health --
affordable housing, educational and vocational opportunities, and
community inclusion -- are far more important to mental and physical
health than access to health care alone. As one recent article explained:
"For many patients, a prescription for housing or food is the most
powerful one that a physician could write, with health effects far
exceeding those of most medications." Yet this wisdom does not
generally guide policymaking in the U.S. Among nations in the
Organization for Economic Co-operation and Development (OECD), the U.S.
ranks first in health care spending, but 25th in spending on social
services. Is there something wrong with our very concept of "care"?
This question is not just theoretical for me. As an adolescent, I
attempted suicide several times. I found myself in the back of a police
car more than once and was frequently hospitalized. At age 16, I was
diagnosed with bipolar disorder. Two years later, I found myself
sitting in a squalid group home, where I was told I needed to remain
for life. I had no high school diploma and no job. My hopelessness and
despair were all-encompassing.
I managed to get on a different path when I obtained access to safe and
stable housing, education, and social support. Today, I am living life
as a mother and a mental health advocate. I train human service
providers in suicide prevention, recovery, trauma-informed approaches,
and person-centered health care. Every day, I'm grateful that I was
able to regain my life, and I want everyone to have this opportunity.
To help promote a paradigm shift in mental health care, I've been part
of starting a new, nonpartisan public awareness campaign called Recovery Now! This
campaign seeks to educate all Americans about the kinds of services and
policies that promote real recovery and whole health for people
affected by mental health conditions. Here are a few key messages of
the Recovery Now! campaign.
Recovery is possible for all.
vast majority of people living with mental health conditions, even
people diagnosed with serious mental illness, can enjoy a high quality
of life in the community with access to the right kinds of services and
supports. Dr. Richard Warner, clinical professor of psychiatry at the
University of Colorado, noted:
"It emerges that one of the most robust findings about schizophrenia is
that a substantial proportion of those who present with the illness
will recover completely or with good functional capacity." A slew of other studies have found similar results.
An argument used against recovery is that there are some who can't or
won't voluntarily seek treatment or services. Yet there are plenty of
evidence-based ways to reach people, such as motivational interviewing, or employing peer-to-peer support or community health workers to do homeless outreach or to engage with persons with complex mental and physical health needs. But these kinds of strategies are vastly underutilized.
We must advocate for recovery-oriented policies.
Hope is essential for recovery. But hope is not enough. Too many people
are still unable to access the kinds of services and supports that
would help them to recover. In particular, people of color are
overrepresented in our jails and prisons, and are underrepresented in
community-based mental health and social services.
A prime example is in Chicago, where newly re-elected Mayor Rahm Emanuel closed six community mental health clinics in
the most economically disadvantaged parts of the city, which has
resulted in an increase in persons with mental health conditions being
incarcerated in the Cook County Jail for low-level, nonviolent offenses
related to their disabilities. While the recent appointment of a psychologist to
head the jail is a step in a better direction, how will this
appointment impact upon the lack of availability of community-based
services in Chicago for people who desperately need them?
Yet Mayor Emanuel is not unique in his choices. Community-based services have been slashed in
many state and local budgets. Any short-term "savings" accomplished by
such cuts will always be offset by the devastating long-term human and
economic costs that result when we deny quality services and supports
to the people who are most vulnerable.
Mental health legislation has been introduced in the House and is
expected in the Senate. All legislation should be evaluated through a recovery lens and
should clearly address the social determinants of health. Policy should
seek to end deadly cycles of poverty, homelessness and incarceration in
ways that are culturally appropriate, rehabilitative rather than
punitive, and community-based. We can't talk about more hospital beds
without talking about supportive housing and other programs that will
actually help people to stay out of the hospital and out of prison. We
need legislation that tackles disparities in access to education and
employment, and funds proven programs that prevent crisis and
We need sound policies that promote recovery for all Americans affected
by mental health conditions. We don't have the luxury of continuing to
get this wrong. Too many individuals, families, and systems are in
crisis, and it doesn't have to be this way. We need recovery, and we
need it now.
Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and Social Justice
Adapted by Briana Gilmore, March 2015
That is how Ron Manderscheid, PhD, opened his address last month at the Together Against Stigma: Each Mind Matters
conference in San Francisco. Manderscheid joined other mental health
experts in a symposium to discuss how stigma can be reduced or
eradicated through policies that support mental health promotion,
prevention, and early intervention strategies.
opening remarks aren’t hyperbolic. People with mental health and
substance abuse conditions die an average of 25 years before other
citizens. Less than half of those with needs receive any care at all,
and it takes an average of a decade before people access the treatment
they need. Suicide rates are also at the historic high of 40,000 people
a year, exacerbated by the economic insecurity and reduction in services brought on by the great recession. And as Manderscheid and this USA Today article
elucidate, people often only receive care when their experiences have
become severe enough that they have turned into complex, illness- and
symptom-based disabilities. Advocates liken this to only admitting a
cancer patient into treatment when they reach stage four of their
how can policy reduce stigmatization that prevents people from
accessing care, living successfully in the community, and sustaining
recovery? Ron Manderscheid advocates for a five-point reform plan that
Leveling the insurance playing field through parity laws is a first
step to affording equitable treatment for mental health and substance
abuse. Many states and insurance companies are just at the beginning of
implementing successful parity reforms, because they necessitate
sweeping financial, regulatory, and programmatic changes that take time
to adopt. They are also not fully applicable to Medicaid and Medicare
recipients in most states, thus further exacerbating stigma for people
and families experiencing poverty. Parity is now also only available
when a person receives specific treatments. Dr. Manderscheid indicates
that if we want true reform through parity, we need to extend it to
equal housing, equal jobs, equal supports, and equal pay.
Practice is moving rapidly toward fully integrated care through
team-based practice approaches and integrated funding models. True
practice integration, however, must integrate behavioral health clients
with all other clients in health and medical homes. Stigmatization can
sustain practices of exclusion that separate people with behavioral
health needs out and away from their peers and people experiencing
other health-related concerns. “Separate but equal” cannot remain a
valid practice strategy if our system aims to achieve parity.
Achieving the benefits outlined in the Affordable Care Act includes
utilizing resources toward health promotion and prevention. Activities
that sustain these opportunities are also ones that can pay for
resources in the community that help clients recover, experience
wellness, and live full lives. Promoting recovery through policy
means that states and counties need to swiftly invest in integrated
practice that promotes and rewards early intervention and
wellness-based strategies. These types of services have been minimally
financed since psychiatric hospitals started closing decades ago.
Integrating these services into mainstream financing mechanisms and
incorporating them into discharge planning and whole-health treatment
plans is essential to promoting community recovery.
Developing a peer workforce can only enhance parity reforms and promote
dignity and community-based recovery. People with lived experience can
actively reduce stigmatization by gaining employment, and helping
consumers and family members understand that behavioral health is not
something to be feared or diminished. Peers should work across the
health system, not just with behavioral health clients, to offer a wide
range of experiences, values, and capacity to people in recovery across
the wellness spectrum.
Moving “out of the office” toward inclusive participation doesn’t only
include outreach and engagement in services. Participative,
community-based action includes public demonstrations, legislative
hearings, key meetings with public leaders and executives, and
coalition building among organizational leaders. Raising the visibility
of a recovery-based movement is essential to reducing the stigma
associated with mental health and substance abuse treatment.
If we begin with a human rights based approach to equality, and
capitalize on the gains made in the Affordable Care Act, we can achieve
measurable reductions in stigmatization through incorporation of the
“five-P’s” outlined above. Defeating stigma demands civil rights and
social justice actions at every level, including transparency of
effective policy leadership in state and local governments. We are all
responsible for reducing stigma, and we can all create opportunities
for growth and change from policy to practice.
For more information about how policy can reduce stigma, contact Ron Manderscheid, PhD at firstname.lastname@example.org or visit the National Association of County Behavioral Health and Developmental Disabilities Directors at www.nacbhdd.org
News report (7/7/15) Mad in America (http://www.madinamerica.com )
Another Study Finds Gun Violence Not Linked to Mental Illnesses
Yet another study -- this one published in Psychiatric Services (in Advance)
-- has found that risk of gun violence is not linked to mental
illnesses. Instead, once again, substance use and history of violence
were found to be better predictors of violence.
The researchers from multiple institutions examined data
from The MacArthur Violence Risk Assessment Study of 1,136 patients who
had been discharged from acute civil inpatient facilities at three U.S.
sites between 1992 and 1995.
Psychiatric News reported that, "Of the 951
persons available for at least one follow-up, 23 (2%) committed acts of
violence with a gun. These 23 people tended to have admission diagnoses
of major depression (61%), alcohol abuse (74%), or drug abuse (52%)."
"(T)he prior arrest rate of discharged patients who
later committed gun violence was almost twice as high as the prior
arrest rate of the overall sample (89% and 49%, respectively)," added Psychiatric News.
"When public perceptions and policies regarding mental
illness are shaped by highly publicized but infrequent instances of gun
violence toward strangers, they are unlikely to help people with mental
illnesses or to improve public safety," concluded the researchers.
Data Show Mental Illness Alone is Not a Risk for Gun Violence (Psychiatric News Alert, June 23, 2015)
Steadman, Henry J., John Monahan, Debra A. Pinals,
Roumen Vesselinov, and Pamela Clark Robbins. “Gun Violence and
Victimization of Strangers by Persons With a Mental Illness: Data From
the MacArthur Violence Risk Assessment Study.” Psychiatric Services,
June 15, 2015, appi.ps.201400512. doi:10.1176/appi.ps.201400512. (Full text)
April 20, 2015 - News of the Week
THERAPY CAN HELP WITH HALLUCINATIONS
Article forwarded by NYAPRS E-News
Note: Thank you to RECOVER-e Works and their April, 2015 newsletter
authors for the two excellent articles below on CBT for people
experiencing extreme states and with serious diagnoses. Link: http://www.coalitionny.org/the_center/recovere-works/RECOVERe-works114-1April2015.html#Jack
CBT for schizophrenia? You don't know Jack.
by Abigail Strubel, MA, LCSW, CASAC
met Jack in a dual diagnosis/re-entry program for parolees. All had
fascinating stories about survival in prison (Got a little tinfoil? You
can make a decent grilled cheese sandwich in a holding cell with a
radiator). Most were symptomatic, because the policy was to take people
off their medication as they neared release and were transferred to
told our admission coordinator his voices had advised him to skip
intake. However, wary of returning upstate, he endured the appointment
and met me. "I think I'll be able to work with you," he said. "You have
did he, along with a glorious James Brown-esque pompadour. Jack was
meticulous about his appearance. “Even when I was shooting ten bags of
heroin a day, I made sure to shave, bathe, and wear clean clothes.”
"Ten bags a day?" I asked.
"Heroin makes the voices stop," he told me. "Better than any medication I ever tried."
Jack entered my office one day in a funk.
went to public assistance, and I know that lady's going to mess up my
case," he said. "I could tell by how she looked at me. She made this
face"—he pursed his lips and narrowed his eyes—"and the voices started
saying, 'She hates you, she's not going to help you—she's going to get
you all twisted.'"
wasn't there," I responded. "I don't know how she looked at you or what
she thought. But there may be another way to interpret her
expression—it could have been about something that happened before you
even came into her office, or maybe she thought about something going
on in her personal life.
"So the way she acted wasn't because of me?" he asked.
I said. "If you're right and she tries to mess with your case, you know
I'll go to bat for you, make sure you get what you need. But it's
possible something else was going on."
Jack nodded, then cocked his head to the side, listening. "The voices don't believe you," he said.
me tell you about 'automatic thoughts,'" I said, and explained how
almost everyone experiences a barely conscious stream of thoughts
throughout the day. Some thoughts are positive, but many are negative.
We can train people to become aware of their negative thoughts, and
then dispute them.
voices," I said, "are just a louder version of automatic thoughts.
They're not real people; they're your own fears and doubts. When a
voice says something negative, you can disagree. Ask, 'How likely is it
that the welfare lady hated me on sight and wanted to make my life
miserable? Could she have been having a bad day, and taking it out on
me? If she did try to mess up my case, can my counselor help me
straighten it out?'"
thought that over. "You know," he said, "that makes a lot of sense.
Because sometimes I can tell the voices are wrong right off the bat."
"And sometimes you might need to think about it a little more," I said, "or discuss it with me."
treatment progressed, Jack's P/A case was resolved favorably, and he
began contesting the negative voices on his own. Ultimately, he became
a drug and alcohol counselor. His medications may never eradicate his
voices, but now he knows how to dispute them.
Ms. Strubel is a clinical supervisor at Services for the Underserved/Palladia Comprehensive Treatment Institute-Bronx.
Cognitive Behavior Therapy (CBT) for Recovery: The Cutting Edge
by Elizabeth Saenger, PhD
Aaron Beck et al showed
that cognitive therapy can promote clinically meaningful improvements
in people with schizophrenia, even if they have significant cognitive
impairment. That finding was published in Archives of General Psychiatry (now JAMA Psychiatry),
America’s journal of record for the discipline. It surprised clinicians
who thought of CBT as a treatment only for patients who were
But that discovery was three years ago. What have CBT researchers done for us lately?
Here are some advances from the last six months.
CBT as an Alternative to Drugs: A Proof-of-concept Study
it comes to schizophrenia, the British seem to make a habit of
upsetting the medical model. First they rejected auditory
hallucinations as psychopathology, set up a hearing voices movement, and imported the concept to the US. Now researchers across the pond suggest in The Lancet: Psychiatry, the British journal of record, that CBT might get rid of persecutory delusions.
small study focused on people with schizophrenia spectrum disorders.
All had persecutory delusions, and had not taken antipsychotic drugs
for at least six months. Researchers randomly assigned subjects to
treatment as usual, or to a package of brief therapy including four CBT
sessions focused on the subject’s specific delusions.
goal of this package was to change people’s reasoning about their
delusions. Investigators taught subjects to become more aware of their
thinking processes, and to identify and inhibit jumping to conclusions.
Researchers also encouraged subjects to be more analytical. These
interventions increased subjects’ sense that they might be mistaken
about their persecutory beliefs.
results indicate that people were comfortable with therapy, and the
intervention worked. Follow up data collected two months afterwards
suggested the model was definitely useful.
frequently use CBT as an adjunct to psychopharmacology for delusions,
but they rarely use CBT alone. If further research confirms the results
of this proof-of-concept study, perhaps people with schizophrenia will
have more choices in the future. Given the common, generally
unpleasant, side effects of antipsychotic drugs—such as weight gain,
metabolic problems, movement disorders, and an increased risk of
cardiac death—having a meaningful treatment choice in the journey
toward recovery would be most welcome.
Merging CBT with Other Evidence-based Treatments
recent tendency to mix and match evidence-based therapy has led to
instances where CBT has been successfully merged with other
psychosocial treatments. Here are three examples.
Social skills training.
CBT material, such as that described above, can be presented using
social skills training techniques, for example, waving a big flag in
group to identify ("flag") beliefs that do not have evidence to support
them. This treatment merger helps clients with cognitive and social
deficits improve their negative (but not positive) symptoms, and is
helpful for clients regardless of the severity of their cognitive
impairments. Further, because the treatment is repetitive, new clients
can join the group at any point.
Data strongly show that CBT with family psychoeducation reduces
stress, increases medication adherence, and decreases
re-hospitalization. Modules are available that teach parents how to use
CBT techniques with clients in recovery, and in other areas of their
CBT can help clients improve coping skills and challenge distorted
beliefs about their vocational abilities. CBT is now being melded with
supported employment to test the effectiveness of the combination.
Preliminary results suggest people who received CBT in addition to
supported employment might be more likely to work more hours per week.
March 29, 2015 - News of the Week
FIVE TIMELY "TALKING POINTS" WORTH REMEMBERING
Kudos to the Huffington Post's Healthy Living Staff for giving us a
concise, doable and user-friendly list of "do's" for talking about a
Germanwings airline crash that killed all who were aboard a flight to
Dusseldorf on March 24.
"When tragedy strikes, it's a natural human inclination to want an
explanation to help get closure for our feelings of anger and loss.
When such information is unavailable to us, our grief remains in this
limbo of sorts -- or worse, we search for our own answer to help us
ARTICLE: "The Way We Talk About Mental Illness After Tragedies Like Germanwings Needs To Change"
The Huffington Post / By Healthy Living Staff
Media reports erupted today with news that Germanwings co-pilot Andreas Lubitz may have been suffering from depression or another mental illness when he crashed the aircraft in the French Alps, most likely killing 150 people, including himself.
While headlines like U.K. tabloid The Sun's "Madman In Cockpit"
are hardly surprising, such sensational links between mental illness
and horrific tragedies can have an undesired outcome when it comes to
Here are five ways to have a more productive
conversation about the complex interplay between mental health,
violence and tragedies such as this one.
1. Depression doesn't cause violence.
The public's perception of mental illness -- which is
largely fueled by movies featuring mentally-ill individuals turned
violent and news headlines that thread mental illness into every story
about mass killings -- needs a readjustment.
People who are depressed are not likely to be violent. If they were, we'd all be in trouble: One in five of us will experience a serious mental health issue at some point in our lives, but only 3-5 percent
of violent acts in the United States are committed by an individual
with serious mental illness -- a tiny fraction of the country's violent
"If we were able to magically cure schizophrenia,
bipolar disorder, and major depression, that would be wonderful, but
overall violence would go down by only about 4 percent," said Dr.
Jeffrey Swanson, an expert on mental health and violence and a
professor in psychiatry and behavioral sciences at the Duke University
School of Medicine, in a recent interview with Pacific Standard.
What makes this misrepresentation even worse is that individuals who suffer from mental illness are 10 times more likely than the general population to be the victim
of violent crime, an under-reported issue that is overlooked in favor
of misleading depictions of depression as a violent condition.
2. Suggesting mental illness as the root
cause of violence stigmatizes those who live healthy, full lives with
conditions like depression.
Approximately one in four U.S. adults
in a given year suffer from a diagnosable mental illness, making it
highly likely that you know someone who has been affected. However, only 25 percent
of people who have mental health symptoms feel that others are
understanding toward people with mental illness, according to the CDC.
And it's no secret why.
Public diagnoses, such as the discussion surrounding the
Germanwings tragedy, plague every single mental illness sufferer. The
truth is, the majority of those who have a mental health problem live
healthy and complete lives. They are reliable at work and beloved by
their families. Yet many people categorize them as "abnormal" because
of unsubstantiated scapegoating during these types of tragedies, which
can have a real impact: Studies have shown that knowledge, culture and social networks
can influence the relationship between stigma and access to care. When
people feel stigma, they are less likely to seek the help they need.
The vast majority of people with mental illnesses are law-abiding, responsible and productive citizens.
3. Mental illness disclosure policies can push people further into the closet.
Lubitz was seeking treatment for an undisclosed medical
condition that he kept from his employers, alleged the public
prosecutor’s office in Dusseldorf, Germany. They didn’t say whether it
was a mental or physical condition, but investigators did note that
they found a torn-up doctor’s note declaring him unfit for work, reported CNN. Employees in Germany are expected to tell their employers immediately
if they can’t work due to an illness, according to Reuters, and that
doctor's note would have kept Lubitz grounded and out of the cockpit.
Lubitz had passed special health screenings, including
psychological ones, before he was hired on as a co-pilot in 2013,
reported ABC News, but unlike in the U.S. airline industry, annual
mental health screenings for pilots aren’t a requirement in Germany.
Additionally, per Federal Aviation Administration rules, U.S. pilots
must disclose all “existing physical and psychological conditions and
medications” or face fines of up to $250,000 if they’re found to have
delivered false information. That means if he were an American pilot,
Lubitz would have been obligated to disclose any and all conditions, as
well as the medicines he was taking, in order to remain in good
standing at his job. Because of these and other policies, U.S. airline
standards are regarded as the strictest and safest around the world (though not without their flaws).
But just because the FAA requires full health disclosure
to an FAA-designated Aviation Medical Examiner doesn’t mean that pilots
may feel completely safe disclosing their conditions, according to Ron
Honberg, director of policy and legal affairs at National Alliance On
“If a person feels that it’s safe to disclose, and that
they’ll have an opportunity to get help -- that there won’t
automatically be adverse consequences like being prohibited from ever
flying again -- then they’re going to be more likely to disclose [a
mental illness],” said Honberg. “But I think historically pilots have
known that if they admitted it, they’d never be able to fly again.”
Generally speaking, barring industries where a person
may be responsible for public safety (like a pilot or a police
officer), one is not obligated to disclose any of this information to
his or her employers in the U.S. Just as people don’t have to tell
their bosses about diabetes, cardiac disease or HIV diagnoses,
employees can’t be forced to discuss their mental health history beyond
anything that may interfere with a person’s function at the job,
explained Honberg. And employers can’t ask job candidates about their
medical records or medical history except to ask about whether
something might impact a person’s functional limitation in a job.
“It has to be focused on if they’re capable of doing the
job,” said Honberg. “Are there physical or mental health factors that
may preclude them from being able to do that?”
The FAA does not track rates of dismissal for pilots who
disclose mental illnesses versus other conditions, or the number of
pilots who continue to fly after disclosing a mental illness. But until
we have all the facts about Lubitz’s situation, it’s important to hold
off on any policy changes that might attempt to close up perceived
loopholes, he said.
“It’s really important to have all the facts,
particularly before we decide on any policies to prevent anything like
this from happening again,” said Honberg. “We want to somehow create a
proper balance that on the one hand protects public safety and on the
other hand encourages people to seek help if needed."
4. The conversation surrounding mental illness and mass violence reveals our ingrained ethnic and racial biases.
Lubitz allegedly committed mass murder and, as many people have pointed out,
it is troubling that his acts are ascribed to mental illness when, if
he were Muslim or a racial minority, he would likely be assigned a
two-dimensional ideological motivation.
Yes, this is a disturbing expression of the dominant
culture's racial pathologies, but rather than trying to correct the
balance by referring to white mass murderers in an un-nuanced fashion, as some have suggested,
perhaps the more productive action would be to view the underlying
mental health problems among everyone who carries out mass violence --
regardless of race, religion or country of origin.
Again, most people with mental illness will never be
violent, but those who are violent often do have an underlying trauma
or condition. "More and more evidence from around the world is
suggesting that many of the terrorists wreaking havoc both in America
and abroad are racked with emotional and mental trauma themselves,"
wrote Cord Jefferson in The Nation in 2012:
To be clear, nobody’s saying that all -- or even most
-- terrorists aren’t cold, bloodthirsty killers who know exactly what
they’re doing every time they commit another heinous act. But there is
reason to believe that a significant number of foreign and domestic
terrorists are suffering from the exact same mental distresses by which
we quickly assume men like James Holmes and boys like Eric Harris and
Dylan Klebold, the Columbine killers, to be afflicted.
Indeed, Jefferson went on to note a study of Palestinian men
who had signed up to be suicide bombers that found 40 percent showed
suicidal tendencies by traditional mental health measures, and
recruiters admitted looking for "sad guys" to carry out mass violence.
More generally, the way we view mental health and race
has a lasting public health impact: Minority and immigrant communities
in the U.S. are dramatically underserved, according to a government report (and corroborated by the American Psychological Association).
One major problem, according to the Surgeon General's report, is
misdiagnosis or lack of diagnosis due to cultural biases on the part of
mental health practitioners.
5. We may never have a diagnosis, and we have to be okay with that.
When tragedy strikes, it's a natural human inclination
to want an explanation to help get closure for our feelings of anger
and loss. When such information is unavailable to us, our grief remains
in this limbo of sorts -- or worse, we search for our own answer to
help us move forward.
In a recent article for The New Yorker, Philip Gourevitch aptly explained this phenomenon:
To be told that a scene of mass death is the result of
an accident of terrorism is to be given not only an explanation of the
cause but also an idea of how to reckon with the consequence -- through
justice, or revenge, or measures meant to prevent a recurrence.
According to CNN, a physician did declare Lubitz unfit
to work the day of the flight, and instead of sharing that information
with Germanwings, Lubitz disposed of the note and boarded the plane.
But even in light of such information, it's highly unlikely that we
will ever know exactly what was going on in the mind of this pilot, and
it is far from our place to speak as though we have a definitive
In the words of Gourevitch, we are left with a sense of
"cosmic meaninglessness and bewilderment" when horrific events such as
this one occur, and while that is one of the toughest collections of
emotions to grapple with, there is no credible alternative in cases
MORE ARTICLES (The Atlantic and The Boston Globe)
March 23, 2015 - News of the Week
!!! PASSING ALONG FOR YOUR INTEREST !!!
NYAPRS Note: Register today for the April 3
BRSS TACS First Fridays with NYAPRS’ own Edye Schwartz, where she will
be describing concrete ways to build effective and sustainable peer run
organizations. This webinar will be relevant for national groups
looking to build peer service options, and for New York agencies
exploring partnership with or expansion to peer run organizations. See
more information and the registration link below!
to the March 2015 BRSS TACS monthly update from SAMHSA’s Bringing
Recovery Supports to Scale Technical Assistance Center Strategy (BRSS
TACS). This month’s update includes: April’s First Fridays with BRSS
TACS event, registration information for the next BRSS TACS webinar,
new SAMHSA grant opportunities, a virtual learning community on
adolescent substance use prevention and treatment, resources about
African-American Behavioral Health, and information about how to
request technical assistance from BRSS TACS.
SAMHSA Grant Opportunities Announced
Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment (CSAT) is accepting applications
for State Adolescent and Transitional Aged Youth Treatment Enhancement and Dissemination Planning
[State Youth Treatment - Planning (SYT-P)]. The purpose of SYT-P is to
support states, territories, and tribes to develop a comprehensive
strategic plan to improve treatment for adolescents (ages 12-18) and/or
transitional aged youth (ages 16-25) with substance use disorders
and/or co-occurring substance use and mental health disorders. The plan
will help strengthen the existing infrastructure system to assure that
youth have access to evidence-based assessments and treatment models
and recovery services.
Anticipated Award Amount: Up to $250,000
Application Due date: Monday, April 6, 2015
Click here for more information.
Additionally, CSAT and SAMHSA’s Center for Mental Health Services (CMHS) are accepting applications for the Cooperative Agreements to Benefit Homeless Individuals for States
(CABHI-States). The purpose of this program is to enhance or develop
the infrastructure of states and their treatment service systems. The
program hopes to increase capacity and provide accessible, effective,
comprehensive, coordinated/integrated, and evidence-based treatment
services; permanent supportive housing; peer supports; and other
recovery support services to:
who experience chronic homelessness and have substance use disorders,
serious mental illnesses (SMI), or co-occurring mental and substance
use disorders; and/or
who experience homelessness/chronic homelessness and have substance use
disorders, SMI, or co-occurring mental and substance use disorders.
Anticipated Award Amount: Up to $250,000
Application Due date: Monday, April 6, 2015
Click here for more information.