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 firstname.lastname@example.org.
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
"MADNESS NETWORK NEWS"
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, and
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
& A: Dr. Insel and Dr. Suzanne Koven, The Boston Globe,
12/16/2013), to name just two of many critics of current psychiatric
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
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 issues).
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
the digitized e-books are undeway.
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
more information about how to purchase all, or parts of the Madness
Network News archive.
January 18, 2014 - News of the Week
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
review by Richard 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
approach, and from the 1990s onward,
Dr.Torrey enjoyed a lion's share of media coverage concerning
mental illnesses. The consequences?
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"
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
to prosecute the case has been cited and
the FBI has opened an investigation to see if Thomas’ civil
rights were violated.
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.
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)
Source: NYAPRS (New York
Association for Psychiatric Rehabilitation Services)
2014 - News of the Week
TAKES HEAT FOR HIS VIEWS ON MARIJUANA
THE PUBLIC NEEDS FACTS ABOUT POTENTIAL HARM
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
Mr. Dolce interviewed Dr. Lester Grinspoon, a well-known
longtime promoter of smoking cannabis. The interview gives an
glimpse of Dr. Grinspoon's idyllic view of marijuana, while dissing
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
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
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"
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
Experiment," NYTimes 1/3/2014
Doubles Mental Illness Risk" (Christchrch New Zealand)
linked to brain-related memory woes, schizophrenia risk in
teens" (CBS News)
Marijuana Experiment" (New York Times editorial)
Use and Risk of Incidence...10 Year Follow-Up Cohort
Study" (Medscape signup needed)
2013 - News of the Week
HEALTH CONSUMER NETWORKS ARE IN JEOPARDY
proposed Congressional Bill is described as helping families in
health crisis. Unfortunately, the bill includes onerous
provisions that would halt effective wellness programs designed by
ex-patients. This alarming Bill would "slash funding
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
encourage the use of force and coercion..." (NDRN).
(NYAPRS, New York Association
Rehabilitation Services; NDRN, National Disability Rights Network)
"Helping Families in Mental Health Crisis Act" was introduced
on December 12 by Rep.Tim Murphy of Pennsylvania.
following links and learn more about this threat to progress.
By David Sherfinski, The
Washington Times, 12/12/13
Urge Congress to Protect SAMHSA and Consumer
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
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!
your Senators and your Representative about these vital programs.
need to hear from YOU now.
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.
Tim Murphy of Pennsylvania released a
mental health bill that—among many other disturbing
reorganize SAMHSA and end funding for state networks, the
Alternatives conference and technical assistance centers.
to do now:
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).
our petition on
Change.org: Go to http://ncmhr.org and
look for the Action Alert with a link to the petition and more
instructions on how counter Tim Murphy’s bill that you will be
receiving in a few days.
to do it:
FIND your U.S. Senators
Click the name of each Senator, scroll down to “ Contact
to send them an email. Before sending, copy and save your message.
Request a reply. You can also call their office and leave a
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
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
mental health consumer network yet tell them you need one.
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.
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
2013 - News of the Week
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
United States." Luhrmann's piece begins, however, with two
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
But auditory hallucinations occur in conditions other
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
'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
spokespeople is badly needed.
NIMH (National Institute of Mental
12-month prevalence," website (2013)
Wallace et al. "Serious criminal
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)
THIRTY-SIX ADVOCACY GROUPS
PRESS FOR FAIR REPORTING
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,
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: 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
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
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.
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
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
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
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
the Surgeon General’s Report on Mental Health in 1999 and the
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 services.
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
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
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.
Association of People with Disabilities
Association on Health and Disability
Home Page/National Stigma Clearinghouse
Housing and Development
of Programs for Rural Independent Living
Self Advocacy Network
Street AEH Inc.
Center for Mental Health Law
Legal Rights Project
Consumer Recovery Coalition
Rights Education and Defense Fund
People of America
Health Association of Nebraska
Health Association Orange County, Inc.
Health Association Suffolk County
Association for Rights Protection and Advocacy
Coalition for Mental Health Recovery
Council for Community Behavioral Healthcare
Council on Independent Living
Disability Rights Network
Mental Health Consumers’ Self-Help Clearinghouse
York Association for Psychiatric Rehabilitation Services, Inc.
Family and Consumer Services
County United Veterans
Program for Recovery and Community Health
October 4, 2013 - News of the Week
NEW VIOLENCE STUDY
SHATTERS POPULAR BELIEFS
Psychiatric Factors Not Linked To Multiple Homicide Victims
Clinical and Research news; Mark Moran; September 17, 2013
Source: Thank you Briana Gilmore,
Characteristics of Homicide Defendants” is posted at http://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
Factors Not Linked to Multiple Victims” is posted at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
Though more than a
the defendants had prior psychiatric treatment, few received treatment
in the three months preceding the crime of which they were accused.
Psychiatric factors do
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
appearing in the SeptemberAmerican Journal of Psychiatry that
assessed the association between homicide and a wide range of
demographic and clinical variables.
Researchers 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.
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.
Individuals with an Axis I disorder were
overrepresented in homicide defendants, but this was due to the high
rate of substance use disorders found in this population.
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.”
In the study,
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
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.
That 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
Steven Hoge, M.D., says
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
Steven Hoge, M.D.,
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.
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
Hoge also said the
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.
Characteristics of Homicide Defendants” is posted athttp://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
Factors Not Linked to Multiple Victims” is posted athttp://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
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
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 "schizophrenia"
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.
commentary by Linda Rosenberg
President and CEO, National Council for Community Behavioral
A Commentary and Source Materials by
Director, National Mental Health
Consumers' Self-Help Clearinghouse
find it surprising that “60 Minutes,” which has a history
serious investigative journalism, would do such a slipshod job on the
segment “starring” E. Fuller Torrey.
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
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
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.”
did they include any information about the Hearing
which helps people learn to cope effectively with the experience of
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
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
. . [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.”
“60 Minutes” producers made a serious error in relying upon
E. Fuller Torrey as its main source. Torrey
admits to fabricating
“evidence” to further his goal of making it easier to
people who have psychiatric diagnoses. Toward this end, he has for
years engaged in “an intensive public relations campaign linking
mental illness with
contrary, according to a NY
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.
Minutes” should do a follow-up piece in which it strives for
accuracy, as opposed to sensationalism.
Mental Health Consumers’ Self-Help Clearinghouse
Health Association of Southeastern Pennsylvania
Chestnut Street, 11th Floor
National Mental Health Consumers’ Self-Help Clearinghouse
consumer-run national technical assistance center funded in part by
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
INTERVENTION TEAMS : Will New York City Act At Last?
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 concerns – often resulting in traumatizing and
sometimes tragic encounters between the police and individuals
experiencing emotional distress.
In 2012, the family of 30 year-old
Shereese Francis called for an ambulance as she was showing signs of
emotional distress. When the police arrived on the scene, they chased
Shereese around her home, amplifying her distress. Instead of
de-escalating the situation, four police officers finally laid on top
of Shereese in an attempt to subdue her, and she died.
NYPD police beat Dustin so badly they
broke his nose and injured his eyes. The 23 year-old was waiting with
police because his family had called for an ambulance when he was in
emotional distress. There was no claim he was holding a weapon or being
Change for the Better
Statistics show that a large percentage of the
calls fielded by the NYPD involve a person facing an emotional crisis.
By recognizing the challenges and realities of this fact, we can make
our streets safer for people with mental illnesses and for the police
officers who respond to their calls.
Crisis Intervention Teams are vital to
reversing the trend of criminalizing people in crisis and depriving
them of the human rights that they deserve. Instead of being
incarcerated, people in crisis need treatment, housing, respite, and
support in order to recover and live to their potential.
We believe that a successful plan to address
issues regarding the policing of people in crisis depends on a
multi-part program and the successful cooperation between many
different entities: the NYPD and the community; the courts and
activists; mental health consumers and healthcare providers.
CCIT-NYC is committed to a citywide approach.
Real change will only be achieved when a program is up-and-running 24
hours a day, seven days a week, in all five boroughs, and accessible to
every New York City resident. Our plan for such change consists of
Community Crisis Intervention Teams
Our proposal calls for a pilot project
establishing at least one specially trained Crisis Intervention Team in
every borough. These teams would operate out of existing facilities and
be ready 24 hours a day to respond to calls involving mental health
Training police officers to respond more
effectively to mental health recipients in crisis will result in the
successful de-escalation of more EDP calls, and will therefore empower
the NYPD to more efficiently deploy their time and resources while
maintaining better community relations.
In a city as large and complicated as New York
City, it is imperative that a committee be formed to ensure that
consistency is maintained across the precincts, and that best practices
are effectively identified and shared. Such a committee would also be
responsible for directing and vetting training programs, hiring, and
The Communities for Crisis Intervention Team
will call for a model that works in NYC through the introduction of a
NYC Council resolution and NYS legislation. See the Proposals
section of this website for more info.
Who We Are
We are a coalition of activists, advocates,
and other community and non-profit members working to promote human
rights, dignity and safety for people in New York City who come in
contact with the NYPD.
How You Can Get Involved
Please join with over 22 organizations on Wednesday, September 25, at
noon, on the steps of City Hall in Manhattan as we call for needed
change. Visit the Events section of this
website to find out more.
We are also seeking organizations to join our campaign. Join
Nami Metro NYC, 100 Blacks in Law Enforcement, Community Access, and
others as we advocate for Crisis Intervention Teams in NYC.
For more info, please contact:
Community Organizer, Community Access
(212) 780-1400, ext. 7726
August 19, 2013 – News of the Week
PEERS AT WORK
A striking video
(Huffington Post, 8-15-13) explains how Lisa Halpern, a young woman
diagnosed with schizophrenia, helps others cope with this
much-misrepresented diagnosis. Ms. Halpern is Director of Recovery
Services at a mental health services facility where she oversees 18
peer recovery coordinators. By sharing her lived experiences, she helps
to reduce the isolation that nearly everyone with a serious psychiatric
vulnerability faces or will face.
Here's the link for the
At Work: My Schizophrenia Helped Me Find A Job (VIDEO)
July 5, 2013 - News
of the Week
MALAJUSTMENT WEEK HAS ARRIVED !!!
Long ago, David Oaks and his staff at Mindfreedom International chose
the week of July 7, 2013 to celebrate the role of 'creative
malajustment' in ending social injustice through non-violent
revolution. Then, six months ago, David suffered a near-fatal
fall followed by complications.
Yet this ambitious first-time-ever event moved forward (as has David
Oaks's recovery) as seen in a beautiful description at http://www.cmweek. org
June 27, 2013 - News
of the Week
REFORMS ARE HAVING AN "INCREDIBLY POSITIVE IMPACT" ON VERMONT'S MENTAL
to advocate Morgan Brown (http://beyond-vsh.blogspot.com/)
for forwarding a Times
Argus article by Peter Hirschfield, 6/22/13 "Good News is reported in mental health care
two years have passed since the historic floods inundated the state's
52-bed psychiatric hospital, crippling the state's ability to care for
its most acutely ill residents..." (more)
for urgent action unleashed a strong, united push for more
community-based care. In 2012, the state passed a wide-ranging
mental health bill intended to increase options for early-stage
intervention, and to spare many patients from involuntary in-patient
able to do things today that we would not have been able to do two
years ago, and it's having an incredibly positive impact on our ability
to intervene in meaningful ways..." (more)
Julie Tessler, executive director, Vermont Council of DMH
Services, praised the community-based model while suggesting that
change won't be easy. "The system
is still one that reacts to crisis, instead of trying to prevent it in
the first place. Rectifying shortcomings in the system will mean
allocating to mental health care the same level of financial resources
being directed to more conventional health care services. We have made
tremendous headway..." but "We really need a whole lot more to make a
June 16, 2013 - News
of the Week
(Changes made on June 20)
BAD RAP CONTINUES...
The most useful
diagnostic terms describe a condition; 'schizophrenia' does not
Dr. Sally Satel, author and psychiatrist, continues to
raise eyebrows. A recent After Words interview on C-Span with Dan
Vergano glued me to the screen for the entire hour. She was a
perfect guest -- engaging, charismatic, thoughtful -- as she
cautioned us to avoid premature and
unrealistic expectations of emerging brain imaging technology, and
explained her views on addiction treatment (her field of expertise).
I am concerned, though, about how she used the word
'schizophrenia'. Yes, I'm over-sensitive about it, but today the
label alone can punish patients with a presumption of violence and
social rejection. Dr. Satel and other psychiatrists
the ability to lighten such unwarranted penalties. But simply
of violent acts is not enough.
One way to help is to support patients and ex-patients. Dr. Satel
other critics have dismissed ex-patients' lived experience with the
mental health system as irrelevant and anti-psychiatry. Yet survivors
of schizophrenia can
share valuable insights about managing symptoms and improving
treatments. Encouraged by the federal agency SAMHSA, individuals
who have 'been there' are at last being heard.
During the C-Span interview, Dr. Satel listed a group of what she
called chronic and relapsing brain
-- multiple sclerosis, schizophrenia, Alzheimer's, and Parkinson's
disease. Such illnesses, she said, can't be modified by a person's
desire to be well because they require interventions such as
medication. (Her point was to differentiate brain diseases from
But Dr. Satel's premise is flawed. Schizophrenia is fundamentally
unlike Alzheimer's and Parkinson's disease. The most obvious
difference is schizophrenia's lack of conclusive biological brain
markers. Further, many experts believe that a patient's
psychological attributes can influence a physical affliction. This is
certainly true for schizophrenia, where patients who have hope and
support tend to fare better than those who rely on meds alone.
Dr. Satel's description of schizophrenia as a 'chronic and relapsing
brain disease' also contradicts well-documented histories of full or
partial recovery. While researchers continue to search for
biological underpinnings in the brain, a growing number of
schizophrenia survivors have gone public with wellness stories.
Among prominent survivor leaders are Pat
Saks, and David
Oaks, who were
diagnosed and hospitalized for schizophrenia in their teens or early
They and their colleagues find innovative, resourceful ways to
lessen despair and enlighten the public.
Over decades, the word schizophrenia has been co-opted and distorted by
entertainment and marketing industries that find its air of mystery
and exploitable. Even academics who should know better sometimes
confuse it with split personality. And a 20-year emphasis on
violent behavior -- disproportionate to its incidence -- has left its
mark on public opinion.
The most useful diagnostic terms briefly describe a
condition. Just as the Japanese chose to use a descriptive term, integration disorder, we too must search for an appropriate
word to replace the fanciful and hopelessly corrupted 'schizophrenia'.
Beginning with a
historical recap, this article traces the current shift toward
recovery as experienced by
individuals diagnosed with schizophrenia. Nearly a dozen
individuals contributed varied views of
what recovery means. The result: a
barrier-breaking boost toward public understanding.
June 6, 2013 - News of the Week
CENTER ALERT: Stigma Wins, Privacy Loses in HHS Proposal
Source: Judge David L. Bazelon
Center for Mental Health Law www.
bazelon.org Washington DC
Proposal Would Diminish Privacy Protections
4, 2013 -- The Department of Health and Human Services (HHS) proposes
to change the Health Insurance Portability and Accountability Act
(HIPAA) in a way that singles out the records of people with mental
illnesses. The changes would apply different rules to certain mental
health records for the purpose of ensuring that more records are
reported to the FBI's gun database.
believe this is unnecessary, will not achieve the intended purpose of
reducing gun violence, and will only further stigmatize people with
mental illnesses and mental health treatment.