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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 view that the
nation's excessive violence is linked to mental illness. At least
$130 billion federal dollars are spread among eight federal
departments and agencies (SAMHSA gets a mere $3-4
billion). The devil is in the details of HR
2646. And in
the priorties of its authors.
!! NEWS ALERT !!
A U.S. Senate bill will be introduced later this summer by Senator Chris Murphy (D-CT)
AN ACTIVIST STATES GOALS
Why We Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!
Mother, storyteller, mental health advocate, and coordinator of the Recovery Now! campaign.
June 12, 2015
"May is Mental Health Month" has come and gone, and it is time to build
on years of awareness campaigns and move into action to promote whole
health and recovery. People with serious mental health conditions are
dying on average 25 years earlier than
the general population, largely due to preventable physical health
conditions, so why do we still focus on mental health separately from
physical health? And when we know that people with serious mental
health conditions face an 80 percent unemployment rate,
why do we largely ignore the role of poverty, economic and social
inequality, and other environmental factors in mainstream discussions
about mental health?
Decades of public health research have
clearly shown that access to the social determinants of health --
affordable housing, educational and vocational opportunities, and
community inclusion -- are far more important to mental and physical
health than access to health care alone. As one recent article explained:
"For many patients, a prescription for housing or food is the most
powerful one that a physician could write, with health effects far
exceeding those of most medications." Yet this wisdom does not
generally guide policymaking in the U.S. Among nations in the
Organization for Economic Co-operation and Development (OECD), the U.S.
ranks first in health care spending, but 25th in spending on social
services. Is there something wrong with our very concept of "care"?
This question is not just theoretical for me. As an adolescent, I
attempted suicide several times. I found myself in the back of a police
car more than once and was frequently hospitalized. At age 16, I was
diagnosed with bipolar disorder. Two years later, I found myself
sitting in a squalid group home, where I was told I needed to remain
for life. I had no high school diploma and no job. My hopelessness and
despair were all-encompassing.
I managed to get on a different path when I obtained access to safe and
stable housing, education, and social support. Today, I am living life
as a mother and a mental health advocate. I train human service
providers in suicide prevention, recovery, trauma-informed approaches,
and person-centered health care. Every day, I'm grateful that I was
able to regain my life, and I want everyone to have this opportunity.
To help promote a paradigm shift in mental health care, I've been part
of starting a new, nonpartisan public awareness campaign called Recovery Now! This
campaign seeks to educate all Americans about the kinds of services and
policies that promote real recovery and whole health for people
affected by mental health conditions. Here are a few key messages of
the Recovery Now! campaign.
Recovery is possible for all.
vast majority of people living with mental health conditions, even
people diagnosed with serious mental illness, can enjoy a high quality
of life in the community with access to the right kinds of services and
supports. Dr. Richard Warner, clinical professor of psychiatry at the
University of Colorado, noted:
"It emerges that one of the most robust findings about schizophrenia is
that a substantial proportion of those who present with the illness
will recover completely or with good functional capacity." A slew of other studies have found similar results.
An argument used against recovery is that there are some who can't or
won't voluntarily seek treatment or services. Yet there are plenty of
evidence-based ways to reach people, such as motivational interviewing, or employing peer-to-peer support or community health workers to do homeless outreach or to engage with persons with complex mental and physical health needs. But these kinds of strategies are vastly underutilized.
We must advocate for recovery-oriented policies.
Hope is essential for recovery. But hope is not enough. Too many people
are still unable to access the kinds of services and supports that
would help them to recover. In particular, people of color are
overrepresented in our jails and prisons, and are underrepresented in
community-based mental health and social services.
A prime example is in Chicago, where newly re-elected Mayor Rahm Emanuel closed six community mental health clinics in
the most economically disadvantaged parts of the city, which has
resulted in an increase in persons with mental health conditions being
incarcerated in the Cook County Jail for low-level, nonviolent offenses
related to their disabilities. While the recent appointment of a psychologist to
head the jail is a step in a better direction, how will this
appointment impact upon the lack of availability of community-based
services in Chicago for people who desperately need them?
Yet Mayor Emanuel is not unique in his choices. Community-based services have been slashed in
many state and local budgets. Any short-term "savings" accomplished by
such cuts will always be offset by the devastating long-term human and
economic costs that result when we deny quality services and supports
to the people who are most vulnerable.
Mental health legislation has been introduced in the House and is
expected in the Senate. All legislation should be evaluated through a recovery lens and
should clearly address the social determinants of health. Policy should
seek to end deadly cycles of poverty, homelessness and incarceration in
ways that are culturally appropriate, rehabilitative rather than
punitive, and community-based. We can't talk about more hospital beds
without talking about supportive housing and other programs that will
actually help people to stay out of the hospital and out of prison. We
need legislation that tackles disparities in access to education and
employment, and funds proven programs that prevent crisis and
We need sound policies that promote recovery for all Americans affected
by mental health conditions. We don't have the luxury of continuing to
get this wrong. Too many individuals, families, and systems are in
crisis, and it doesn't have to be this way. We need recovery, and we
need it now.
Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and Social Justice
Adapted by Briana Gilmore, March 2015
That is how Ron Manderscheid, PhD, opened his address last month at the Together Against Stigma: Each Mind Matters
conference in San Francisco. Manderscheid joined other mental health
experts in a symposium to discuss how stigma can be reduced or
eradicated through policies that support mental health promotion,
prevention, and early intervention strategies.
opening remarks aren’t hyperbolic. People with mental health and
substance abuse conditions die an average of 25 years before other
citizens. Less than half of those with needs receive any care at all,
and it takes an average of a decade before people access the treatment
they need. Suicide rates are also at the historic high of 40,000 people
a year, exacerbated by the economic insecurity and reduction in services brought on by the great recession. And as Manderscheid and this USA Today article
elucidate, people often only receive care when their experiences have
become severe enough that they have turned into complex, illness- and
symptom-based disabilities. Advocates liken this to only admitting a
cancer patient into treatment when they reach stage four of their
how can policy reduce stigmatization that prevents people from
accessing care, living successfully in the community, and sustaining
recovery? Ron Manderscheid advocates for a five-point reform plan that
Leveling the insurance playing field through parity laws is a first
step to affording equitable treatment for mental health and substance
abuse. Many states and insurance companies are just at the beginning of
implementing successful parity reforms, because they necessitate
sweeping financial, regulatory, and programmatic changes that take time
to adopt. They are also not fully applicable to Medicaid and Medicare
recipients in most states, thus further exacerbating stigma for people
and families experiencing poverty. Parity is now also only available
when a person receives specific treatments. Dr. Manderscheid indicates
that if we want true reform through parity, we need to extend it to
equal housing, equal jobs, equal supports, and equal pay.
Practice is moving rapidly toward fully integrated care through
team-based practice approaches and integrated funding models. True
practice integration, however, must integrate behavioral health clients
with all other clients in health and medical homes. Stigmatization can
sustain practices of exclusion that separate people with behavioral
health needs out and away from their peers and people experiencing
other health-related concerns. “Separate but equal” cannot remain a
valid practice strategy if our system aims to achieve parity.
Achieving the benefits outlined in the Affordable Care Act includes
utilizing resources toward health promotion and prevention. Activities
that sustain these opportunities are also ones that can pay for
resources in the community that help clients recover, experience
wellness, and live full lives. Promoting recovery through policy
means that states and counties need to swiftly invest in integrated
practice that promotes and rewards early intervention and
wellness-based strategies. These types of services have been minimally
financed since psychiatric hospitals started closing decades ago.
Integrating these services into mainstream financing mechanisms and
incorporating them into discharge planning and whole-health treatment
plans is essential to promoting community recovery.
Developing a peer workforce can only enhance parity reforms and promote
dignity and community-based recovery. People with lived experience can
actively reduce stigmatization by gaining employment, and helping
consumers and family members understand that behavioral health is not
something to be feared or diminished. Peers should work across the
health system, not just with behavioral health clients, to offer a wide
range of experiences, values, and capacity to people in recovery across
the wellness spectrum.
Moving “out of the office” toward inclusive participation doesn’t only
include outreach and engagement in services. Participative,
community-based action includes public demonstrations, legislative
hearings, key meetings with public leaders and executives, and
coalition building among organizational leaders. Raising the visibility
of a recovery-based movement is essential to reducing the stigma
associated with mental health and substance abuse treatment.
If we begin with a human rights based approach to equality, and
capitalize on the gains made in the Affordable Care Act, we can achieve
measurable reductions in stigmatization through incorporation of the
“five-P’s” outlined above. Defeating stigma demands civil rights and
social justice actions at every level, including transparency of
effective policy leadership in state and local governments. We are all
responsible for reducing stigma, and we can all create opportunities
for growth and change from policy to practice.
For more information about how policy can reduce stigma, contact Ron Manderscheid, PhD at firstname.lastname@example.org or visit the National Association of County Behavioral Health and Developmental Disabilities Directors at www.nacbhdd.org
News report (7/7/15) Mad in America (http://www.madinamerica.com )
Another Study Finds Gun Violence Not Linked to Mental Illnesses
Yet another study -- this one published in Psychiatric Services (in Advance)
-- has found that risk of gun violence is not linked to mental
illnesses. Instead, once again, substance use and history of violence
were found to be better predictors of violence.
The researchers from multiple institutions examined data
from The MacArthur Violence Risk Assessment Study of 1,136 patients who
had been discharged from acute civil inpatient facilities at three U.S.
sites between 1992 and 1995.
Psychiatric News reported that, "Of the 951
persons available for at least one follow-up, 23 (2%) committed acts of
violence with a gun. These 23 people tended to have admission diagnoses
of major depression (61%), alcohol abuse (74%), or drug abuse (52%)."
"(T)he prior arrest rate of discharged patients who
later committed gun violence was almost twice as high as the prior
arrest rate of the overall sample (89% and 49%, respectively)," added Psychiatric News.
"When public perceptions and policies regarding mental
illness are shaped by highly publicized but infrequent instances of gun
violence toward strangers, they are unlikely to help people with mental
illnesses or to improve public safety," concluded the researchers.
Data Show Mental Illness Alone is Not a Risk for Gun Violence (Psychiatric News Alert, June 23, 2015)
Steadman, Henry J., John Monahan, Debra A. Pinals,
Roumen Vesselinov, and Pamela Clark Robbins. “Gun Violence and
Victimization of Strangers by Persons With a Mental Illness: Data From
the MacArthur Violence Risk Assessment Study.” Psychiatric Services,
June 15, 2015, appi.ps.201400512. doi:10.1176/appi.ps.201400512. (Full text)
April 20, 2015 - News of the Week
THERAPY CAN HELP WITH HALLUCINATIONS
Article forwarded by NYAPRS E-News
Note: Thank you to RECOVER-e Works and their April, 2015 newsletter
authors for the two excellent articles below on CBT for people
experiencing extreme states and with serious diagnoses. Link: http://www.coalitionny.org/the_center/recovere-works/RECOVERe-works114-1April2015.html#Jack
CBT for schizophrenia? You don't know Jack.
by Abigail Strubel, MA, LCSW, CASAC
met Jack in a dual diagnosis/re-entry program for parolees. All had
fascinating stories about survival in prison (Got a little tinfoil? You
can make a decent grilled cheese sandwich in a holding cell with a
radiator). Most were symptomatic, because the policy was to take people
off their medication as they neared release and were transferred to
told our admission coordinator his voices had advised him to skip
intake. However, wary of returning upstate, he endured the appointment
and met me. "I think I'll be able to work with you," he said. "You have
did he, along with a glorious James Brown-esque pompadour. Jack was
meticulous about his appearance. “Even when I was shooting ten bags of
heroin a day, I made sure to shave, bathe, and wear clean clothes.”
"Ten bags a day?" I asked.
"Heroin makes the voices stop," he told me. "Better than any medication I ever tried."
Jack entered my office one day in a funk.
went to public assistance, and I know that lady's going to mess up my
case," he said. "I could tell by how she looked at me. She made this
face"—he pursed his lips and narrowed his eyes—"and the voices started
saying, 'She hates you, she's not going to help you—she's going to get
you all twisted.'"
wasn't there," I responded. "I don't know how she looked at you or what
she thought. But there may be another way to interpret her
expression—it could have been about something that happened before you
even came into her office, or maybe she thought about something going
on in her personal life.
"So the way she acted wasn't because of me?" he asked.
I said. "If you're right and she tries to mess with your case, you know
I'll go to bat for you, make sure you get what you need. But it's
possible something else was going on."
Jack nodded, then cocked his head to the side, listening. "The voices don't believe you," he said.
me tell you about 'automatic thoughts,'" I said, and explained how
almost everyone experiences a barely conscious stream of thoughts
throughout the day. Some thoughts are positive, but many are negative.
We can train people to become aware of their negative thoughts, and
then dispute them.
voices," I said, "are just a louder version of automatic thoughts.
They're not real people; they're your own fears and doubts. When a
voice says something negative, you can disagree. Ask, 'How likely is it
that the welfare lady hated me on sight and wanted to make my life
miserable? Could she have been having a bad day, and taking it out on
me? If she did try to mess up my case, can my counselor help me
straighten it out?'"
thought that over. "You know," he said, "that makes a lot of sense.
Because sometimes I can tell the voices are wrong right off the bat."
"And sometimes you might need to think about it a little more," I said, "or discuss it with me."
treatment progressed, Jack's P/A case was resolved favorably, and he
began contesting the negative voices on his own. Ultimately, he became
a drug and alcohol counselor. His medications may never eradicate his
voices, but now he knows how to dispute them.
Ms. Strubel is a clinical supervisor at Services for the Underserved/Palladia Comprehensive Treatment Institute-Bronx.
Cognitive Behavior Therapy (CBT) for Recovery: The Cutting Edge
by Elizabeth Saenger, PhD
Aaron Beck et al showed
that cognitive therapy can promote clinically meaningful improvements
in people with schizophrenia, even if they have significant cognitive
impairment. That finding was published in Archives of General Psychiatry (now JAMA Psychiatry),
America’s journal of record for the discipline. It surprised clinicians
who thought of CBT as a treatment only for patients who were
But that discovery was three years ago. What have CBT researchers done for us lately?
Here are some advances from the last six months.
CBT as an Alternative to Drugs: A Proof-of-concept Study
it comes to schizophrenia, the British seem to make a habit of
upsetting the medical model. First they rejected auditory
hallucinations as psychopathology, set up a hearing voices movement, and imported the concept to the US. Now researchers across the pond suggest in The Lancet: Psychiatry, the British journal of record, that CBT might get rid of persecutory delusions.
small study focused on people with schizophrenia spectrum disorders.
All had persecutory delusions, and had not taken antipsychotic drugs
for at least six months. Researchers randomly assigned subjects to
treatment as usual, or to a package of brief therapy including four CBT
sessions focused on the subject’s specific delusions.
goal of this package was to change people’s reasoning about their
delusions. Investigators taught subjects to become more aware of their
thinking processes, and to identify and inhibit jumping to conclusions.
Researchers also encouraged subjects to be more analytical. These
interventions increased subjects’ sense that they might be mistaken
about their persecutory beliefs.
results indicate that people were comfortable with therapy, and the
intervention worked. Follow up data collected two months afterwards
suggested the model was definitely useful.
frequently use CBT as an adjunct to psychopharmacology for delusions,
but they rarely use CBT alone. If further research confirms the results
of this proof-of-concept study, perhaps people with schizophrenia will
have more choices in the future. Given the common, generally
unpleasant, side effects of antipsychotic drugs—such as weight gain,
metabolic problems, movement disorders, and an increased risk of
cardiac death—having a meaningful treatment choice in the journey
toward recovery would be most welcome.
Merging CBT with Other Evidence-based Treatments
recent tendency to mix and match evidence-based therapy has led to
instances where CBT has been successfully merged with other
psychosocial treatments. Here are three examples.
Social skills training.
CBT material, such as that described above, can be presented using
social skills training techniques, for example, waving a big flag in
group to identify ("flag") beliefs that do not have evidence to support
them. This treatment merger helps clients with cognitive and social
deficits improve their negative (but not positive) symptoms, and is
helpful for clients regardless of the severity of their cognitive
impairments. Further, because the treatment is repetitive, new clients
can join the group at any point.
Data strongly show that CBT with family psychoeducation reduces
stress, increases medication adherence, and decreases
re-hospitalization. Modules are available that teach parents how to use
CBT techniques with clients in recovery, and in other areas of their
CBT can help clients improve coping skills and challenge distorted
beliefs about their vocational abilities. CBT is now being melded with
supported employment to test the effectiveness of the combination.
Preliminary results suggest people who received CBT in addition to
supported employment might be more likely to work more hours per week.
March 29, 2015 - News of the Week
FIVE TIMELY "TALKING POINTS" WORTH REMEMBERING
Kudos to the Huffington Post's Healthy Living Staff for giving us a
concise, doable and user-friendly list of "do's" for talking about a
Germanwings airline crash that killed all who were aboard a flight to
Dusseldorf on March 24.
"When tragedy strikes, it's a natural human inclination to want an
explanation to help get closure for our feelings of anger and loss.
When such information is unavailable to us, our grief remains in this
limbo of sorts -- or worse, we search for our own answer to help us
ARTICLE: "The Way We Talk About Mental Illness After Tragedies Like Germanwings Needs To Change"
The Huffington Post / By Healthy Living Staff
Media reports erupted today with news that Germanwings co-pilot Andreas Lubitz may have been suffering from depression or another mental illness
when he crashed the aircraft in the French Alps, most likely killing 150 people
, including himself.
While headlines like U.K. tabloid The Sun's "Madman In Cockpit"
are hardly surprising, such sensational links between mental illness
and horrific tragedies can have an undesired outcome when it comes to
Here are five ways to have a more productive
conversation about the complex interplay between mental health,
violence and tragedies such as this one.
1. Depression doesn't cause violence.
The public's perception of mental illness -- which is
largely fueled by movies featuring mentally-ill individuals turned
violent and news headlines that thread mental illness into every story
about mass killings -- needs a readjustment.
People who are depressed are not likely to be violent. If they were, we'd all be in trouble: One in five of us will experience a serious mental health issue at some point in our lives, but only 3-5 percent
of violent acts in the United States are committed by an individual
with serious mental illness -- a tiny fraction of the country's violent
"If we were able to magically cure schizophrenia,
bipolar disorder, and major depression, that would be wonderful, but
overall violence would go down by only about 4 percent," said Dr.
Jeffrey Swanson, an expert on mental health and violence and a
professor in psychiatry and behavioral sciences at the Duke University
School of Medicine, in a recent interview with Pacific Standard.
What makes this misrepresentation even worse is that individuals who suffer from mental illness are 10 times more likely than the general population to be the victim
of violent crime, an under-reported issue that is overlooked in favor
of misleading depictions of depression as a violent condition.
2. Suggesting mental illness as the root
cause of violence stigmatizes those who live healthy, full lives with
conditions like depression.
Approximately one in four U.S. adults
in a given year suffer from a diagnosable mental illness, making it
highly likely that you know someone who has been affected. However, only 25 percent
of people who have mental health symptoms feel that others are
understanding toward people with mental illness, according to the CDC.
And it's no secret why.
Public diagnoses, such as the discussion surrounding the
Germanwings tragedy, plague every single mental illness sufferer. The
truth is, the majority of those who have a mental health problem live
healthy and complete lives. They are reliable at work and beloved by
their families. Yet many people categorize them as "abnormal" because
of unsubstantiated scapegoating during these types of tragedies, which
can have a real impact: Studies have shown that knowledge, culture and social networks
can influence the relationship between stigma and access to care. When
people feel stigma, they are less likely to seek the help they need.
The vast majority of people with mental illnesses are law-abiding, responsible and productive citizens.
3. Mental illness disclosure policies can push people further into the closet.
Lubitz was seeking treatment for an undisclosed medical
condition that he kept from his employers, alleged the public
prosecutor’s office in Dusseldorf, Germany. They didn’t say whether it
was a mental or physical condition, but investigators did note that
they found a torn-up doctor’s note declaring him unfit for work, reported CNN. Employees in Germany are expected to tell their employers immediately
if they can’t work due to an illness, according to Reuters, and that
doctor's note would have kept Lubitz grounded and out of the cockpit.
Lubitz had passed special health screenings, including
psychological ones, before he was hired on as a co-pilot in 2013,
reported ABC News, but unlike in the U.S. airline industry, annual
mental health screenings for pilots aren’t a requirement in Germany.
Additionally, per Federal Aviation Administration rules, U.S. pilots
must disclose all “existing physical and psychological conditions and
medications” or face fines of up to $250,000 if they’re found to have
delivered false information. That means if he were an American pilot,
Lubitz would have been obligated to disclose any and all conditions, as
well as the medicines he was taking, in order to remain in good
standing at his job. Because of these and other policies, U.S. airline
standards are regarded as the strictest and safest around the world (though not without their flaws).
But just because the FAA requires full health disclosure
to an FAA-designated Aviation Medical Examiner doesn’t mean that pilots
may feel completely safe disclosing their conditions, according to Ron
Honberg, director of policy and legal affairs at National Alliance On
“If a person feels that it’s safe to disclose, and that
they’ll have an opportunity to get help -- that there won’t
automatically be adverse consequences like being prohibited from ever
flying again -- then they’re going to be more likely to disclose [a
mental illness],” said Honberg. “But I think historically pilots have
known that if they admitted it, they’d never be able to fly again.”
Generally speaking, barring industries where a person
may be responsible for public safety (like a pilot or a police
officer), one is not obligated to disclose any of this information to
his or her employers in the U.S. Just as people don’t have to tell
their bosses about diabetes, cardiac disease or HIV diagnoses,
employees can’t be forced to discuss their mental health history beyond
anything that may interfere with a person’s function at the job,
explained Honberg. And employers can’t ask job candidates about their
medical records or medical history except to ask about whether
something might impact a person’s functional limitation in a job.
“It has to be focused on if they’re capable of doing the
job,” said Honberg. “Are there physical or mental health factors that
may preclude them from being able to do that?”
The FAA does not track rates of dismissal for pilots who
disclose mental illnesses versus other conditions, or the number of
pilots who continue to fly after disclosing a mental illness. But until
we have all the facts about Lubitz’s situation, it’s important to hold
off on any policy changes that might attempt to close up perceived
loopholes, he said.
“It’s really important to have all the facts,
particularly before we decide on any policies to prevent anything like
this from happening again,” said Honberg. “We want to somehow create a
proper balance that on the one hand protects public safety and on the
other hand encourages people to seek help if needed."
4. The conversation surrounding mental illness and mass violence reveals our ingrained ethnic and racial biases.
Lubitz allegedly committed mass murder and, as many people have pointed out,
it is troubling that his acts are ascribed to mental illness when, if
he were Muslim or a racial minority, he would likely be assigned a
two-dimensional ideological motivation.
Yes, this is a disturbing expression of the dominant
culture's racial pathologies, but rather than trying to correct the
balance by referring to white mass murderers in an un-nuanced fashion, as some have suggested,
perhaps the more productive action would be to view the underlying
mental health problems among everyone who carries out mass violence --
regardless of race, religion or country of origin.
Again, most people with mental illness will never be
violent, but those who are violent often do have an underlying trauma
or condition. "More and more evidence from around the world is
suggesting that many of the terrorists wreaking havoc both in America
and abroad are racked with emotional and mental trauma themselves,"
wrote Cord Jefferson in The Nation in 2012:
To be clear, nobody’s saying that all -- or even most
-- terrorists aren’t cold, bloodthirsty killers who know exactly what
they’re doing every time they commit another heinous act. But there is
reason to believe that a significant number of foreign and domestic
terrorists are suffering from the exact same mental distresses by which
we quickly assume men like James Holmes and boys like Eric Harris and
Dylan Klebold, the Columbine killers, to be afflicted.
Indeed, Jefferson went on to note a study of Palestinian men
who had signed up to be suicide bombers that found 40 percent showed
suicidal tendencies by traditional mental health measures, and
recruiters admitted looking for "sad guys" to carry out mass violence.
More generally, the way we view mental health and race
has a lasting public health impact: Minority and immigrant communities
in the U.S. are dramatically underserved, according to a government report (and corroborated by the American Psychological Association).
One major problem, according to the Surgeon General's report, is
misdiagnosis or lack of diagnosis due to cultural biases on the part of
mental health practitioners.
5. We may never have a diagnosis, and we have to be okay with that.
When tragedy strikes, it's a natural human inclination
to want an explanation to help get closure for our feelings of anger
and loss. When such information is unavailable to us, our grief remains
in this limbo of sorts -- or worse, we search for our own answer to
help us move forward.
In a recent article for The New Yorker, Philip Gourevitch aptly explained this phenomenon:
To be told that a scene of mass death is the result of
an accident of terrorism is to be given not only an explanation of the
cause but also an idea of how to reckon with the consequence -- through
justice, or revenge, or measures meant to prevent a recurrence.
According to CNN, a physician did declare Lubitz unfit
to work the day of the flight, and instead of sharing that information
with Germanwings, Lubitz disposed of the note and boarded the plane.
But even in light of such information, it's highly unlikely that we
will ever know exactly what was going on in the mind of this pilot, and
it is far from our place to speak as though we have a definitive
In the words of Gourevitch, we are left with a sense of
"cosmic meaninglessness and bewilderment" when horrific events such as
this one occur, and while that is one of the toughest collections of
emotions to grapple with, there is no credible alternative in cases
MORE ARTICLES (The Atlantic and The Boston Globe)
March 23, 2015 - News of the Week
!!! PASSING ALONG FOR YOUR INTEREST !!!
NYAPRS Note: Register today for the April 3
BRSS TACS First Fridays with NYAPRS’ own Edye Schwartz, where she will
be describing concrete ways to build effective and sustainable peer run
organizations. This webinar will be relevant for national groups
looking to build peer service options, and for New York agencies
exploring partnership with or expansion to peer run organizations. See
more information and the registration link below!
to the March 2015 BRSS TACS monthly update from SAMHSA’s Bringing
Recovery Supports to Scale Technical Assistance Center Strategy (BRSS
TACS). This month’s update includes: April’s First Fridays with BRSS
TACS event, registration information for the next BRSS TACS webinar,
new SAMHSA grant opportunities, a virtual learning community on
adolescent substance use prevention and treatment, resources about
African-American Behavioral Health, and information about how to
request technical assistance from BRSS TACS.
SAMHSA Grant Opportunities Announced
Substance Abuse and Mental Health Services Administration (SAMHSA),
Center for Substance Abuse Treatment (CSAT) is accepting applications
for State Adolescent and Transitional Aged Youth Treatment Enhancement and Dissemination Planning
[State Youth Treatment - Planning (SYT-P)]. The purpose of SYT-P is to
support states, territories, and tribes to develop a comprehensive
strategic plan to improve treatment for adolescents (ages 12-18) and/or
transitional aged youth (ages 16-25) with substance use disorders
and/or co-occurring substance use and mental health disorders. The plan
will help strengthen the existing infrastructure system to assure that
youth have access to evidence-based assessments and treatment models
and recovery services.
Anticipated Award Amount: Up to $250,000
Application Due date: Monday, April 6, 2015
Click here for more information.
Additionally, CSAT and SAMHSA’s Center for Mental Health Services (CMHS) are accepting applications for the Cooperative Agreements to Benefit Homeless Individuals for States
(CABHI-States). The purpose of this program is to enhance or develop
the infrastructure of states and their treatment service systems. The
program hopes to increase capacity and provide accessible, effective,
comprehensive, coordinated/integrated, and evidence-based treatment
services; permanent supportive housing; peer supports; and other
recovery support services to:
who experience chronic homelessness and have substance use disorders,
serious mental illnesses (SMI), or co-occurring mental and substance
use disorders; and/or
who experience homelessness/chronic homelessness and have substance use
disorders, SMI, or co-occurring mental and substance use disorders.
Anticipated Award Amount: Up to $250,000
Application Due date: Monday, April 6, 2015
Click here for more information.
First Fridays with BRSS TACS
Friday, April 3, 2015
Building Effective and Sustainable Peer Run Organizations
Edye Schwartz, D.S.W., L.C.S.W.R.,
Director of Systems Transformation Initiatives, New York Association for Psychiatric Rehabilitation Services
Click here to learn more about Dr. Schwartz.
Did you miss March’s First Fridays event, “Shared Decision Making: Empowered; Informed; Engaged” with Laurie Curtis?
Click here to review the slides.
Save the Date
The next BRSS TACS webinar, “Motivational Interviewing for Peer Support Workers” is scheduled for Thursday, April 9, 2015 from 2:00-3:30pm ET.
Click here to learn about the presenters.
Screening, Brief Intervention, and Referral to Treatment (SBIRT) Youth Learning Community Webinar
American Academy of Pediatrics and other organizations recommend SBIRT
as part of routine care to prevent or reduce adolescent substance use.
This learning community, sponsored by the Institute for Research,
Education & Training in Addictions, will focus on implementing
SBIRT for youth. It is scheduled for Tuesday, March 31, 2015 from 1:00-2:30pm ET.
Click here for more information.
TACS is dedicated to promoting wide-scale adoption of recovery-oriented
supports, services, and systems for people in recovery from substance
use and/or mental health conditions. The BRSS TACS team can assist you in
your work to promote recovery through free training opportunities,
telephone consultations, email resources, peer learning, webcasts, and
distance learning. If you are interested in receiving technical
assistance please fill out a TA request form and submit it to email@example.com.
Questions or comments about this email? Let us know!
SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities.
1 Choke Cherry Road • Rockville, MD 20857 • 1-877-SAMHSA-7
February 27, 2015 - News of the Week
NYC'S FIRST LADY, CHIRLANE McCRAY, SPEAKS OUT ABOUT MENTAL HEALTHCARE
See her article: http://www.nydailynews.com/news/politics/guest-column-shatter-mental-illness-stigma-article-1.2129792
Article Source: New York Daily News, February 26, 2015
Background Note by Briana Gilmore, NYAPRS (New York Association of Prychiatric Rehabilitation Services )
NYAPRS Note: As NYC First Lady increasingly becomes a champion for
mental health community members, she promotes solutions to complex
problems that the recovery field has worked towards for decades:
increased access, local community services, culturally competent and
linguistically appropriate providers, and the integration of people
with lived experience into treatment. She advocates for an honest
public health dialogue around mental health in order to combat stigma.
Her passion for mental health awareness may make immeasurable strides
in not only the perception of psychiatric diagnoses, but the way people
access and receive services. But how else can a public health dialogue
combat stigma? How can we as a community get ahead of the negative
images perpetuated about us in the media and among our family and
friends? How do we change the statewide and national language of mental
health, in a time where we are incarcerated, victimized, and
criminalized more than any other unique population? Join the
conversation and offer your solution on our facebook community here.
How We Will Shatter the Mental Illness Stigma
By Chirlane McCray
‘I’m sorry, but the doctor isn’t taking new patients right now.”
It took me a moment to grasp what the receptionist was telling
After hours of internet research, innumerable phone calls, and
frustrating discussions with some well-meaning but distant
professionals, the psychiatrist we had identified as a good fit for
Chiara wouldn’t be able to help us.
I hung up the phone and put my head down on the table. My first impulse
was to leave it there until the world started making sense again, but
there was no time for that. My daughter needed help. Our search had begun weeks earlier, when Chiara, then 18 years old,
bravely revealed to Bill and me that she was suffering from anxiety,
depression, and addiction.
I felt everything you’d expect a mother to feel: love, sadness, fear
and a great deal of uncertainty. Our child was in terrible pain, but
because it originated in her brain and not another part of her body,
there wasn’t an established series of steps to follow. We had to trust
the recommendations of people we didn’t really know and make some major
decisions on our own. Our family got lucky. We eventually found the right doctors and program
for Chiara, and I’m happy to report that she is kicking butt at
But even after our crisis ended, I couldn’t forget how scared and
helpless I felt during those first frantic weeks. So I continued my
research, wanting to understand how other people manage in these
situations, especially those who don’t have the same advantages as us.
The more I learned, the harder it was to avoid a troubling conclusion:
Our mental health system is broken — and as a result, we are facing a
national mental health crisis.
Just look at the numbers. All told, 25% of American adults — one in
four — deal with mental illness in a given year. That means it’s pretty
much impossible to go through life without you or someone you love
being touched by mental illness.Tragically, our system doesn’t even begin to address the problem. A
remarkable 61% of New York State adults who need mental health services
aren’t getting them. And it’s not just adults who are suffering — 35%
of New York’s children also go without the mental health services they
The situation is even worse for people of color and those who are
living in poverty. Here in New York City, research by our Health
Department indicates that African Americans experiencing serious
psychological distress are significantly less likely than their white
counterparts to have received treatment in the past year — 30% compared
to 48%. And numerous studies have found that the stresses of low
economic status are often a catalyst for poor mental health.
The first step to solving the crisis is to simply acknowledge that it
exists. We must start a real public conversation about mental illness,
and we must start connecting people to appropriate services. That is
how we will shatter the stigma.
Over the next few months, I will visit New Yorkers in all five boroughs
to hear some of the stories behind the troubling statistics. I will
meet with teenagers, mothers, people without a home, people in jail,
senior citizens and veterans. I am also going to sit down with service
providers and advocates. From them, I will learn what is working — and
what needs fixing.
The stories I hear will inform the plan the de Blasio administration is
developing to build a more inclusive mental health system. This effort
will be led by the Mayor’s Fund to Advance New York City, which I
oversee as chair; the Department of Health and Mental Hygiene, and the
Fund for Public Health.
When I say a “more inclusive” system, I mean one that meets — and
treats — people where they live. That addresses the most pervasive and
burdensome conditions. That promotes the most effective treatments.
That features caregivers who understand the language and culture of the
people they serve.
The good news is that the building blocks of this system already exist.
I’m thinking about the family resource center that I recently visited
in the Bronx, where advocates with experience raising a child with
special needs are sharing that hard-won knowledge with their neighbors.
I’m also thinking about all the public servants I’ve met, from line
staff to commissioners, who are convinced that there has never been a
better time than now to fix a problem that has been building for
And I’m thinking about everyone who helped Chiara regain her
equilibrium. She has built a support network that has grown to include
not just doctors and therapists, but an entire community of people
helping each other walk the long and winding path toward recovery. With
their help, Chiara is stronger than ever.
As I said, our family was lucky. But luck should have nothing to do
with it. Together, we can create a mental health system that meets the
needs of all New Yorkers.
Note: Chirlane McCray is the wife of New York City's Mayor Bill de Blasio
February 19, 2015 - News of the Week
'ASYLUM TALK' ALARMS EXPERIENCED ADVOCATES
Article Source: Mad in America ( http://www.madinamerica.com )
Click article: http://www.madinamerica.com/2015/02/return-asylums-lets-not/
RETURN TO ASYLUMS? LET'S NOT !
by Susan Rogers
Susan Rogers is director of the National Mental Health
Consumers’ Self-Help Clearinghouse, and director of special projects of
the Mental Health Association
of Southeastern Pennsylvania. A writer,
editor, and advocate, she has been active in the c/s/x movement since
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
“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 community.
“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
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.”
News of the Week - January 8, 2015
This thought-provoking article can be found at
Explaining Away Empathy - Mental Illness and Reduced Compassion
by Jennifer Gibson, PharmD
Empathy is critical for health care providers.
Especially in mental health care, empathy and compassion improve
outcomes and enhance overall patient well-being. Thanks to innovative
explorations into the way the brain works, mental illness is
increasingly defined by biological mechanisms. But, new research claims
that these biological explanations lead to less empathy for patients.
A recent trend in mental health has focused on
offering biological and genetic mechanisms for mental illness. Experts
believed that such explanations would decrease the blame that patients
receive for their illnesses since genes, cells, and chemicals are named
as culprits. Feelings of compassion should increase for the patients
since the illnesses are not their faults, right?
In a series of studies, clinicians expressed less empathy and
compassion for patients when symptoms of mental illnesses were
explained with biological mechanisms. The authors of a recent analysis
indicate that biological explanations do decrease patient blame but,
albeit unintentionally, also dehumanize patients. The biological
explanations for mental illness seem to enhance the perception that
patients are abnormal or deserving of social exclusion. In additional
studies, clinicians indicated that they believed psychotherapy would be
less effective and medication would be more effective when mental
illness was explained by biological mechanisms instead of psychosocial
reasons. (Most mental health experts agree that psychotherapy is
effective in many mental illnesses, despite the cause of the illnesses.)
Biological explanations also affect the
perspectives of the patients themselves. Patients who attribute their
conditions to biology are more pessimistic about their prognosis than patients who accept psychosocial explanations for their illnesses.
Many questions still remain about causes,
predictive factors, and prognosis of mental illness, and biological
features should not be ignored as one piece of the mental health
puzzle. The biological conceptualization of many conditions is a
significant step toward the safe and effective treatment of mental
illness. But, like patients with any other condition – cancer, autism,
asthma, or even high blood pressure – patients with mental illness
deserve respect and compassion. Treatment for all patients and all
diseases should focus on the whole patient and consider biology, psychosocial, and emotional factors.
WK, Proctor CC, & Flanagan EH (2009). Mental Health Clinicians’
Beliefs About the Biological, Psychological, and Environmental Bases of
Mental Disorders. Cognitive science, 33 (2), 147-182 PMID: 20411158
EP, Gottdiener WH, & Haslam N (2013). Biogenetic explanations and
stigma: a meta-analytic review of associations among laypeople.
Social science & medicine (1982), 96
, 95-103 PMID: 24034956 *Kvaale
EP, Haslam N, & Gottdiener WH (2013). The ‘side effects’ of
medicalization: a meta-analytic review of how biogenetic explanations
affect stigma. Clinical psychology review, 33 (6), 782-94 PMID: 23831861
*Lebowitz MS, & Ahn WK (2014). Effects
of biological explanations for mental disorders on clinicians’ empathy.
Proceedings of the National Academy of Sciences of the United States of America, 111
(50), 17786-90 PMID: 25453068 *Lelorain S, Brédart A, Dolbeault S,
& Sultan S (2012). A systematic review of the associations between
empathy measures and patient outcomes in cancer care. Psycho-oncology, 21 (12), 1255-64 PMID: 22238060
B, Schmick S, & Lincoln TM (2014). No matter of etiology:
biogenetic, psychosocial and vulnerability-stress causal explanations
fail to improve attitudes towards schizophrenia. Psychiatry research, 215 (3), 753-9 PMID: 24485063
R, Chaudhary R, Ryali VS, Bhat PS, Srivastava K, Prakash J, &
Basannar D (2014). Cross sectional assessment of empathy among
undergraduates from a medical college.
Medical journal, Armed Forces India, 70
(2), 179-85 PMID: 24843209
*Speerforck S, Schomerus G, Pruess S, &
Angermeyer MC (2014). Different biogenetic causal explanations and
attitudes towards persons with major depression, schizophrenia and
alcohol dependence: is the concept of a chemical imbalance beneficial?
Journal of affective disorders, 168
, 224-8 PMID: 25064807
Here's another article describing how the current emphasis on
biological aspects of mental illnesses affects the way diagnosed
individuals are viewed and treated: "Downside of Treating Mental
Illness Like A Physical Problem" by Lindsay Holmes, Huffington Post,
December 1, 2014
December 18, 2014 - News of the Week
CORRECTION added by Jean Arnold on December 20-21, 2014
When I posted this item on Dec. 18, I assumed,
mistakenly, that DJ Jaffe meant SAMHSA when
he told a NAMI audience, "The federal government
spends $130 billion mental health dollars, much
on improving the lives of all Americans." ja
Mr. Jaffe was NOT referring to SAMHSA's budget ($3 to $4 billion dollars)
My mistaken assumption has been deleted.
ARE POLICY MAKERS LISTENING TO ALL INVOLVED ?
Does SAMHSA's mental health budget favor people with minor needs?
Does the term "mental health" exclude individuals with "serious mental illness" ?
questions and more have led psychiatrist Allen Frances to suggest there
is a civil war among mental health advocates. In an ongoing dialogue
with Mad in America's Robert Whitaker, Dr. Frances seems to be siding
with those who say SAMHSA, the federal oversight agency for substance
abuse and mental health programs, has neglected the seriously mentally
ill. Frances also appears to have joined forced meds advocates such as
the Treatment Advocacy Center in Arlington VA. and D. J. Jaffe, an
activist who in 2011 founded the Mental Illness Policy Org, an offshoot
of the Treatment Advocacy Center.
SAMHSA's annual budget
stays close to $3.6 billion. Two-thirds of the SAMHSA budget is spent
on substance abuse, one-third is spent on mental health. Eighty percent
of SAMHSA's Center for Mental Health Services budget targets
individuals with serious mental illnesses. ( Note: SAMHSA is the
nation's Substance Abuse/ Mental Health Services Administration.
SAMHSA's budget for 2014 and its budget request for 2015 are posted
online at http://www.samhsa.gov/budget
SAMHSA's use of the term "mental heath," claiming that it excludes
people diagnosed with serious mental illnesses. To the contrary, SAMHSA
encourages experienced former inpatients diagnosed with serious mental
illnesses to join efforts to avoid the egregious mistakes of the past.
Ex-inpatients are likely to know best what can reduce an escalation of
symptoms. Efforts to intervene early with user-friendly
recovery-oriented methods are rightly included on SAMHSA's list of
advocates are bound to disagree about words. Some people use "assisted"
for what others call "compulsory," or "treatment" when "medication" is
the mandatory treatment. Despite their differences, most members of
the mental health constituency agree on similar goals but have opposing
ideas about reaching them. The choice of words reflects their
October 18, 2014 - News of the Week
SURVIVOR STORIES SHATTER STEREOTYPES
Honors Psychiatric Survivor Carmen Lee
tell us how Winston Churchill and Abraham Lincoln battled
disabling depression even as they made history. But before the general public
can truly empathize with people who have
psychiatric vulnerabilities, we need people of our own time and
environment to tell us what they experience.
access to videos and social media allows the 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 justice. This
public awareness gem (a discussion ice-breaker) captures Lee's
transition from 20 years of hospitalizations to 28 years of tireless
community outreach...and still counting.
In 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.
Carmen 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.
October 1, 2014 - News of the Week
2014 ALTERNATIVES CONFERENCE CONTINUES QUEST FOR SOCIAL JUSTICE
28th annual national conference organized by and for individuals with
psychiatric histories will be held on October 22-26 at the Caribe
Royale Hotel in Orlando, Florida. This annual event has been a
prime catalyst in the building of an active and effective movement for
social justice for people with psychiatric labels.
Register now! Below are links to more information, speakers list, and registration forms.
Article: Mad in America (http://www.madinamerica.com/2014/09/alternatives-conference-helps-movement-grow ) : The Alternatives Conference Helps Our Movement Grow, by Susan Rogers.
Registration forms: http://alternatives2014.mhasp.org/registration
2014 - News of the Week
TO REDUCE GUN VIOLENCE AND SUICIDE
misperceptions must be replaced with facts
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
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
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
complicated the policymaking process. The full article is FREE
ONLINE, click here.
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.
On 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.
2014 - News of the Week
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:
the most misunderstood mental illness?
By Rachel Hobbs
"While mental health stigma is
decreasing overall ... people
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
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
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
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
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
“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
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
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
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,
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
#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.
2014 - News of the Week
A "60 MINUTES" BIAS HARMS
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
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
are painted as consigned to a life of misery and as ticking time bombs
with the potential to become violent at any time."
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
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 "preventable tragedies."
Dr. Torrey's collection of well over 3,000 "Preventable
Tragedies" holds some surprises. After downloading the
homicide summaries years ago, the National Stigma Clearinghouse found
that medication failed to deter homicide in many cases. Further,
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 inmates:
"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."
effect has Dr. Torrey's 20-year over-emphasis on violence had on public
MORE LETTERS AND INFORMATION
For still more
information, read a New York Times 4-part series
on "Rampage Killers" (link is below)
9, 2000 News of the Week
NEW YORK TIMES ATTEMPTS TO UNDERSTAND "RAMPAGE
"Rampage Killers Chart a Well-marked Course to
A 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.)
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.)
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.
access 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.
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.
Times series is well worth saving for study. Click www.nytimes.com/library/national/040900rampage-killers.html
May 2, 2014 - News of the Week
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
abnormalities that block awareness. They say nearly 50 percent of
and bipolar disorder require forced anti-psychotic medication to combat
the assumed cause of treatment refusal. Although the faulty brain
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
University School of Medicine
Issue of Insight
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?
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.
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?
But what about people who won't accept any
treatment, who deny they need any help? How does recovery-oriented care
apply to them?
February 24, 2014
- News of the Week