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"Mass media is, far and away, the public's primary source of information about mental illnesses."---Survey of public attitudes, Robert Wood Johnson Foundation


NEWS & LINKS to Battle Bias
Editor: Jean Arnold
Email: jeanarnold@stigmanet.org

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Stigmatizing Fear Tactics

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NEWS ARCHIVE (chronlogical) INDEX for years 2002-2010 (click item needed)
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Kendra's Law Updates (2006 - Current)
Kendra's Law Controversy 2005
National Criminal Background Check System (NICS)
Archive concerning use of straitjackets to sell products
Stigmatizing Fear Tactics (16 items, a small sample)

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 illness."

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 State University.

"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."

Granello 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.

"When 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," he said.

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, Granello said.

"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."

The 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 Counseling Association.

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.

The 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:

  • Authoritarianism: "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."
  • 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.

"The 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 said.

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.

"I 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)


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 lesions.

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 its critics.

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 (TAC)  has 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 coercion supporters also consider potential violence to be a hallmark of anosognosia.  

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 Am 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 lasting.


 "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. [13]


December 1, 2015 - News of the Week


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 nation's violence?  

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.

                                                                         MORE INFORMATION

Links to the largest studies of Kendra's Law's effectiveness are posted below.  

Kendra's Law: Final Report on the Status, March 2005, by the New York State Office of Mental Health.  

1st independent evaluation of Assisted Outpatient Treatment (AOT)
New York State Assisted Outpatient Treatment Program Evaluation

Independent evaluation June 30, 2009.  This evaluation, led by Marvin S. Swartz et. al, was required by the New York State Legislature when it extended the law in 2005.   (The "Duke  Report")

2nd independent evaluation by Jo C. Phelan et. al,  published in Psychiatric Services 2010 
Effectiveness and Outcomes of Assisted 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 14-16, 2009. 

3rd independent evaluation by Pamela Clark Robbins, et.al, published in Psychiatric Services 2010 
Assisted Outpatient Treatment in New York: Regional Differences in New York's  AOT program
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


A 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.

Under the leadership of executive director Steve Miccio, PEOPLe, Inc. 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.



  in article that is also about the recovery movement.


July 1, 2015 - News of the Week


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)


Why We Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!

By Leah Harris 

Mother, storyteller, mental health advocate, and coordinator of the Recovery Now! campaign.

Huffington Post   
June 12, 2015


Another "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.

The 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 recidivism.

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

“Stigma kills.”

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.

Manderscheid’s 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 illness.

So 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 includes:


1. Parity: 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.

2. Practice: 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.

3. Promotion: 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.

4. Peers: 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.

5. Participation: 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 rmanderscheid@nacbhd.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


Article forwarded by NYAPRS E-News

 NYAPRS 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


I 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 special barracks.

Jack 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 intelligent eyes."

So 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.

"I 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.'"

"I 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.

"Look," 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.

"Let 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.

"Your 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?'"

Jack 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."

As 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 high-functioning.

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

When 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.

A 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.

The 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.

The 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.

Clinicians 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

A 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.

Family psychoeducation.  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 own lives.

Supported employment. 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



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 move forward." 

ARTICLE: "The Way We Talk About Mental Illness After Tragedies Like Germanwings Needs To Change"
The Huffington Post  /  By Healthy Living Staff  
Published 3/27/2015

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 stigma.

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 crimes.

"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 Mental Illness.

“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 answer.

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 like this.

MORE ARTICLES (The Atlantic and The Boston Globe)





March 23, 2015 - News of the Week


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!




Welcome 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


The 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:

  • Individuals who experience chronic homelessness and have substance use disorders, serious mental illnesses (SMI), or co-occurring mental and substance use disorders; and/or 
  • Veterans 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.