Under construction.....May, 2016
January 28, 2016 - News of the Week
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 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
"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 email@example.com 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)
, 2015 - News of the Week
'ASYLUM TALK' ALARMS EXPERIENCED ADVOCATES
Return to Asylums? Let’s not!
By Susan Rogers
link to article
A recent JAMA opinion piece calling for a return to asylums – not the bad kind, the authors (three Penn
bioethicists) insist, but a “safe, modern and humane” kind of asylum – led to a radio debate between co-
author Dominic Sisti, associate professor of medical ethics at the University of Pennsylvania, and Joseph
Rogers, chief advocacy officer of the Mental Health Association of Southeastern Pennsylvania (MHASP)
and executive director of the National Mental Health Consumers’ Self-Help Clearinghouse. The debate,
on WHYY’s Voices in the Family, was moderated by the show’s host, Dr. Dan Gottlieb. To listen to the
archived program, click here.
Dr. Sisti began by insisting that “we do not want to return to those asylums…that are now infamous for
incarcerating thousands of Americans….What we were calling for is a rehabilitation of the term
‘asylum’…[as] a safe sanctuary where they may be able to heal and reclaim their lives in recovery.”
Asked about the reason for the widespread use of chemical restraints, Dr. Sisti responded that it is “a lot
easier to maintain control and safety in an overcrowded institution when individuals are chemically
controlled. We’re seeing this now in prisons,” where individuals with mental health conditions who are
often without access to adequate treatment are “oftentimes given large doses of drugs to keep them
both safe and comfortable” (emphasis added).
Throughout the hour-long program, Joseph Rogers was the voice of reason, debunking Dr. Sisti’s
arguments. After establishing his credentials – “I’ve been in hospitals; I’ve been in jails; I’ve been
homeless; I have a diagnosis of bipolar disorder which at times has left me incapacitated” – Rogers
talked about his experience in a state hospital: “When I hear the term ‘asylum’ I get my back up because
there was no asylum. These places…are not safe places.…You were warehoused.”
“We can create alternatives” such as peer-run crisis respites, he continued. This model, he said, “has had
wonderful success, even with people with some very difficult challenges.”
Rogers also noted that, although Dr. Sisti is based in Philadelphia, he didn’t talk about the Philadelphia
experience, when “we closed down Philadelphia State Hospital and years later they found that those
individuals” who had been released from the hospital when it closed were living successfully in the
“We know how to do it,” Rogers said. The key is providing for people’s individualized needs. The
question, he continued, is whether we have the power politically. It’s a matter of funding community-
based, evidence-based programs that we know work for even individuals with the most serious mental
health conditions. “And we need to fund them fully and not let them become budget basketball.”
Among those who called in to the program, the most compelling was “Christy,” who said she had
recently been released from Norristown State Hospital after six days. “I ended up there for some severe
depression. I was forced to take medication against my will; I was disrespected; any time I tried to
advocate for myself, I was told to cooperate or threatened with a longer stay,” she recalled. “I thought it
was completely unethical. I think it goes to show how few rights you have when you are deemed
mentally ill. I don’t think it was set up to help people succeed. Many people were just drugged. I didn’t
get any therapy. I repeatedly told them about myself and how meds affect me – and I was forced to take
medication. I went in voluntarily and was forced to stay longer. I’m a college-educated person and I tried
to advocate for myself and I was not listened to. I’m seeing an outpatient therapist but the experience at
Norristown scarred me for life. It was very extreme.”
In response to the moderator’s question about what works and what doesn’t, Rogers responded: “We
have to treat people as individuals.” Perhaps referring to the fact that the moderator consistently
avoided the use of “people first” language, Rogers said, “We don’t like to label people as ‘the mentally
ill’; we talk about people with mental health challenges.”
“What we have found here in Philadelphia,” he continued, “is that we have to really meet the person
where they are at.” Referencing some of the individualized outreach efforts in the city, including a street
outreach program called ACCESS (operated by MHASP), he said that “we learned early on” that you can’t
set up a big community mental health center and put the counselor on the fourth or fifth floor and
expect people with serious problems to make an appointment and come to the fourth or fifth floor.
“You need to be on the street, to work with people where they are at, to find out exactly what they are
concerned about that you can address, and by addressing those issues you gain their trust.” That is how
you are able to help a person seek and gain the support they need, he said.
“One thing that doesn’t work is overmedicating people,” Rogers noted. “Many people do much better
on small amounts of medication or no medication at all.” Some people’s behavior may be the result of
heavy medication, he added.
To the moderator’s question about people who don’t have loved ones who can help them, Rogers
responded, “A lot of times family members burn out or aren’t around….We’ve got to create an artificial
family. One of the things peer-run crisis respites do is use peers who have been trained to work one on
one with individuals in crisis and provide a homelike environment and prevent hospitalization or going
into a jail. You thus prevent further trauma.”
Rogers also talked about Housing First, a program in Philadelphia and elsewhere: “You provide decent,
affordable housing for that person and you build the supports around the person based on their
needs….You can help the person get involved in the community.”
In response to Dr. Sisti’s continued insistence that institutions can be effective, Rogers countered that
with large, congregate living situations, even with 15, 20, or 30 people, “the rights situation is
problematic. At 3 in the morning, when there are no advocates around and no chance to make a phone
call to an advocate, that’s when the abuses take place. This model of a ‘safe congregate living place’ is
not one that is borne out, with years of research into it.”
Rogers emphasized the need for adequate resources, saying that Philadelphia probably needs 3,000 or
4,000 more supported housing units than the city currently has. “That would just address people
rotating in and out of hospitals and jails, just in Philadelphia alone, not the whole region.” MHASP is
advocating for additional resources with the Pennsylvania state government.
Asked by the moderator to define his dream, Rogers responded that his dream would be to create a
massive movement of individuals with lived experience, families, and allies. “That’s the only way we’re
going to change things.”
Susan Rogers is the Director of the National Mental Health Consumers' Self-Help Clearinghouse,
and the Director of Special Projects, Mental Health Association of Southeastern Pennsylvania
Links: http://www.mhselfhelp.org http://www.mhasp.org
18, 2014 - News of the Week
STORIES SHATTER STEREOTYPES
San Francisco Honors
Psychiatric Survivor Carmen Lee
accounts tell us how Winston Churchill and Abraham Lincoln battled
disabling depression even as they made history. But before we can
truly understand and empathize with people who have psychiatric
vulnerabilities, we need people of our own time and environment to
tell us what they experience.
easy access to videos and social media allows the general public
unprecedented views of how mental illnesses affect a life. Every
story is unique. A recent example comes from Carmen Lee, a
Californian whose suicide attempts in her early 20s prefaced 20 years
of hospitalizations. In a remarkable 6-minute video on Facebook. "No
Longer Pretending..." (https://vimeo.com/105064330)
Lee explains the essence of her survival. Put most simply, Lee used
her positive energy to refute the stereotypes that misrepresent the
mental health community, thereby aiding progress toward social
1985 Carmen Lee began the Peninsula Network of Mental Health Clients,
and in 1990 she developed the Stamp Out Stigma program (SOS)
Traveling throughout the bay area and beyond, SOS teams have
delivered over 2,600 presentations to organizations and agencies of
every description, having directly reached well over 500,000 people
and many more by ripple effect. Lee's advocacy includes participation
in statewide planning forums.
Lee's video premiered on September 25th for a large crowd in San
Francisco's new Levi Stadium, home of the 49ers. It was a gala event
honoring mental health activism and educational outreach in Northern
California and beyond. The event was sponsored by Caminar, a San
Francisco Bay Area mental health agency that helped Carmen Lee
recognize her strengths and encouraged her work.
August 11, 2014 - News of the Week
HOW TO REDUCE
GUN VIOLENCE AND SUICIDE
misperceptions must be replaced with facts
new study by an international team of leading researchers suggests
that an infusion of evidence-based data could jump-start a reduction
in U.S. gun violence. The study focuses on gun assaults
involving suicide and people with behavioral disorders. It
proposes that effective, fair, and feasible policies can be applied
to the tiny portion of the U.S. population where gun violence and
mental illness intersect. Forbes correspondent Todd Essig
describes the research as a "comprehensive, critical survey of
the available data ... that pulls together the facts we need to
consider if we really want to adopt evidence-based policies to reduce
random gun violence."
introduction (excerpt below) explains how misconceptions have
complicated the policymaking process. The full article is FREE
ONLINE, click here.
The massacre of
schoolchildren in Newtown, Connecticut, in late 2012 stirred a
wrenching national conversation at the intersection of guns, mental
illness, safety, and civil rights. In the glare of sustained
media attention and heightened public concern over mass shootings, it
seemed that policymakers had a rare window of opportunity to enact
meaningful reforms to reduce gun violence in America. And yet,
the precise course of action was far from clear; competing ideas
about the nature and causes of the problem -- and thus, what to do
about it -- collided in the public square.
the one side, public health experts focused on the broader complex
problem of firearms-related injury and mortality in the United
States, where each year approximately 32,000 people are killed with
guns -- about 19,000 of them by their own hand -- and another 34,000
are injured in nonfatal gunshot incidents. more...
illness and reduction of gun violence and suicide: bringing
epidemiologic research into policy (Article
W. Swanson, Duke University
Elizabeth McGinty, Johns Hopkins University
Fazel, University of Oxford UK
M. Mays, Univerity of California at Los Angeles
July 15, 2014 - News of the Week
A BRITISH SURVIVOR CHALLENGES SCHIZOPHRENIA'S BAD RAP
Article Source: The Independent, July 15, 2014 http://www.independent.co.uk
For article and a video, click title:
SCHIZOPHRENIA: the most misunderstood mental illness?
By Rachel Hobbs
"While mental health stigma is decreasing overall ... people
with schizophrenia are still feared and demonised."
Earlier this year Jonny Benjamin set up a nationwide search to #findmike, the stranger who
talked him out of taking his own life on Waterloo bridge. People told him he ‘didn’t look like a
schizophrenic’ - so what do people imagine?
Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be
overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, googled
the phrase ‘schizophrenics should...’ when researching a potential campaign, we were so
distressed by the results, we decided to drop the idea completely. I won’t go into details,
but what we found confirmed our worst suspicions.
Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised
and misunderstood of all mental illnesses. While mental health stigma is decreasing overall,
thanks in large part to the Time to Change anti-stigma campaign which we run with Mind,
people with schizophrenia are still feared and demonised.
Over 60 per cent of people with mental health problems say the stigma and discrimination
they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives.
It means people end up suffering alone, afraid to tell friends, family and colleagues about
what they’re going through. This silence encourages feelings of shame and can ultimately
deter people from getting help.
Someone who knows first hand how damaging this stigma can be is 33 year-old Erica
Camus*, who was sacked from her job as a university lecturer, after her bosses found out
about her schizophrenia diagnosis, which she’d kept hidden from them.
Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open
about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was
She says that since then, she’s become even more cautious about being open. “I’ve
discussed it with lots of people who’re in a similar position, but I still don’t know what the
best way is. My strategy now is to avoid telling people unless it’s comes up, although it can
be very hard to keep under wraps.”
Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of
schizophrenia can have a direct impact on patients. “Some people definitely do internalise
the shame associated with it. For someone already suffering from paranoia, to feel that
people around you perceive you as strange or dangerous can compound things.
“I think part of the problem is that most people who have never experienced psychosis, find
it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of
us struggle to empathise with people affected by schizophrenia.”
Another problem is that when schizophrenia is mentioned in the media or portrayed on
screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers
and fictional characters in film or on TV are often no better. Too often, characters with
mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re
supposed to be frightened of, not empathise with. This is particularly worrying in light of
research by Time to Change, which found that people develop their understanding of mental
illness from films, more than any other type of media.
These skewed representations of mental illness have created a false association between
schizophrenia and violence in the public imagination. In reality, violence is not a symptom of
the illness and those affected are much more likely to be the victim of a crime than the
We never hear from the silent majority, who are quietly getting on with their lives and pose
no threat to anyone. We also never hear about people who are able to manage their
symptoms and live normal and happy lives.
That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny
Benjamin set up a nationwide search to find the stranger who talked him out of taking his
own life on Waterloo bridge, was such an incredible experience. Jonny, who has
schizophrenia, wanted to thank the man who had saved him and tell him how much his life
had changed for the better since that day.
The search captured the public imagination in a way we never could have predicted. Soon
#Findmike was trending all over the world and Jonny was making headlines. For me, the best
thing about it was seeing a media story about someone with schizophrenia that wasn’t linked
to violence and contained a message of hope and recovery. Jonny is living proof that things
can get better, no matter how bleak they may seem. This is all too rare.
June 15, 2014 - News of the Week
A "60 MINUTES" BIAS HARMS MILLIONS
September of last year, 60 Minutes infuriated many viewers by
portraying people with schizophrenia and similar conditions as
individuals at high risk of committing violence. Viewers deluged CBS
with angry protests.
Sunday, June 8, the feature, "Imminent Danger" was aired for the second
time. Clearly, 60 Minutes showed bias by repeating a one-sided feature
that was full of inaccuracies.
the September broadcast, the Bazelon Center for Mental Health Law
outlined the viewers' objections and pointed out the segment's
inaccuracies in a letter to CBS (for the full letter skip down to More
"Imminent Danger" portrays individuals diagnosed with schizophrenia as
people with hopeless futures whose primary life options are
hospitalization, homelessness, or incarceration. The segment
provides no indication that individuals with schizophrenia can and do
live fulfilling lives, start their own families, work, live
independently, and participate fully in their communities.
Instead, such individuals are painted as consigned to a life of misery
and as ticking time bombs with the potential to become violent at any
Danger" was hosted by Steve Croft and featured Dr. E. Fuller Torrey,
the nation's leading proponent of compulsory antipsychotic medication
and preventive hospital commitment. Both men showed a strong
commitment to coercive treatment, and both were willing to distort
facts to win public support for regressive practices. As
one angry viewer wrote,
time to get another 'reporter' to do some real investigation and offer
a balanced story rather than what seems like a personal mission by Mr.
Croft to further disenfranchise people who have received psychiatric
diagnoses. Ten years ago in October 2002 and June 2003, Mr. Croft
did a story called "Armed and Dangerous" that, like this segment,
relied mostly on the singular opinion of Dr. Torrey ... he's obviously
not done any more real research in the past decade as this piece is as
uninformed, biased and journalistically irresponsible as the last
Croft's flowery introduction made clear that Dr. Torrey had determined
the program's direction. Dr. Torrey and Dr. Jeffrey Lieberman,
leading proponents of compulsory antipsychotic medication, used the
time to convince viewers that meds, forced if necessary, will end
Dr. Torrey's collection of well over 3,000 "Preventable Tragedies"
holds some surprises. After downloading the collection's homicide
summaries years ago, the National Stigma Clearinghouse found that
medication failed to deter homicide in many cases. Further, a New
York Times series analyzing 50 years of mass murders (April 2000)
reported that among the 24 slayers who had been prescribed medication,
nearly half (10) were taking medication at the time of their rampage.
regarding violence, Dr. Torrey's guesstimates have media appeal, but
more to the point are figures from authoritative sources.
Schizophrenia affects just over 1% of the adult population (National
Institute of Mental Health-NIMH) and of these people, 99.97% of them
will not be convicted of serious violence in a given year (Walsh et.al.
2002. "Violence and Schizphrenia: Examining the Evidence," British
Journal of Psychiatry, 180: page 494)
Danger's" lack of balance is easily confirmed in its online
transcript. The over-emphasis on schizophrenia was particularly
insightful observation was made by Tom Dart, the Cook County Sheriff,
after he described the petty offenses of most incarcerated mentally ill
"This is a population that people don't care about and so as a result of that there are not the resources out there for them."
What effect has Dr. Torrey's 20-year over-emphasis on violence had on public opinion?
For more information, read a New York Times 4-part series on "Rampage Killers" (link is below)
THE NEW YORK TIMES ATTEMPTS TO UNDERSTAND "RAMPAGE KILLERS"
April 9, 2000 -News of the Week
"Rampage Killers Chart a Well-marked Course to Their Unraveling"
New York Times 4-part series on "Rampage Killers," launched on Sunday,
April 9,  attempts to replace opinions and hype with what is actually
known about multiple murderers. After scouring 50 years of records, the
Times investigators found 102 rampage killers and 425 victims of mass
homicide. (Military style weapons had not become commonplace.)
The first article of the Times series is crammed with food for thought. It provokes several quick observations.
to the popular assumption that mass murders are the work of people with
mental illness, of the 102 "rampage killers" recorded over a span of 50
years, only 25 were diagnosed with mental illness before the murderous
incident; another 23 were diagnosed in hindsight. (Troubling questions
about mis-diagnosed schizophrenia in earlier decades will perhaps be
examined later in the series.)
who commit mass murders are always caught, says the Times, mainly
because they want to be. They signal their intent in many ways before
acting. This series may well heighten public interest in recognizing
the precursors of violence.
Of the 102
"rampage killers," 24 were individuals who had been prescribed
medication for a mental illness. Only 14 of these were not taking their prescribed meds. The fact that 10 out of the 24 diagnosed mentally ill "rampage killers" were taking their medication surely calls into question any quick-fix solutions based on medication.
to rapid-fire assault weapons is the underlying factor in mass murders.
The focus on mentally ill assailants, though not irrelevant, does not
warrant finger-pointing and the creation of new laws specifically
directed at them.
The Times series is well worth saving for study. Click www.nytimes.com/library/national/040900rampage-killers.html
May 2, 2014 - News of the Week
A CLOSER LOOK AT "LACK OF INSIGHT"
articles and briefing papers by supporters of forced treatment assume
that patients who refuse psychiatric treatment do so because of
structural brain abnormalities that block awareness. They say nearly 50
percent of people with schizophrenia and bipolar disorder require
forced anti-psychotic medication to combat the assumed cause of
treatment refusal. Although the faulty brain lesions have not
been found and their response to anti-psychotic medication is unknown,
supporters expect these hurdles to be cleared by advanced brain imaging techniques within a few years.
thought-provoking article below addresses the "lack of insight" concept
and approaches to treatment. This analysis is a valuable resource
for understanding the variety of ways to view "lack of insight.".
With pressure building for a major expansion of forced meds, an
informed public is crucial..
THE ISSUE OF INSIGHT
by Larry Davidson, Ph.D.
Yale University School of Medicine
February 6, 2012
But what about people who won't accept having a mental illness?
How can a person recover if he or she won't even acknowledge being ill?
How is recovery relevant for people who say there is nothing wrong with them?
what about people who won't accept any treatment, who deny they need
any help? How does recovery-oriented care apply to them?
questions—and others like them—are frequently posed by frustrated
practitioners and distressed family members trying to assist people who
appear not to want help. One concern, or assumption, about these
questions is that they point to a key limitation of the recovery
paradigm, implying recovery and recovery-oriented practices are only
for people who readily acknowledge having a mental illness. After all,
how can a person be "in recovery" if he or she has nothing to recover
from? One of the major differences between mental illnesses and other
medical conditions is the issue of insight. People with diabetes know
they have diabetes; people with asthma know they have asthma, etc., but
some will argue that most people with serious mental illnesses (or at
least those with schizophrenia) lack insight into having the illness.
Therefore, they will not participate in the treatments needed to manage
their conditions. Such perceptions lead some people to argue that
coercion and involuntary treatments are necessary, at least for those
who refuse any or all treatments. The lack of insight also poses a
major challenge to person-centered care planning and recovery-oriented
practice, if both presume the person will take responsibility for
driving his or her own care and overall recovery process. Is not
insight, therefore, required for recovery?
While it may sound contradictory at this
point, I intend to show in the following two sections not only that
recovery-oriented practice is possible for people who appear to lack
insight, but that it may also be precisely these people who most need
recovery-oriented care. (Click for full article)
February 24, 2014
- News of the Week
"MADNESS NETWORK NEWS" RETURNS
to view samples of the MNN archive, and more...
Network News (1972-1986) began as an open forum for young people people
facing the social isolation that comes with a psychiatric label.
Happily, these historic quarterly publications have now been re-issued
in two formats: seven hard copy books averaging 170 pages each and 45
digital e-books. Each decades-old issue of MNN teems with
personal experiences, commentary, poems, letters, cartoons, photos, and
calls for action -- resulting in a kaleidoscope of artwork, emotion,
A recurring theme throughout the 45 issues
is angry protest against dehumanizing psychiatric practices and the
loss of civil rights. Today, those grievances are legitimized by
experts such as journalist/activist Robert Whitaker (www.madinamerica.com) and Dr. Thomas Insel, Director of the National Institute of Mental Health (Q& A: Dr. Insel and Dr. Suzanne Koven, The Boston Globe, 12/16/2013), to name just two of many critics of current psychiatric practices.
In the summer of 2013, two determined
long-time activists, David Gonzalez (Brooklyn NY) and Ron Schraiber
(Los Angeles CA), received the support and approval from MNN's
co-founder, Leonard Roy Frank, to reprint the complete set of original
issues. Working from home due to medical problems, David first
re-sized the original 11"x17" newsletter format to 8.5"x 11", then
assembled the complete collection of 45 issues into seven handsome
soft-cover 8.5"x 11" books. Each of these, on average, contains
approximately 170 pages of resized original material (6 MNN issues)
except for Volume 1, which combines MNN's first and its final issues (9
To further enhance access, David then
turned each of MNN's 45 issues into a high-quality e-book. Plans
for distribution of the seven hard copy volumes and the digitized
e-books are undeway.
Suggestions are welcome! Please visit http://www.madnessnetworkinews.com , click "Misc." and scroll to the "Questions and/or Comments" box.
The project's two sponsors hope to recover
the considerable expense of preserving this unique moment in cultural
history. Please visit http://www.madnessnetworknews.com for more information about how to purchase all, or parts of the Madness Network News archive.
January 18, 2014 - News of the Week
DR. TORREY'S FIXATION ON VIOLENCE FUELS FEAR AND DISCRIMINATION
Dr. E. Fuller Torrey's latest book. "American Psychosis," begins by
describing the events, shortsighted decisions, and inertia that led to
the present quagmire we call the nation's mental health system.
The book's main message, however, promotes Dr. Torrey's solution: more
psychiatric hospitals and court-ordered medication. This is Torrey's
mantra. What's galling is his continuing reliance on lurid
stories to win public support for his controversial - many say
regressive - agenda. A book revue by Michael A. Friedman, M.D. notes that Dr. Torrey "does not shy away from recounting one horror story after another."
National Stigma Clearinghouse files show that for at least twenty
years, Dr. Torrey has relied on the fear of violence to win new laws
forcing psychiatric treatment. In 1994, D.J. Jaffe, an
advertising executive and Torrey supporter, wrote: "From a marketing
perspective, it may be necessary to capitalize on the fear of violence
to get the law passed." This was not a passing comment.
Five years later, Mr. Jaffe advised a national NAMI audience, "Laws
change for a single reason, in reaction to highly publicized incidents
of violence." And later that year, 1999, the passage of NY's
Kendra's Law proved Jaffe right. (It didn't matter that Kendra
Webdale's assailant was the opposite of a 'treatment refuser', a label
he carries to this day as he serves his prison term).
Just as disturbing is the Torrey/Jaffe team's "ends justify the means"
approach. After advising his NAMI audience to use violence to
attain their goals, Jaffe added, "I am not saying it is right, I am
saying this is the reality." The media welcomed the Torrey/Jaffe
team's sensational approach, and from the 1990s onward, Dr.Torrey
enjoyed a lion's share of media coverage concerning mental illnesses.
Blame for the nation's horrific amount of gun violence now falls on a
minority with little means of defense. Injustice against innocent
people is condoned. And many who need help are afraid to ask for
A tragic example: "Dad! Dad! Learning from the Kelly Thomas Tragedy"
Source: NYAPRS (New York Association for Psychiatric Rehabilitation Services)
An Orange County California jury’s acquittal last week of Fullerton
police officers charged with causing the brutal death of Kelly Thomas,
a homeless man with a mental health history, has set off a national
uproar amongst human rights and mental health advocates. In the
wake of the court’s action, the County DA’s courage to prosecute the
case has been cited and the FBI has opened an investigation to see if Thomas’ civil rights were violated.
Kelly Thomas had struggled for years with mental
health issues and homelessness. His pointless, tragic death has
devastated his family, community, and the national and international
mental health community. His death also brings attention to the
misconception that people with a psychiatric diagnosis are violent,
whereas evidence shows that they are far more likely to be the victims
of violence than the perpetrators of it.
Sunday’s 7 pm Albany
vigil has been getting a lot of national attention and support as
advocates from around the country call for justice and accountability
of our law enforcement to the rights and protection of each and every
citizen. (Vigil Announcement:
Mental health and human rights advocates gather to grieve and decry
police killing, First Unitarian Church, Albany, NY, 7:00 pm, Sunday,
January 18, 2014)
January 11, 2014 - News of the Week
DAVID BROOKS TAKES HEAT FOR HIS VIEWS ON MARIJUANA
THE PUBLIC NEEDS FACTS ABOUT POTENTIAL HARM
NYTimes columnist David Brooks recently expressed misgivings
concerning recreational marijuana use, based on his own
experiences. A displeased pro-marijuana advocate, Joe Dolce, was
quick to counter Mr. Brooks online. For his takedown,
Mr. Dolce interviewed Dr. Lester Grinspoon, a well-known longtime
promoter of smoking cannabis. The interview gives an enticing
glimpse of Dr. Grinspoon's idyllic view of marijuana, while dissing
David Brooks as uninformed.
May I suggest a bit of balance.
While there is little conclusive research on pot's hazards, many
studies done over the past decade, mostly in the UK and Europe, have
found brain changes among young users. Findings from British
researchers ten years ago are now being confirmed by studies in the
US. CBS News "Marijuana use linked to schizoprenia risk in teens"
A quote in 2008 from the UK's Guardian indicated pot's harmful potential. "Last year, a review of all the studies to date, published in The Lancet,
was able to assert that even having tried cannabis once can be shown to
increase the risk of developing schizophrenia. And it is
estimated by Murray [Robin Murray, a British researcher] that at least
10 percent of all people with schizophrenia in the UK would not have
developed the illness had they not smoked cannabis." "My brother's first joint and his descent into a mental war zone"
Many families with a 'seriously mentally ill' family
member will attest that pot-smoking has led to family tragedies.
Last week, a NYTimes editorial stated that "Roughly 36 percent of 12th
graders reported having used marijuana in 2013." "The Marijuana Experiment," NYTimes 1/3/2014
"Smoking Pot Doubles Mental Illness Risk" (Christchrch New Zealand)
"Marijuana linked to brain-related memory woes, schizophrenia risk in teens" (CBS News)
"The Marijuana Experiment" (New York Times editorial)
"Continued Cannabis Use and Risk of Incidence...10 Year Follow-Up Cohort Study" (Medscape signup needed)
December 15, 2013 - News of the Week
MENTAL HEALTH CONSUMER NETWORKS ARE IN JEOPARDY
A proposed Congressional Bill is described as helping families in
mental health crisis. Unfortunately, the bill includes onerous
provisions that would halt effective wellness programs designed by
patients and ex-patients. This alarming Bill would "slash funding
for recovery oriented services--including peer-run services and family
supports--in exchange for regressive and involuntary treatment"
(NYAPRS). Further, it would "restructure federal funding to
heavily encourage the use of force and coercion..." (NDRN).
(NYAPRS, New York Association for Psychiatric Rehabilitation Services; NDRN, National Disability Rights Network)
The "Helping Families in Mental Health Crisis Act" was introduced on December 12 by Rep.Tim Murphy of Pennsylvania.
Read the following links and learn more about this threat to progress.
"Mental Health America Faults Rep. Tim Murphy's Legislation..."
Statement of David Shern, Ph.D., president and CEO, Mental Health America
Mental Health Advocates Blast Murphy Bill as Regressive
GOP Rep. Murphy rolls out mental health legislation
By David Sherfinski, The Washington Times, 12/12/13
Alert: Urge Congress to Protect SAMHSA and Consumer Programs!
News: This comes from the National Coalition for Mental Health
Recovery, an organization that NYAPRS supports. We urge you to contact
your representatives to demand that budget cuts do not impact mental
health recovery services that keep people engaged and working toward
their well-being. Along with the Congressional deal to tighten the
budget and restrict mental health spending, an act submitted by
Representative Tim Murphy would favor involuntary services and reduce
funding for rehabilitation services, including peers and family
support. Contact your representative today, sign the petition at change.org, and get on the NCMHR action list!
Grants for State Networks, The Alternatives Conference and the 5
Mental Health Technical Assistance Centers Are At Risk!
YOU can help.
Educate your Senators and your Representative about these vital programs.
They need to hear from YOU now.
Budget negotiators in Congress just reached a deal that squeezes dollars for all health funding including mental health. Most
members of Congress don’t know about the life-saving work and value of
state mental health consumer networks and national TA
centers. It is up to you to educate them.
Yesterday, Representative Tim Murphy of Pennsylvania released a mental health bill that—among many other disturbing changes-- would reorganize SAMHSA and end funding for state networks, the Alternatives conference and technical assistance centers.
What to do now:
Right now, send emails and make phone calls to you members of the House and Senate appropriations committees telling them why they
should protect funding for state mental health networks, the
Alternatives conference and the five mental health technical assistance
centers and how important they have been in your life, the life of
people you love and for citizens of your state. (See How to do it below and the attached document on what to say).
Next, Sign our petition on Change.org: Go to http://ncmhr.org and look for the Action Alert with a link to the petition and more background.
Stay tuned for instructions on how counter Tim Murphy’s bill that you will be receiving in a few days.
How to do it:
1. FIND your U.S. Senators at http://www.opencongress.org/people/zipcodelookup.
Click the name of each Senator, scroll down to “ Contact Webform” to
send them an email. Before sending, copy and save your message. Request
a reply. You can also call their office and leave a message.
The attached document includes a list of Senators and Congressmen on
Appropriations Committees. If they represent you it’s doubly important
to educate them. If your Senators/Congressman is not on this
list, don’t worry--It’s still vital that contact them.
3. TELL your Senators to
RESTORE the 20 percent cut in funding for SAMHSA grants for
statewide mental health consumer networks that the Senate
Appropriations Committee agreed to. ASK them to resist any
further cuts. TELL them these grants, which total just $2.5 million
now, teach people with serious mental health conditions to stay well
and recover. TELL them how YOUR state network (and the local peer-run
centers it supports) have changed your life as a person with a serious
mental health condition and how you now help others. If your state
doesn’t have a mental health consumer network yet tell them you need
4. TELL your member of the House of Representatives to fully
fund SAMHSA grants for statewide mental health consumer networks,
mental health technical assistance centers, the Alternatives
conference, and protection and advocacy programs. TELL
them state network grants, which total just $2.5 million now, teach
people with serious mental health conditions to stay well and recover.
TELL them how YOUR state network (and the local peer-run centers it
supports) have changed your life as a person with a serious mental
health condition and how you now help others. If your state doesn’t
have a mental health consumer network yet tell them you need one.
If your representative is listed on the attached document, it is doubly
important that they hear from you.
6. Email raymond.bridge@ncmhr to
get on our action list. Like us on Facebook (National Coalition for
Mental Health Recovery) Find us at http:ncmhr.org -
Note from Jean Arnold: I regret that the lists (referred to above) of
Congressional Committee members did not transfer to this posting.
November 20, 2013 - News of the Week
SCHIZOPHRENIA'S BAD RAP... AGAIN
Tanya M. Luhrmann's opinion piece "The Violence in Our Heads"
(NYTimes, 9/19/13) is a thought-provoking discussion of the effects of
culture on auditory hallucinations. Deserving wide attention is
her description of intriguing and effective ways to relieve distressing
symptoms of psychosis. For example, the 'hearing voices'
movement in Europe has discovered ways to alleviate voices that "flies
in the face of much clinical practice in the United States."
Luhrmann's piece begins, however, with two troubling assumptions: (1)
that people who hear voices have schizophrenia, and (2) that
schizophrenia carries a risk of violence "significantly greater than it
is in the broader population."
Professor Luhrmann, an anthropologist at Stanford
University, begins by speculating about recent mass murderers, Adam
Lanza and Aaron Alexis. (Neither, to my knowledge, has been given
a professional diagnosis.) She suggests that these assailants
were fueled by tormenting 'voices' and concludes that they were
suffering from schizophrenia.
But auditory hallucinations occur in conditions other
than schizophrenia. Several readers' comments posted by
clinicians explain that 'voices' are not confined to schizophrenia.
Their lists include bipolar disorder, psychotic depression, PTSD,
seizure disorders, brain tumors, hallucinogenic drugs, multiple
personality disorder...and one clinician wrote that 'voices' occur most
often during manic episodes with psychotic symptoms.
Further, 'schizophrenia' is not a descriptive
diagnosis like 'depression' or 'chronic lymphocyctic leukemia'.
The public's perception depends largely on context. For years,
schizophrenia's violent image has been shaped by sensationalist images
in the media, and by advocates who have promoted a forced-medication
agenda by fanning public fear. Few people know that violence
rates for people diagnosed with schizophrenia (minus complications) are
similar to, or lower than violence rates for the general
population. Schizophrenia affects 1% of the population (NIMH) and
of this one percent, 99.97% will not be convicted of serious violence
in a given year (Walsh et.al. 2002 and Wallace et.al, 1998).
Balanced portrayals of schizophrenia are rare; help from authoritative spokespeople is badly needed.
NIMH (National Institute of Mental Health), "Schizophrenia, 12-month prevalence," website (2013)
Wallace et al. "Serious criminal offending and mental disorder," British Journal of Psychiatry, 172, 477-484. (1998)
Walsh et al. "Violence and schizophrenia: examining the evidence," British Journal of Psychiatry, 180: page 494 (2002)
Link to Luhrmann article: http://www.nytimes.com/2013/09/20/opinion/luhrmann-the-violence-in-our-heads.html?_r=0
October 12, 2013 - News of the Week
THIRTY-SIX ADVOCACY GROUPS PRESS FOR FAIR REPORTING
A recent 60 MINUTES
segment hosted by Steve Croft focused on a national disgrace -- the
nation's undisputed neglect of Americans who are diagnosed with serious
psychiatric conditions. Ignoring an opportunity to discuss the
scarcity of user-friendly treatments, the segment focused on
psychotropic medications and forced treatment. The coercion
proponents' marketing strategy, "fear of violence," dominated the
segment -- note its (shortened) title, "Imminent Danger".
Below is a letter from the Bazelon Center for Mental Health Law to
60 MINUTES protesting "Imminent Danger's" harmful bias. The
letter is signed by 36 mental health organizations, and it joins many
other protests from individuals and organizations. (E-mail:
firstname.lastname@example.org and email@example.com)
NYAPRS Note: This week, the Bazelon Center for Mental Health Law drafted a letter to the Executive Producer of CBS 60 Minutes,
in regards to the September 29 segment “Imminent Danger”. The views
expressed in that program were regressive; the segment falsely
portrayed persons with mental health diagnoses as hopeless, futureless
individuals at high risk for committing violence. NYAPRS—as well as
numerous other organizations indicated below—have signed this letter in
protest of the unacceptable and misguided views expressed in the show
that not only go against our mission, but also the consensus priorities
of our mental health services system. Please read the full letter below.
Dear Mr. Fager:
undersigned organizations, together representing tens of thousands of
individuals with psychiatric disabilities, family members, service
providers, and advocates, write to express our great disappointment
that CBS’ 60 Minutes chose to offer a dismal and inaccurate portrayal
of individuals with psychiatric disabilities in the September 29, 2013,
segment “Untreated Mental Illness an Imminent Danger?” We call on 60
Minutes to devote a future segment to presenting a different
perspective than that offered by E. Fuller Torrey, the psychiatrist
whose highly controversial views are featured in “Imminent Danger.”
Danger” portrays individuals diagnosed with schizophrenia as people
with hopeless futures whose primary life options are hospitalization,
homelessness, or incarceration.The segment provides no indication that
individuals with schizophrenia can and do live fulfilling lives, start
their own families, work, live independently, and participate fully in
their communities. Instead, such individuals are painted as consigned
to a life of misery and as ticking time bombs with the potential to
become violent at any time.
segment perpetuates false assumptions that there is a significant link
between mental health conditions and violence. Indeed, the point of the
segment seems to be that mass shootings would be preventable if it were
easier to hospitalize individuals with psychiatric disabilities.
Apparently relying on Dr. Torrey’s inaccurate statement that half of
mass killings are committed by individuals with serious mental illness,
the report states: “It's becoming harder and harder to ignore the fact
that the majority of the people pulling the triggers have turned out to
be severely mentally ill—not in control of their faculties—and not
receiving treatment.” Research shows that this is far from accurate.
One survey of mass shootings between 2009 and 2013 found that
perpetrators had a known mental health condition in only 11 percent of
these incidents.1 A recent study of the psychiatric characteristics of
homicide defendants found that psychiatric factors do not appear to
predict whether a homicide defendant used a firearm or killed multiple
Danger” also inaccurately suggests that the primary need in our mental
health system is for more involuntary hospitalization. In fact, we have
a long history of national and state reports—including the Surgeon
General’s Report on Mental Health in 1999 and the 2003 report of the
President’s New Freedom Commission on Mental Health—indicating that our
mental health system is broken because we are failing to invest in
effective community services (such as supported housing, supported
employment, mobile crisis services, peer supports, and mobile community
support teams).6Dr. Torrey’s focus on hospitalization and forced
treatment as the primary need in mental health systems is at odds with
a virtual national consensus that the focus should be community
the segment incorrectly suggests that the requirement that individuals
be dangerous before they can be involuntarily committed to a
psychiatric hospital is a significant barrier to treatment. Dr. Torrey
states in the segment that due to this requirement, in most states, it
is “almost impossible” to commit people. This is a gross misstatement
of fact. In fact, more than 52,000 individuals were involuntarily
committed to psychiatric hospitals last year. Moreover, the vast
majority of individuals who come before courts on involuntary
commitment petitions are committed.7
inaccuracies and omissions in “Imminent Danger” create a harmful
portrayal of Americans diagnosed with schizophrenia and other
psychiatric disabilities. This portrayal is likely to lead to further
discrimination and scapegoating of these individuals and to suggest
misguided policy solutions. Moreover, this segment misses the
opportunity to highlight the need for greater investment in effective
community services. We hope that 60 Minutes will devote a segment to
presenting a different perspective and we stand ready to work with you
on making that happen.
American Association of People with Disabilities
American Association on Health and Disability
Anti-Bias Home Page/National Stigma Clearinghouse
Arbor Housing and Development
Association of Programs for Rural Independent Living
Autistic Self Advocacy Network
Baltic Street AEH Inc.
Bazelon Center for Mental Health Law
Clubhouse of Suffolk
Connecticut Legal Rights Project
Delaware Consumer Recovery Coalition
Disability Rights Education and Defense Fund
Disability Rights International
Equip for Equality
Little People of America
Maine Center, Inc.
Mental Health America
Mental Health Association of Nebraska
Mental Health Association Orange County, Inc.
Mental Health Association Suffolk County
National Association for Rights Protection and Advocacy
National Coalition for Mental Health Recovery
National Council for Community Behavioral Healthcare
National Council on Independent Living
National Disability Rights Network
National Mental Health Consumers’ Self-Help Clearinghouse
New York Association for Psychiatric Rehabilitation Services, Inc.
Parsons Family and Consumer Services
Suffolk County United Veterans
Yale Program for Recovery and Community Health
October 4, 2013 - News of the Week
NEW VIOLENCE STUDY SHATTERS POPULAR BELIEFS
Study Finds Psychiatric Factors Not Linked To Multiple Homicide Victims
Article: Clinical and Research news; Mark Moran; September 17, 2013
Source: Thank you Briana Gilmore, NYAPRS
“Psychiatric Characteristics of Homicide Defendants” is posted at http://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
“Psychiatric Factors Not Linked to Multiple Victims” is posted at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
more than a third of the defendants had prior psychiatric treatment,
few received treatment in the three months preceding the crime of which
they were accused.
factors do not appear to predict whether a homicide defendant used a
firearm, killed multiple victims, or is convicted of the crime, a
finding that would seem to counter the popular notion—prevalent in the
wake of recent mass killings that have made the news—that perpetrators
of mass gun violence are invariably mentally ill.
The finding is from a study appearing in the SeptemberAmerican Journal of Psychiatry that assessed the association between homicide and a wide range of demographic and clinical variables.
found no relationship between the presence of psychiatric disorders and
the use of firearms. Also, the presence of a psychiatric disorder was
not related to offenses involving multiple victims.
37 percent of the sample had prior psychiatric treatment, only 8
percent of the defendants with diagnosed Axis I disorders had
outpatient treatment during the three months preceding the homicide.
with an Axis I disorder were overrepresented in homicide defendants,
but this was due to the high rate of substance use disorders found in
is notable that clinical variables, such as Axis I diagnoses, were not
associated with offense characteristics or case outcomes when
demographic and historical characteristics of the cases were included
in the models,” wrote lead author Edward Mulvey, Ph.D., of the
University of Pittsburgh Medical Center, and colleagues. “In
particular, while age and race were significantly related to the use of
a firearm, the addition of clinical variables to demographic and
historical variables did not improve model fit. Furthermore, a model
including demographic/historical and clinical variables did not
significantly predict a guilty verdict, suggesting that case-specific
factors were more salient in these determinations.”
the study, defendants charged with homicide in a U.S. urban county
between 2001 and 2005 received a psychiatric evaluation after arrest.
Demographic, historical, and psychiatric variables as well as offense
characteristics and legal outcomes were described. The researchers
examined differences by age group and by race; they also looked at
predictors of having multiple victims, firearm use, guilty plea, and
Fifty-eight percent of the sample had at least one Axis I or II diagnosis usingDSM-IV
criteria, most often a substance use disorder (47 percent). Axis I or
II diagnoses were more common (78 percent) among defendants over age
40. Although 37 percent of the sample had prior psychiatric treatment,
only 8 percent of the defendants with diagnosed Axis I disorders had
outpatient treatment during the three months preceding the homicide.
suggests limited opportunities for prevention by mental health
providers, Mulvey and colleagues said. “The rate of previous treatment
observed in this sample raises issues relevant to mental health
policy,” they wrote. “Although 53 percent of the sample were diagnosed
with an Axis I diagnosis (including substance use disorders), less than
half of these individuals had ever been hospitalized. Also, among those
with an Axis I diagnosis, only 8 percent had received any treatment in
the three months preceding the homicide offense. Moreover, this low
frequency of recent psychiatric treatment differed markedly by
race….Widespread disparities in access to care and cultural differences
regarding help seeking are likely explanations for this difference. The
low rate of treatment in the months preceding the offense, however,
highlights the need for enhanced engagement of high-risk individuals
(especially during times of emotional crisis) if mental health care
providers expect to have an impact on serious violence.”
Hoge, M.D., says that study findings showing low rates of treatment in
the period prior to a crime suggest that crime-prevention strategies
relying on psychiatrists’ reports regarding treatment encounters will
not be effective.
Hoge, M.D., chair of APA’s Council on Psychiatry and Law, reviewed the
report. “Individuals with an Axis I disorder were overrepresented among
homicide defendants,” he told Psychiatric News, “but this was
due to the high rate of substance use disorders found. The relationship
between substance use and serious criminal behavior is well
established. The study identified only 15 individuals—just 5 percent of
the sample—who had a mental disorder and no co-occurring substance use
disorder. Identification and treatment of substance use disorders are
important not only to alleviate individual suffering, but also to
improve public safety.
study findings address current concerns regarding gun use and mass
killings by those with mental illnesses,” he continued.“There is
widespread belief that mental illness is an important cause of firearm
violence and mass murder. In fact, the researchers found no
relationship between the presence of psychiatric disorders and the use
of firearms. Nor did the presence of a psychiatric disorder relate to
offenses involving multiple victims. These findings suggest that
policies designed to keep firearms out of the hands of individuals with
a history of mental illness will not prove to be effective as a
also said the study underscores the need for better access to
psychiatric treatment, particularly substance use treatment. However,
crime-prevention strategies that rely on psychiatrists’ reports are
likely to be ineffective because most of this population is not in
treatment or getting timely treatment.
“Psychiatric Characteristics of Homicide Defendants” is posted athttp://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
“Psychiatric Factors Not Linked to Multiple Victims” is posted athttp://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
October 1, 2013 - News of the Week
A PLEA TO MAINSTREAM MEDIA
(See more information below)
"Imminent Danger" is the now-shortened title of a
recent "60 MINUTES" segment about violence and mental illnesses.
The segment aired on September 29th and was followed by an onslaught of
online viewer comments and criticism.
Most mental health advocates are seeking expansion of high-quality
community programs and safe housing. They deplore "Imminent
Danger's" sole emphasis on a national disgrace that no one
disputes. The program reminds us of the "walking time bomb"
imagery often used in CBS features during the 1990s. The
segment's original title, "Untreated mental illness an imminent
danger?", implied an open-minded, solution-seeking approach -- but no
balance was seen, and there was an appalling over-emphasis on
As many advocates point out, Dr. E. Fuller Torrey, a primary guest on
the show, is known for his disparagement of community programs favored
by many people with diagnoses of serious mental illnesses. These
user-friendly programs that promote good outcomes deserve publicity as
much, if not more, than programs that have failed.
This is a plea for the mainstream media to give national exposure to
user-friendly, high-quality community programs and safe housing.
A commentary by Linda Rosenberg
President and CEO, National Council for Community Behavioral Healthcare
A Commentary and Source Materials from Susan Rogers
Director, National Mental Health Consumers' Self-Help Clearinghouse
find it surprising that “60 Minutes,” which has a history of serious
investigative journalism, would do such a slipshod job on the segment
“starring” E. Fuller Torrey.
The producers apparently saw no reason to include the fact that people diagnosed with schizophrenia can and do recover. Significantly, a decades-long study by
the World Health Organization found that individuals diagnosed with
schizophrenia usually do better in countries in the developing world –
such as India, Nigeria and Colombia – than they do in such Western
nations as Denmark, England and the United States. According to an
analysis of results, “Patients in developing countries experienced
significantly longer periods of unimpaired functioning in the
community, although only 16% of them were on continuous antipsychotic
medication (compared with 61% in the developed countries). . . . The
sobering experience of high rates of chronic disability and dependency
associated with schizophrenia in high-income countries, despite access
to costly biomedical treatment, suggests that something essential to recovery is missing in the social fabric.”
Nor did they include any information about the Hearing Voices movement, which helps people learn to cope effectively with the experience of hearing voices.
In addition, in a small British pilot study,
16 individuals diagnosed with schizophrenia were able to control their
auditory hallucinations with an experimental treatment called “avatar
therapy.” The treatment involves creating a computer-based
representation – including a face and a voice – of the entity they
believe is talking to them. The individual’s therapist is then able to
speak through the avatar, encouraging the individual to counter the
voice and to take control of the hallucinations. Three of the 16 people
who participated in the study completely stopped hearing their voices
as a result of the therapy, and almost all of the participants reported
a reduction in frequency and in the severity of distress the voices
caused, according to a published report. Because of the pilot’s
success, The Wellcome Trust will fund a larger study, to be led by
researchers at King’s College London’s Institute of Psychiatry. Thomas
Craig, the psychiatrist who will lead the larger trial, said that if
the study is successful, the therapy could be widely available within a
Dr. Torrey believes that individuals diagnosed with mental health
conditions should be force-medicated if they refuse to take medication
voluntarily, award-winning journalist Robert Whitaker believes that
medication contributes to chronicity. In the era that followed the
introduction of Thorazine in 1955, there has been an exponential rise
in the numbers of individuals disabled by mental health disorders, he
reports in his book “Anatomy of an Epidemic.” Whitaker told Behavioral Healthcare,
“. . . [U]nfortunately I’m afraid psychiatry no longer knows how to get
back on track with honest reporting of what it does and does not know,
and honest investigations of psychiatric medications. . . . Ultimately,
I think we need a new paradigm built on the framework of psychosocial
and recovery practices.”
The “60 Minutes” producers made a serious error in relying upon Dr. E. Fuller Torrey as its main source. Torrey admits to fabricating “evidence” to further his goal of making it easier to lock up people who have psychiatric diagnoses. Toward this end, he has for years engaged in “an intensive public relations campaign linking mental illness with violence.”
To the contrary, according to a NY Times article,
only about 4 percent of violence in the United States can be attributed
to people with mental illness.” And the 4 percent statistic is about
violence of any kind – which, according to the study cited,
would include something as relatively innocuous as threatening
threatening behavior – as opposed to just homicides. Also, since the
fears of the general public largely focus on strangers with mental
health conditions, it is significant to report another study, which estimated that there is only one stranger homicide per 14.3 million peopl year.
“60 Minutes” should do a follow-up piece in which it strives for accuracy, as opposed to sensationalism.
Susan Rogers, Director
National Mental Health Consumers’ Self-Help Clearinghouse
Director of Special Projects
Mental Health Association of Southeastern Pennsylvania
1211 Chestnut Street, 11th Floor
Philadelphia, PA 19107
800-553-4539, ext. 3812
800-688-4226, ext. 3812
The National Mental Health Consumers’ Self-Help Clearinghouse
is a consumer-run national technical assistance center funded in part by
the Substance Abuse and Mental Health Services Administration.
views, opinions, and content on the Clearinghouse website and in
anything posted on the website or in these e-mails or attached to these
e-mails donot necessarily reflect the views, opinions, or policies of
the Center for Mental Health Services (CMHS), the Substance Abuse and
Mental Health Services Administration (SAMHSA), or the U.S. Department
of Health and Human Services (HHS).
September 23, 2013
- News of the Week
CRISIS INTERVENTION TEAMS : Will New York City Act At Last?
Communities for Crisis Intervention Teams in NYC
Welcome to the online home of Communities for Crisis Intervention Teams
(CCIT-NYC). If you’d like to share this website with others,
the web address is: http://www.ccitnyc.org.
CCIT-NYC seeks to improve police responses to 911 calls involving individuals with mental health concerns – often referred to as
“Emotionally Disturbed Person” (EDP) calls. (The NYPD gets more than 100,000 EDP calls per year.)
By establishing a new community-police approach to EDP calls, we hope to divert mental health recipients away from the criminal
justice system, and thereby avoid traumatic encounters and injuries to police and mental health recipients.
Current State of Affairs:
At present, the NYPD are insufficiently prepared to deal effectively with 911 calls involving individuals with mental health