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


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Editor: Jean Arnold
Email: jeanarnold@stigmanet.org

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Stigmatizing Fear Tactics

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Kendra's Law Updates (2006 - Current)
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June 4, 2016 - News of the Week

March 29, 2016

What’s at Stake When Race and Coercive Mental Health Treatment Collide?

by Octavio N. Martinez and Grgory Vincent


In 2009, a team of Duke University researchers set out to answer one of the thorniest questions at the intersection of mental health policy and race: Is the practice of involuntary outpatient commitment used more often with African-Americans than whites? And if so, what does that mean?

It was an important question to answer seven years ago. It’s even more important now, on two fronts.

We’re at a moment in the nation’s political consciousness when issues of race and state coercion are at the forefront. We also, somewhat coincidentally, may soon see the largest structural change to the nation’s federal mental health care system in decades, with reform bills currently under debate in both houses of Congress.

Both bills include increased funding for state programs that support involuntary outpatient commitment, or assisted outpatient treatment as it’s sometimes known. The practice allows judges to order people with serious and persistent mental illness to involuntary outpatient treatment plans even if they haven’t broken any laws or reached the threshold for inpatient commitment.

It’s an issue that has divided the mental health community to a rare extent. For its advocates, it’s a humane alternative to leaving people to deteriorate to the point where they’ll end up in jail, on the streets, or in acute crisis. For its critics, it’s an unnecessary and potentially traumatic act that violates people’s civil liberties and serves politically as a deflection from the real problems facing the mental health care system.

From either direction, questions over racial disparities need to be recognized and addressed sooner rather than later. We have to pay close attention, in other words, to the answers from that 2009 paper, and perhaps even closer attention to the much larger structural questions the researchers candidly admitted they couldn’t answer.

The researchers found that in New York, where the study was conducted, African-Americans were over-represented by a factor of five, compared to whites, among those mandated to outpatient commitment.

Upon closer inspection, the data showed that the reasons for this difference aren’t likely to be any bias or prejudice at the moment a clinician recommends outpatient commitment, or a judge orders it. Instead, it’s pre-existing disparities in factors like poverty, severe mental illness, and public hospitalizations.

In this realm, as in so many others, our nation’s history of racism and discrimination has rendered African-Americans more vulnerable and exposed. And these fundamental disparities have to inform the questions we ask about public policy.

Loss of autonomy over one’s own life and choices matters to all of us, of all races, but it may matter more when state coercion is applied to people from groups that have historically been subject to horribly unjust and destructive state coercion. It may mean that the protection of autonomy and liberty, for a person of color, should weigh heavier in the balance against the potential good of the forced treatment.

These aren’t easy concerns to balance. But the federal mental health care system, and any new laws that change it, can and should address them. There is more research to be done on potential disparities at all levels of the mental health care system. There is more work to be done integrating cultural and linguistic competency into the mental health care system. There is more research needed on the outcomes of outpatient commitment programs.

Above all, we all have a responsibility to make sure that we are not perpetuating a broader system of racial injustice and disparity. We have to be vigilant, particularly when it comes to programs that are coercive. The existing research on the outcomes of such programs is mixed, but even if they are beneficial, it is no guarantee that if the practice is expanded at the state level, each program in each state will be beneficial. If history is any guide, what may work well in New York for example, without bias or prejudice, could become something discriminatory and destructive in another state.

If lawmakers do end up moving forward on increased funding for involuntary outpatient commitment, let’s put measures in place to study the outcomes, identify racial differences and potential disparities, and revoke funding if state programs prove ineffective or discriminatory.

January 28, 2016 - News of the Week


Why You Should Never Use the Term "The Mentally Ill"

Article By Jeff Grabmeier  MedicalXpress.com January 26, 2016


Even subtle differences in how you refer to people with mental illness can affect levels of tolerance, a new study has found.

In a first-of-its-kind study, researchers found that participants showed less tolerance toward people who were referred to as "the mentally ill" when compared to those referred to as "people with mental illness."

For example, participants were more likely to agree with the statement "the mentally ill should be isolated from the community" than the almost identical statement "people with mental illnesses should be isolated from the community."

These results were found among college students and non-student adults - and even professional counselors who took part in the study.

The findings suggest that language choice should not be viewed just as an issue of "political correctness," said Darcy Haag Granello, co-author of the study and professor of educational studies at The Ohio State University.
"This isn't just about saying the right thing for appearances," she said. "The language we use has real effects on our levels of tolerance for people with mental illness.  Granello conducted the study with Todd Gibbs, a graduate student in educational studies at Ohio State. Their results appear in the January 2016 issue of The Journal of Counseling and Development.

The push to change how society refers to people with mental illness began in the 1990s when several professional publications proposed the use of what they called "person-first" language when talking about people with disabilities or chronic conditions.

"Person-first language is a way to honor the personhood of an individual by separating their identity from any disability or diagnosis he or she might have," Gibbs said.  "When you say 'people with a mental illness,' you are emphasizing that they aren't defined solely by their disability. But when you talk about 'the mentally ill' the disability is the entire definition of the person," he said.

Although the use of person-first language was first proposed more than 20 years ago, this is the first study examining how the use of such language could affect tolerance toward people with mental illness, Granello said.  "It is shocking to me that there hasn't been research on this before. It is such a simple study. But the results show that our intuition about the importance of person-first language was valid."

The research involved three groups of people: 221 undergraduate students, 211 non-student adults and 269 professional counselors and counselors-in-training who were attending a meeting of the American Counseling Association.  The design of the study was very simple. All participants completed a standard, often-used survey instrument created in 1979 called the Community Attitudes Toward the Mentally Ill.

The CAMI is a 40-item survey designed to measure people's attitudes toward people with diagnosable mental illness. Participants indicated the degree to which they agreed with the statements on a five-point scale from 1(strongly disagree) to 5 (strongly agree).

The questionnaires were identical in all ways except one: Half the people received a survey where all references were to "the mentally ill" and half received a survey where all references were to "people with mental illnesses."

 The questionnaires had four subscales looking at different aspects of how people view those with mental illnesses. The four subscales (and sample questions) are:

  • Authoritarianism: "The mentally ill (or "People with mental illness") need the same kind of control and discipline as a young child."
  • Benevolence: "The mentally ill (or "People with mental illness") have for too long been the subject of ridicule."
  • Social restrictiveness: "The mentally ill (or "People with mental illness") should be isolated from the rest of the community."
  • Community mental health ideology: "Having the mentally ill (or "people with mental illness") living within residential neighborhoods might be good therapy, but the risks to residents are too great."

Results showed that each of the three groups studied (college students, other adults, counselors) showed less tolerance when their surveys referred to "the mentally ill," but in slightly different ways.

College students showed less tolerance on the authoritarianism and social restrictiveness scales; other adults showed less tolerance on benevolence and community mental health ideology subscales; and counselors and counselors-in-training showed less tolerance on the authoritarianism and social restrictiveness subscales.

However, because this was an exploratory study, Granello said it is too early to draw conclusions about the differences in how each group responded on the four subscales.

"The important point to take away is that no one, at least in our study, was immune," Granello said. "All showed some evidence of being affected by the language used to describe people with mental illness."

One surprising finding was that the counselors - although they showed more tolerance overall than the other two groups - showed the largest difference in tolerance levels depending on the language they read.  "Even counselors who work every day with people who have mental illness can be affected by language. They need to be aware of how language might influence their decision-making when they work with clients," she said.

Granello said the overall message of the study is that everyone - including the media, policymakers and the general public - needs to change how they refer to people with mental illness.  "I understand why people use the term 'the mentally ill.' It is shorter and less cumbersome than saying 'people with mental illness," she said.

"But I think people with mental illness deserve to have us change our language. Even if it is more awkward for us, it helps change our perception, which ultimately may lead us to treat all people with the respect and understanding they deserve."



January 4, 2016 - News of the Week


Has  "anosognosia" tripled in ten years?

The diagnostic term "anosognosia," was created in 1914  by Joseph Babinski, a French-Polish neurologist.  The diagnosis is primarily given to stroke patients who have lost awareness of a body part, a condition attributed to brain lesions.

In 2000, intense lobbying by Dr. E. Fuller Torrey and  Dr. Xavier Amador convinced psychiatrists to add anosogosia to the psychiatrists' diagnostic bible, the DSM-IV.  Anosognosia can be used to justify coercive treatment; this and the uncertainty of its relevance to mental illnesses raises moral and ethical concerns among its critics.

Before "anosognosia" became a psychiatric diagnosis, psychiatrists had relied on a "lack of insight" concept that  allowed patients at least some voice concerning their treatment and medications.  Now, the Treatment Advocacy Center in Arlington, Va (TAC)  has reportedly conflated "lack of insight" with anosognosia.

It's worth noting that in 2004, Anthony S. David and Dr. Amador estimated that 15% of people with schizophrenia were affected by anosognosia (source: Wikipedia)  That estimate has increased alarmingly. According to TAC, the 15% has grown to 50% for people diagnosed with schizophrenia, 40% of those with bipolar disorder.  TAC and other coercion supporters also consider potential violence to be a hallmark of anosognosia.  

An even further escalation of anosogosia has come from promoters of Congressional bill #HR 2646.  When asked by a radio host if mentally ill people are more likely to be violent, Rep.Tim Murphy prefaced his circuitous answer by noting that "we're dealing with 60 million folks..."  (10 million is the typical estimate of people diagosed with schizophrenia and bipolar disorder.)  The Murphy statement suggests a flexible approach to diagnosing anosognosia.       http://whyy.org/cms/radiotimes/2015/12/01/mental-illness-and-the-law/

How times have changed since 2000.  In Dr. Amador's book. "I Am Not Sick,  I Don't Need Help," he considered coercive treatment to be counter-productive. The book makes a convincing case that a treatment partnership is more effective than coercion and its results are more lasting.


"Anosognosia: How Conjecture Becomes Medical Fact" by Sandra Steingard, MD, concerning the rise of the term "anosognosia" in psychiatry

"Psychiatrists Raise Doubts on Brain Scan Studies"

 Read more about insightul awareness in "The Issue of Insight" by Larry Davidson, Yale University Medical School,

Here's a brief description of the source of the word "anosognosia"
June 11, 1914. In a brief communication presented to the Neurological Society of Paris, Joseph Babinski (1857-1932), a prominent French-Polish neurologist, former student of Charcot and contemporary of Freud, described two patients with “left severe hemiplegia” – a complete paralysis of the left side of the body – left side of the face, left side of the trunk, left leg, left foot. Plus, an extraordinary detail. These patients didn’t know they were paralyzed. To describe their condition, Babinski coined the term anosognosia – taken from the Greek agnosia, lack of knowledge, and nosos, disease. [13]


December 1, 2015 - News of the Week


Three questions need answers. Has Kendra's Law reduced violence?  Does the law alienate people who need help?  Does the fear-focused marketing strategy used to pass New York's Kendra'a Law distort public understanding of the nation's violence?
It took 6 years of "imminent-danger" marketing by determined activists to launch Kendra's Law (KL), a compulsory treatment law intended for people with serious mental illnesses.  Marketed as a public safety necessity, Kendra's Law was approved with unheard-of speed  by New York's legislature and Governor George Pataki, and began operation in November 1999.  The framers' ultimate goal -- a nationwide expansion of compulsory treatment -- has become a mainstay of HR 2646 now under discussion in the House.  HR 2646 is one of several healthcare laws under consideration.

A tabloid editorial, "All right, let's turn back the clock" (NY Post (10/15/93), was an early sign that fear tactics would dominate the campaign for involuntary outpatient commitment (now called "assisted outpatient treatment" or AOT). Dr. E. Fuller Torrey launched the campaign at an APA conference in Baltimore with an unsubstantiated assertion: "The public stereotype that llinks mental illness to violence is based on reality, and not merely a stigma."

Next came opinion pieces, interviews, television features, and books by Kendra's Law's creators :  Help the Ill Before They Kill - Armed and Dangerous -  Imminent Danger - Why Deinstitutionalization Turned Deadly, - Mental Illness, Public Safety - Deadly Madmen - The Insanity Offense: How America's Failure to Treat The Seriously Mentally Ill Endangers Its Citizens -  to name a few.

Critics say KL's marketing strategy has reduced community willingness  to accept supportive services. They contend that fear of coercion turns away people in need.   HR 2646's remedies -- coercion and institutions -- are unacceptable to ex-inpatient activists who want to expand existing programs that engage people who need help in non-threatening, non-stigmatizing community settings.
Supporters of HR 2646 proclaim KL's success by quoting numbers.  Oddly, the outcome figures most quoted are based on data gathered not by outsiders but by the program's staff in 2005.  At the time, 85 percent of Kendra's Law participants had no history of violence to others during the 3 years prior to entering  the program.  A later "first-ten-year report" simply repeats the 2005 outcome figures.

The public needs to know the 10-year outcomes for KL participants who had committed violent acts toward others before enterng the program. The law's expansion seems unjustified without an independent evaluation of the target population's long-term outcomes.

It is disappointing that the media madness leading up to the passage of Kendra's Law missed a timely opportunity to protest Gov. Pataki's drastic cutbacks to New York's struggling mental-health system.  Instead, the fear-focused publicity transformed patients into imminent threats to every New Yorker.

It's been twenty-two years since the New York Post's "Let's Turn Back the Clock" editorial,  and HR 2646 would make it happen.

                                                                         MORE INFORMATION

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

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

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

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

2nd independent evaluation by Jo C. Phelan et. al,  published in Psychiatric Services 2010 
Effectiveness and Outcomes of Assisted Outpatient Treatment in New York State 

This evaluation was published in February 2010 after its initial presentation at the annual conference of the Internationals Association for Forensic Mental Health Services, Vienna, Austria, July 14-16, 2009. 

3rd independent evaluation by Pamela Clark Robbins, et.al, published in Psychiatric Services 2010 
Assisted Outpatient Treatment in New York: Regional Differences in New York's  AOT program
This independent report includes several charts to illustrate the uneven implementation of Kendra's Law from 1999-2006 .

August 14, 2015 - News of the Week


A highly respected and successful 100% peer-run program in Poughkeepsie NY, PEOPLe, Inc., helps people whose lives have been derailed by mental health diagnoses.  Opening soon, a crisis and stabilization center will expand PEOPLe Inc's recovery-oriented treatment options.

Under the leadership of executive director Steve Miccio, PEOPLe, Inc. brings hope and renewal to New Yorkers diagnosed with mental illnesses and to those whose conditions are complicated by mind-altering substance use. The program has been acclaimed and copied by activists here and abroad, despite derision of its user-friendly approach from advocates of forced treatment.



in article that is also about the recovery movement.

July 1, 2015 - News of the Week


Or will it arrest progress and turn back the clock on mental healthcare

Congressman Tim Murphy (R-PA) has vowed  to conquer a thorny national disgrace: the public's neglect -- many would say abandonment -- of psychiatrically-labeled Americans and their families.

Rep. Murphy and Rep. Eddie Bernice Johnson (D-TX) have proposed a bill, HR 2646, titled "Helping Families in Mental Health Crisis Act of 2015," to rescue suffering families with psychiatrically-labeled members who are unable to find appropriate treatment and housing.

(Link to text of HR 2646 introduced June 4, 2015)

But the 173-page bill goes far beyond helping families in crisis.  It proposes a massive restructuring of a system that distributes billions of federal mental health dollars to states and federal agencies. The question is whether HR 2646 would replace an unmanageable system with a worse one.

1) The bill does not address the negative public attitudes that have derailed attempts to establish community housing and supports.   For forty years, essential housing and supportive programs have been rejected by communities, leaving only a small percentage of  families able to find crucial community support.  This serious impedimentt to community inclusion has caused untold pain and jeopardized the well-being of all concerned.

2) The bill has impressive support from pharmaceutical companies.  It's now become clear, however, that countless lives were damaged by over-diagnosis and over-medication while families were assured by trusted experts that neuroleptics were completely safe.  Many of us see the bill's overwhelming support by big pharma as an ominous sign.  Provisions in HR 2646 assure that forced meds will be expanded.  And progress toward treatments using less medication will be curtailed or defunded.

3) Another concern is the Murphy bill's disabling of SAMHSA, a federal overseer of mental health and substance abuse programs.  HR 2646 culminates an ongoing attack on SAMHSA led by Dr. E. F. Torrey and D. J. Jaffe who have for years disparaged  SAMHSA's encouragement of former patients who favor recovery-oriented practices.   Just as the rise of experienced  ex-patient voices is beginning to shape positive changes in mental healthcare, the bill's dismantling of SAMHSA would make client activism more difficult. 

4) Beyond the "disable SAMHSA" provisions, HR 2646 curtails the ability of patients and their advocates to seek social justice.   It strips Protection & Advocacy agencies of their ability to assist their clients beyond "abuse and neglect."  This gratuitous restriction prevents advocacy for better services.

MORE about the bill....

The Murphy-Johnson bill overlooks a main reason millions of people with psychiatric labels are destitute.  Advocates have for 40 years sought the effective community treatments, safe housing, programs and services that were promised when psychiatric institutions were emptied into unprepared communities. Yet the public has consistently and effectively blocked community housing and support.  Why?  There is an unreasonable amount of fear and rejection of people with psychiatric labels.  This fact was stated most strongly by former Surgeon General David Satcher in his groundbreaking mental health report of 1999:  "Because most people should have little reason to fear violence from those with mental illness, even in its most severe forms, why is fear of violence so entrenched?"   At least some of that unwarranted fear was deliberately spawned by supporters of forced outpatient medication to promote their controversial agenda.

Using a twisted but effective strategy, suppporters of compulsory medication chose to "capitalize on the fear of violence" (their words) for 20 years to win public support for involuntary outpatient treatment and re-institutionalization.  How will Rep. Murphy and Rep. Johnson convince the public that psychiatrically-labeled  people are not to be feared as neighbors and co-workers?   Will they even try, since they need a fearful public's support for HR 2646's restrictive provisions.

At worst, the exhaustively complex Murphy-Johnson bill may be raising false hope among families, proposing programs that alienate the people most in need of help, and reinforcing the public's misguided view that the nation's excessive violence is linked to mental illness.  At least $130 billion federal dollars are spread among eight federal departments and agencies (SAMHSA gets a mere $3-4 billion).  The devil is in the details of HR 2646.  And in the priorties of its authors.


!!  NEWS ALERT !!  

A U.S. Senate bill will be introduced later this summer by Senator Chris Murphy (D-CT)


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

By Leah Harris 

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

Huffington Post   
June 12, 2015


Another "May is Mental Health Month" has come and gone, and it is time to build on years of awareness campaigns and move into action to promote whole health and recovery. People with serious mental health conditions are dying on average 25 years earlier than the general population, largely due to preventable physical health conditions, so why do we still focus on mental health separately from physical health? And when we know that people with serious mental health conditions face an 80 percent unemployment rate, why do we largely ignore the role of poverty, economic and social inequality, and other environmental factors in mainstream discussions about mental health? 

Decades of public health research have clearly shown that access to the social determinants of health -- affordable housing, educational and vocational opportunities, and community inclusion -- are far more important to mental and physical health than access to health care alone. As one recent article explained: "For many patients, a prescription for housing or food is the most powerful one that a physician could write, with health effects far exceeding those of most medications." Yet this wisdom does not generally guide policymaking in the U.S. Among nations in the Organization for Economic Co-operation and Development (OECD), the U.S. ranks first in health care spending, but 25th in spending on social services. Is there something wrong with our very concept of "care"?

This question is not just theoretical for me. As an adolescent, I attempted suicide several times. I found myself in the back of a police car more than once and was frequently hospitalized. At age 16, I was diagnosed with bipolar disorder. Two years later, I found myself sitting in a squalid group home, where I was told I needed to remain for life. I had no high school diploma and no job. My hopelessness and despair were all-encompassing.

I managed to get on a different path when I obtained access to safe and stable housing, education, and social support. Today, I am living life as a mother and a mental health advocate. I train human service providers in suicide prevention, recovery, trauma-informed approaches, and person-centered health care. Every day, I'm grateful that I was able to regain my life, and I want everyone to have this opportunity. 

To help promote a paradigm shift in mental health care, I've been part of starting a new, nonpartisan public awareness campaign called Recovery Now! This campaign seeks to educate all Americans about the kinds of services and policies that promote real recovery and whole health for people affected by mental health conditions. Here are a few key messages of the Recovery Now! campaign.

Recovery is possible for all.

The vast majority of people living with mental health conditions, even people diagnosed with serious mental illness, can enjoy a high quality of life in the community with access to the right kinds of services and supports. Dr. Richard Warner, clinical professor of psychiatry at the University of Colorado, noted: "It emerges that one of the most robust findings about schizophrenia is that a substantial proportion of those who present with the illness will recover completely or with good functional capacity." A slew of other studies have found similar results.

An argument used against recovery is that there are some who can't or won't voluntarily seek treatment or services. Yet there are plenty of evidence-based ways to reach people, such as motivational interviewing, or employing peer-to-peer support or community health workers to do homeless outreach or to engage with persons with complex mental and physical health needs. But these kinds of strategies are vastly underutilized.

We must advocate for recovery-oriented policies.
Hope is essential for recovery. But hope is not enough. Too many people are still unable to access the kinds of services and supports that would help them to recover. In particular, people of color are overrepresented in our jails and prisons, and are underrepresented in community-based mental health and social services.

A prime example is in Chicago, where newly re-elected Mayor Rahm Emanuel closed six community mental health clinics in the most economically disadvantaged parts of the city, which has resulted in an increase in persons with mental health conditions being incarcerated in the Cook County Jail for low-level, nonviolent offenses related to their disabilities. While the recent appointment of a psychologist to head the jail is a step in a better direction, how will this appointment impact upon the lack of availability of community-based services in Chicago for people who desperately need them?


Yet Mayor Emanuel is not unique in his choices. Community-based services have been slashed in many state and local budgets. Any short-term "savings" accomplished by such cuts will always be offset by the devastating long-term human and economic costs that result when we deny quality services and supports to the people who are most vulnerable.

Mental health legislation has been introduced in the House and is expected in the Senate. All legislation should be evaluated through a recovery lens and should clearly address the social determinants of health. Policy should seek to end deadly cycles of poverty, homelessness and incarceration in ways that are culturally appropriate, rehabilitative rather than punitive, and community-based. We can't talk about more hospital beds without talking about supportive housing and other programs that will actually help people to stay out of the hospital and out of prison. We need legislation that tackles disparities in access to education and employment, and funds proven programs that prevent crisis and recidivism.

We need sound policies that promote recovery for all Americans affected by mental health conditions. We don't have the luxury of continuing to get this wrong. Too many individuals, families, and systems are in crisis, and it doesn't have to be this way. We need recovery, and we need it now.



Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and Social Justice

Adapted by Briana Gilmore, March 2015

“Stigma kills.”

That is how Ron Manderscheid, PhD, opened his address last month at the Together Against Stigma: Each Mind Matters conference in San Francisco. Manderscheid joined other mental health experts in a symposium to discuss how stigma can be reduced or eradicated through policies that support mental health promotion, prevention, and early intervention strategies.

Manderscheid’s opening remarks aren’t hyperbolic. People with mental health and substance abuse conditions die an average of 25 years before other citizens. Less than half of those with needs receive any care at all, and it takes an average of a decade before people access the treatment they need. Suicide rates are also at the historic high of 40,000 people a year, exacerbated by the economic insecurity and reduction in services brought on by the great recession. And as Manderscheid and this USA Today article elucidate, people often only receive care when their experiences have become severe enough that they have turned into complex, illness- and symptom-based disabilities. Advocates liken this to only admitting a cancer patient into treatment when they reach stage four of their illness.

So how can policy reduce stigmatization that prevents people from accessing care, living successfully in the community, and sustaining recovery? Ron Manderscheid advocates for a five-point reform plan that includes:


1. Parity: Leveling the insurance playing field through parity laws is a first step to affording equitable treatment for mental health and substance abuse. Many states and insurance companies are just at the beginning of implementing successful parity reforms, because they necessitate sweeping financial, regulatory, and programmatic changes that take time to adopt. They are also not fully applicable to Medicaid and Medicare recipients in most states, thus further exacerbating stigma for people and families experiencing poverty. Parity is now also only available when a person receives specific treatments. Dr. Manderscheid indicates that if we want true reform through parity, we need to extend it to equal housing, equal jobs, equal supports, and equal pay.

2. Practice: Practice is moving rapidly toward fully integrated care through team-based practice approaches and integrated funding models. True practice integration, however, must integrate behavioral health clients with all other clients in health and medical homes. Stigmatization can sustain practices of exclusion that separate people with behavioral health needs out and away from their peers and people experiencing other health-related concerns. “Separate but equal” cannot remain a valid practice strategy if our system aims to achieve parity.

3. Promotion: Achieving the benefits outlined in the Affordable Care Act includes utilizing resources toward health promotion and prevention. Activities that sustain these opportunities are also ones that can pay for resources in the community that help clients recover, experience wellness, and live full lives.  Promoting recovery through policy means that states and counties need to swiftly invest in integrated practice that promotes and rewards early intervention and wellness-based strategies. These types of services have been minimally financed since psychiatric hospitals started closing decades ago. Integrating these services into mainstream financing mechanisms and incorporating them into discharge planning and whole-health treatment plans is essential to promoting community recovery.

4. Peers: Developing a peer workforce can only enhance parity reforms and promote dignity and community-based recovery. People with lived experience can actively reduce stigmatization by gaining employment, and helping consumers and family members understand that behavioral health is not something to be feared or diminished. Peers should work across the health system, not just with behavioral health clients, to offer a wide range of experiences, values, and capacity to people in recovery across the wellness spectrum.

5. Participation: Moving “out of the office” toward inclusive participation doesn’t only include outreach and engagement in services. Participative, community-based action includes public demonstrations, legislative hearings, key meetings with public leaders and executives, and coalition building among organizational leaders. Raising the visibility of a recovery-based movement is essential to reducing the stigma associated with mental health and substance abuse treatment.

If we begin with a human rights based approach to equality, and capitalize on the gains made in the Affordable Care Act, we can achieve measurable reductions in stigmatization through incorporation of the “five-P’s” outlined above. Defeating stigma demands civil rights and social justice actions at every level, including transparency of effective policy leadership in state and local governments. We are all responsible for reducing stigma, and we can all create opportunities for growth and change from policy to practice.

For more information about how policy can reduce stigma, contact Ron Manderscheid, PhD at rmanderscheid@nacbhd.org or visit the National Association of County Behavioral Health and Developmental Disabilities Directors at www.nacbhdd.org

News report (7/7/15) Mad in America (http://www.madinamerica.com )

Another Study Finds Gun Violence Not Linked to Mental Illnesses

Yet another study -- this one published in Psychiatric Services (in Advance) -- has found that risk of gun violence is not linked to mental illnesses. Instead, once again, substance use and history of violence were found to be better predictors of violence.

The researchers from multiple institutions examined data from The MacArthur Violence Risk Assessment Study of 1,136 patients who had been discharged from acute civil inpatient facilities at three U.S. sites between 1992 and 1995.

Psychiatric News reported that, "Of the 951 persons available for at least one follow-up, 23 (2%) committed acts of violence with a gun. These 23 people tended to have admission diagnoses of major depression (61%), alcohol abuse (74%), or drug abuse (52%)."

"(T)he prior arrest rate of discharged patients who later committed gun violence was almost twice as high as the prior arrest rate of the overall sample (89% and 49%, respectively)," added Psychiatric News.

"When public perceptions and policies regarding mental illness are shaped by highly publicized but infrequent instances of gun violence toward strangers, they are unlikely to help people with mental illnesses or to improve public safety," concluded the researchers.

Data Show Mental Illness Alone is Not a Risk for Gun Violence (Psychiatric News Alert, June 23, 2015)

Steadman, Henry J., John Monahan, Debra A. Pinals, Roumen Vesselinov, and Pamela Clark Robbins. “Gun Violence and Victimization of Strangers by Persons With a Mental Illness: Data From the MacArthur Violence Risk Assessment Study.” Psychiatric Services, June 15, 2015, appi.ps.201400512. doi:10.1176/appi.ps.201400512. (Full text)

April  20, 2015 - News of the Week


Article forwarded by NYAPRS E-News

 NYAPRS Note: Thank you to RECOVER-e Works and their April, 2015 newsletter authors for the two excellent articles below on CBT for people experiencing extreme states and with serious diagnoses.  Link: http://www.coalitionny.org/the_center/recovere-works/RECOVERe-works114-1April2015.html#Jack


CBT for schizophrenia? You don't know Jack.

by Abigail Strubel, MA, LCSW, CASAC


I met Jack in a dual diagnosis/re-entry program for parolees. All had fascinating stories about survival in prison (Got a little tinfoil? You can make a decent grilled cheese sandwich in a holding cell with a radiator). Most were symptomatic, because the policy was to take people off their medication as they neared release and were transferred to special barracks.

Jack told our admission coordinator his voices had advised him to skip intake. However, wary of returning upstate, he endured the appointment and met me. "I think I'll be able to work with you," he said. "You have intelligent eyes."

So did he, along with a glorious James Brown-esque pompadour. Jack was meticulous about his appearance. “Even when I was shooting ten bags of heroin a day, I made sure to shave, bathe, and wear clean clothes.”

"Ten bags a day?" I asked.

"Heroin makes the voices stop," he told me. "Better than any medication I ever tried."

Jack entered my office one day in a funk.

"I went to public assistance, and I know that lady's going to mess up my case," he said. "I could tell by how she looked at me. She made this face"—he pursed his lips and narrowed his eyes—"and the voices started saying, 'She hates you, she's not going to help you—she's going to get you all twisted.'"

"I wasn't there," I responded. "I don't know how she looked at you or what she thought. But there may be another way to interpret her expression—it could have been about something that happened before you even came into her office, or maybe she thought about something going on in her personal life.

"So the way she acted wasn't because of me?" he asked.

"Look," I said. "If you're right and she tries to mess with your case, you know I'll go to bat for you, make sure you get what you need. But it's possible something else was going on."

Jack nodded, then cocked his head to the side, listening. "The voices don't believe you," he said.

"Let me tell you about 'automatic thoughts,'" I said, and explained how almost everyone experiences a barely conscious stream of thoughts throughout the day. Some thoughts are positive, but many are negative. We can train people to become aware of their negative thoughts, and then dispute them.

"Your voices," I said, "are just a louder version of automatic thoughts. They're not real people; they're your own fears and doubts. When a voice says something negative, you can disagree. Ask, 'How likely is it that the welfare lady hated me on sight and wanted to make my life miserable? Could she have been having a bad day, and taking it out on me? If she did try to mess up my case, can my counselor help me straighten it out?'"

Jack thought that over. "You know," he said, "that makes a lot of sense. Because sometimes I can tell the voices are wrong right off the bat."

"And sometimes you might need to think about it a little more," I said, "or discuss it with me."

As treatment progressed, Jack's P/A case was resolved favorably, and he began contesting the negative voices on his own. Ultimately, he became a drug and alcohol counselor. His medications may never eradicate his voices, but now he knows how to dispute them.

Ms. Strubel is a clinical supervisor at Services for the Underserved/Palladia Comprehensive Treatment Institute-Bronx.  

Cognitive Behavior Therapy (CBT) for Recovery: The Cutting Edge

by Elizabeth Saenger, PhD

Aaron Beck et al showed that cognitive therapy can promote clinically meaningful improvements in people with schizophrenia, even if they have significant cognitive impairment. That finding was published in Archives of General Psychiatry (now JAMA Psychiatry), America’s journal of record for the discipline. It surprised clinicians who thought of CBT as a treatment only for patients who were high-functioning.

But that discovery was three years ago. What have CBT researchers done for us lately?

Here are some advances from the last six months.

CBT as an Alternative to Drugs: A Proof-of-concept Study

When it comes to schizophrenia, the British seem to make a habit of upsetting the medical model. First they rejected auditory hallucinations as psychopathology, set up a hearing voices movement, and imported the concept to the US. Now researchers across the pond suggest in The Lancet: Psychiatry, the British journal of record, that CBT might get rid of persecutory delusions.

A small study focused on people with schizophrenia spectrum disorders. All had persecutory delusions, and had not taken antipsychotic drugs for at least six months. Researchers randomly assigned subjects to treatment as usual, or to a package of brief therapy including four CBT sessions focused on the subject’s specific delusions.

The goal of this package was to change people’s reasoning about their delusions. Investigators taught subjects to become more aware of their thinking processes, and to identify and inhibit jumping to conclusions. Researchers also encouraged subjects to be more analytical. These interventions increased subjects’ sense that they might be mistaken about their persecutory beliefs.

The results indicate that people were comfortable with therapy, and the intervention worked. Follow up data collected two months afterwards suggested the model was definitely useful.

Clinicians frequently use CBT as an adjunct to psychopharmacology for delusions, but they rarely use CBT alone. If further research confirms the results of this proof-of-concept study, perhaps people with schizophrenia will have more choices in the future. Given the common, generally unpleasant, side effects of antipsychotic drugs—such as weight gain, metabolic problems, movement disorders, and an increased risk of cardiac death—having a meaningful treatment choice in the journey toward recovery would be most welcome.

Merging CBT with Other Evidence-based Treatments

A recent tendency to mix and match evidence-based therapy has led to instances where CBT has been successfully merged with other psychosocial treatments. Here are three examples.

Social skills training. CBT material, such as that described above, can be presented using social skills training techniques, for example, waving a big flag in group to identify ("flag") beliefs that do not have evidence to support them. This treatment merger helps clients with cognitive and social deficits improve their negative (but not positive) symptoms, and is helpful for clients regardless of the severity of their cognitive impairments. Further, because the treatment is repetitive, new clients can join the group at any point.

Family psychoeducation.  Data strongly show that CBT with family psychoeducation reduces stress, increases medication adherence, and decreases re-hospitalization. Modules are available that teach parents how to use CBT techniques with clients in recovery, and in other areas of their own lives.

Supported employment. CBT can help clients improve coping skills and challenge distorted beliefs about their vocational abilities. CBT is now being melded with supported employment to test the effectiveness of the combination. Preliminary results suggest people who received CBT in addition to supported employment might be more likely to work more hours per week.


March 29, 2015 - News of the Week



Kudos to the Huffington Post's Healthy Living Staff for giving us a concise, doable and user-friendly list of "do's" for talking about a Germanwings airline crash that killed all who were aboard a flight to Dusseldorf on March 24.

"When tragedy strikes, it's a natural human inclination to want an explanation to help get closure for our feelings of anger and loss. When such information is unavailable to us, our grief remains in this limbo of sorts -- or worse, we search for our own answer to help us move forward." 

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

Media reports erupted today with news that Germanwings co-pilot Andreas Lubitz may have been suffering from depression or another mental illness when he crashed the aircraft in the French Alps, most likely killing 150 people, including himself.

While headlines like U.K. tabloid The Sun's "Madman In Cockpit" are hardly surprising, such sensational links between mental illness and horrific tragedies can have an undesired outcome when it comes to stigma.

Here are five ways to have a more productive conversation about the complex interplay between mental health, violence and tragedies such as this one.

1. Depression doesn't cause violence.

The public's perception of mental illness -- which is largely fueled by movies featuring mentally-ill individuals turned violent and news headlines that thread mental illness into every story about mass killings -- needs a readjustment.

People who are depressed are not likely to be violent. If they were, we'd all be in trouble: One in five of us will experience a serious mental health issue at some point in our lives, but only 3-5 percent of violent acts in the United States are committed by an individual with serious mental illness -- a tiny fraction of the country's violent crimes.

"If we were able to magically cure schizophrenia, bipolar disorder, and major depression, that would be wonderful, but overall violence would go down by only about 4 percent," said Dr. Jeffrey Swanson, an expert on mental health and violence and a professor in psychiatry and behavioral sciences at the Duke University School of Medicine, in a recent interview with Pacific Standard.

What makes this misrepresentation even worse is that individuals who suffer from mental illness are 10 times more likely than the general population to be the victim of violent crime, an under-reported issue that is overlooked in favor of misleading depictions of depression as a violent condition.

2. Suggesting mental illness as the root cause of violence stigmatizes those who live healthy, full lives with conditions like depression.

Approximately one in four U.S. adults in a given year suffer from a diagnosable mental illness, making it highly likely that you know someone who has been affected. However, only 25 percent of people who have mental health symptoms feel that others are understanding toward people with mental illness, according to the CDC. And it's no secret why.

Public diagnoses, such as the discussion surrounding the Germanwings tragedy, plague every single mental illness sufferer. The truth is, the majority of those who have a mental health problem live healthy and complete lives. They are reliable at work and beloved by their families. Yet many people categorize them as "abnormal" because of unsubstantiated scapegoating during these types of tragedies, which can have a real impact: Studies have shown that knowledge, culture and social networks can influence the relationship between stigma and access to care. When people feel stigma, they are less likely to seek the help they need.

The vast majority of people with mental illnesses are law-abiding, responsible and productive citizens.

3. Mental illness disclosure policies can push people further into the closet.

Lubitz was seeking treatment for an undisclosed medical condition that he kept from his employers, alleged the public prosecutor’s office in Dusseldorf, Germany. They didn’t say whether it was a mental or physical condition, but investigators did note that they found a torn-up doctor’s note declaring him unfit for work, reported CNN. Employees in Germany are expected to tell their employers immediately if they can’t work due to an illness, according to Reuters, and that doctor's note would have kept Lubitz grounded and out of the cockpit.

Lubitz had passed special health screenings, including psychological ones, before he was hired on as a co-pilot in 2013, reported ABC News, but unlike in the U.S. airline industry, annual mental health screenings for pilots aren’t a requirement in Germany. Additionally, per Federal Aviation Administration rules, U.S. pilots must disclose all “existing physical and psychological conditions and medications” or face fines of up to $250,000 if they’re found to have delivered false information. That means if he were an American pilot, Lubitz would have been obligated to disclose any and all conditions, as well as the medicines he was taking, in order to remain in good standing at his job. Because of these and other policies, U.S. airline standards are regarded as the strictest and safest around the world (though not without their flaws).

But just because the FAA requires full health disclosure to an FAA-designated Aviation Medical Examiner doesn’t mean that pilots may feel completely safe disclosing their conditions, according to Ron Honberg, director of policy and legal affairs at National Alliance On Mental Illness.

“If a person feels that it’s safe to disclose, and that they’ll have an opportunity to get help -- that there won’t automatically be adverse consequences like being prohibited from ever flying again -- then they’re going to be more likely to disclose [a mental illness],” said Honberg. “But I think historically pilots have known that if they admitted it, they’d never be able to fly again.”

Generally speaking, barring industries where a person may be responsible for public safety (like a pilot or a police officer), one is not obligated to disclose any of this information to his or her employers in the U.S. Just as people don’t have to tell their bosses about diabetes, cardiac disease or HIV diagnoses, employees can’t be forced to discuss their mental health history beyond anything that may interfere with a person’s function at the job, explained Honberg. And employers can’t ask job candidates about their medical records or medical history except to ask about whether something might impact a person’s functional limitation in a job.

“It has to be focused on if they’re capable of doing the job,” said Honberg. “Are there physical or mental health factors that may preclude them from being able to do that?”

The FAA does not track rates of dismissal for pilots who disclose mental illnesses versus other conditions, or the number of pilots who continue to fly after disclosing a mental illness. But until we have all the facts about Lubitz’s situation, it’s important to hold off on any policy changes that might attempt to close up perceived loopholes, he said.

“It’s really important to have all the facts, particularly before we decide on any policies to prevent anything like this from happening again,” said Honberg. “We want to somehow create a proper balance that on the one hand protects public safety and on the other hand encourages people to seek help if needed."

4. The conversation surrounding mental illness and mass violence reveals our ingrained ethnic and racial biases.

Lubitz allegedly committed mass murder and, as many people have pointed out, it is troubling that his acts are ascribed to mental illness when, if he were Muslim or a racial minority, he would likely be assigned a two-dimensional ideological motivation.

Yes, this is a disturbing expression of the dominant culture's racial pathologies, but rather than trying to correct the balance by referring to white mass murderers in an un-nuanced fashion, as some have suggested, perhaps the more productive action would be to view the underlying mental health problems among everyone who carries out mass violence -- regardless of race, religion or country of origin.

Again, most people with mental illness will never be violent, but those who are violent often do have an underlying trauma or condition. "More and more evidence from around the world is suggesting that many of the terrorists wreaking havoc both in America and abroad are racked with emotional and mental trauma themselves," wrote Cord Jefferson in The Nation in 2012:

To be clear, nobody’s saying that all -- or even most -- terrorists aren’t cold, bloodthirsty killers who know exactly what they’re doing every time they commit another heinous act. But there is reason to believe that a significant number of foreign and domestic terrorists are suffering from the exact same mental distresses by which we quickly assume men like James Holmes and boys like Eric Harris and Dylan Klebold, the Columbine killers, to be afflicted.

Indeed, Jefferson went on to note a study of Palestinian men who had signed up to be suicide bombers that found 40 percent showed suicidal tendencies by traditional mental health measures, and recruiters admitted looking for "sad guys" to carry out mass violence.

More generally, the way we view mental health and race has a lasting public health impact: Minority and immigrant communities in the U.S. are dramatically underserved, according to a government report (and corroborated by the American Psychological Association). One major problem, according to the Surgeon General's report, is misdiagnosis or lack of diagnosis due to cultural biases on the part of mental health practitioners.

5. We may never have a diagnosis, and we have to be okay with that.

When tragedy strikes, it's a natural human inclination to want an explanation to help get closure for our feelings of anger and loss. When such information is unavailable to us, our grief remains in this limbo of sorts -- or worse, we search for our own answer to help us move forward.

In a recent article for The New Yorker, Philip Gourevitch aptly explained this phenomenon:

To be told that a scene of mass death is the result of an accident of terrorism is to be given not only an explanation of the cause but also an idea of how to reckon with the consequence -- through justice, or revenge, or measures meant to prevent a recurrence.

According to CNN, a physician did declare Lubitz unfit to work the day of the flight, and instead of sharing that information with Germanwings, Lubitz disposed of the note and boarded the plane. But even in light of such information, it's highly unlikely that we will ever know exactly what was going on in the mind of this pilot, and it is far from our place to speak as though we have a definitive answer.

In the words of Gourevitch, we are left with a sense of "cosmic meaninglessness and bewilderment" when horrific events such as this one occur, and while that is one of the toughest collections of emotions to grapple with, there is no credible alternative in cases like this.

MORE ARTICLES (The Atlantic and The Boston Globe)


February 19, 2015 - News of  the Week


Return to Asylums? Let’s not!

By Susan Rogers

link to article

A recent JAMA opinion piece calling for a return to asylums – not the bad kind, the authors (three Penn
bioethicists) insist, but a “safe, modern and humane” kind of asylum – led to a radio debate between co-
author Dominic Sisti, associate professor of medical ethics at the University of Pennsylvania, and Joseph
Rogers, chief advocacy officer of the Mental Health Association of Southeastern Pennsylvania (MHASP)
and executive director of the National Mental Health Consumers’ Self-Help Clearinghouse. The debate,
on WHYY’s Voices in the Family, was moderated by the show’s host, Dr. Dan Gottlieb. To listen to the
archived program, click here.

Dr. Sisti began by insisting that “we do not want to return to those asylums…that are now infamous for
incarcerating thousands of Americans….What we were calling for is a rehabilitation of the term
‘asylum’…[as] a safe sanctuary where they may be able to heal and reclaim their lives in recovery.”

Asked about the reason for the widespread use of chemical restraints, Dr. Sisti responded that it is “a lot
easier to maintain control and safety in an overcrowded institution when individuals are chemically
controlled. We’re seeing this now in prisons,” where individuals with mental health conditions who are
often without access to adequate treatment are “oftentimes given large doses of drugs to keep them
both safe and comfortable” (emphasis added).

Throughout the hour-long program, Joseph Rogers was the voice of reason, debunking Dr. Sisti’s
arguments. After establishing his credentials – “I’ve been in hospitals; I’ve been in jails; I’ve been
homeless; I have a diagnosis of bipolar disorder which at times has left me incapacitated” – Rogers
talked about his experience in a state hospital: “When I hear the term ‘asylum’ I get my back up because
there was no asylum. These places…are not safe places.…You were warehoused.”

“We can create alternatives” such as peer-run crisis respites, he continued. This model, he said, “has had
wonderful success, even with people with some very difficult challenges.”

Rogers also noted that, although Dr. Sisti is based in Philadelphia, he didn’t talk about the Philadelphia
experience, when “we closed down Philadelphia State Hospital and years later they found that those
individuals” who had been released from the hospital when it closed were living successfully in the

“We know how to do it,” Rogers said. The key is providing for people’s individualized needs. The
question, he continued, is whether we have the power politically. It’s a matter of funding community-
based, evidence-based programs that we know work for even individuals with the most serious mental
health conditions. “And we need to fund them fully and not let them become budget basketball.”

Among those who called in to the program, the most compelling was “Christy,” who said she had
recently been released from Norristown State Hospital after six days. “I ended up there for some severe
depression. I was forced to take medication against my will; I was disrespected; any time I tried to
advocate for myself, I was told to cooperate or threatened with a longer stay,” she recalled. “I thought it
was completely unethical. I think it goes to show how few rights you have when you are deemed
mentally ill. I don’t think it was set up to help people succeed. Many people were just drugged. I didn’t
get any therapy. I repeatedly told them about myself and how meds affect me – and I was forced to take
medication. I went in voluntarily and was forced to stay longer. I’m a college-educated person and I tried
to advocate for myself and I was not listened to. I’m seeing an outpatient therapist but the experience at
Norristown scarred me for life. It was very extreme.”

In response to the moderator’s question about what works and what doesn’t, Rogers responded: “We
have to treat people as individuals.” Perhaps referring to the fact that the moderator consistently
avoided the use of “people first” language, Rogers said, “We don’t like to label people as ‘the mentally
ill’; we talk about people with mental health challenges.”

“What we have found here in Philadelphia,” he continued, “is that we have to really meet the person
where they are at.” Referencing some of the individualized outreach efforts in the city, including a street
outreach program called ACCESS (operated by MHASP), he said that “we learned early on” that you can’t
set up a big community mental health center and put the counselor on the fourth or fifth floor and
expect people with serious problems to make an appointment and come to the fourth or fifth floor.

“You need to be on the street, to work with people where they are at, to find out exactly what they are
concerned about that you can address, and by addressing those issues you gain their trust.” That is how
you are able to help a person seek and gain the support they need, he said.

“One thing that doesn’t work is overmedicating people,” Rogers noted. “Many people do much better
on small amounts of medication or no medication at all.” Some people’s behavior may be the result of
heavy medication, he added.

To the moderator’s question about people who don’t have loved ones who can help them, Rogers
responded, “A lot of times family members burn out or aren’t around….We’ve got to create an artificial
family. One of the things peer-run crisis respites do is use peers who have been trained to work one on
one with individuals in crisis and provide a homelike environment and prevent hospitalization or going
into a jail. You thus prevent further trauma.”

Rogers also talked about Housing First, a program in Philadelphia and elsewhere: “You provide decent,
affordable housing for that person and you build the supports around the person based on their
needs….You can help the person get involved in the community.”

In response to Dr. Sisti’s continued insistence that institutions can be effective, Rogers countered that
with large, congregate living situations, even with 15, 20, or 30 people, “the rights situation is
problematic. At 3 in the morning, when there are no advocates around and no chance to make a phone
call to an advocate, that’s when the abuses take place. This model of a ‘safe congregate living place’ is
not one that is borne out, with years of research into it.”

Rogers emphasized the need for adequate resources, saying that Philadelphia probably needs 3,000 or
4,000 more supported housing units than the city currently has. “That would just address people
rotating in and out of hospitals and jails, just in Philadelphia alone, not the whole region.” MHASP is
advocating for additional resources with the Pennsylvania state government.

Asked by the moderator to define his dream, Rogers responded that his dream would be to create a
massive movement of individuals with lived experience, families, and allies. “That’s the only way we’re
going to change things.”

Susan Rogers is the Director of the National Mental Health Consumers' Self-Help Clearinghouse,
and the Director of Special Projects, Mental Health Association of Southeastern Pennsylvania

Links: http://www.mhselfhelp.org http://www.mhasp.org

October 18, 2014 - News of the Week


San Francisco Honors Psychiatric Survivor Carmen Lee

Vivid accounts tell us how Winston Churchill and Abraham Lincoln battled disabling depression even as they made history. But before we can truly understand and empathize with people who have psychiatric vulnerabilities, we need people of our own time and environment to tell us what they experience.

Today's easy access to videos and social media allows the general public unprecedented views of how mental illnesses affect a life. Every story is unique. A recent example comes from Carmen Lee, a Californian whose suicide attempts in her early 20s prefaced 20 years of hospitalizations. In a remarkable 6-minute video on Facebook. "No Longer Pretending..." (https://vimeo.com/105064330) Lee explains the essence of her survival. Put most simply, Lee used her positive energy to refute the stereotypes that misrepresent the mental health community, thereby aiding progress toward social justice.

In 1985 Carmen Lee began the Peninsula Network of Mental Health Clients, and in 1990 she developed the Stamp Out Stigma program (SOS) (www.stampoutstigma.net). 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.

                    August 11, 2014 - News of the Week


Popular misperceptions must be replaced with facts

A new study by an international team of leading researchers suggests that an infusion of evidence-based data could jump-start a reduction in U.S. gun violence.  The study focuses on gun assaults involving suicide and people with behavioral disorders.  It proposes that effective, fair, and feasible policies can be applied to the tiny portion of the U.S. population where gun violence and mental illness intersect.  Forbes correspondent Todd Essig describes the research as a "comprehensive, critical survey of the available data ... that pulls together the facts we need to consider if we really want to adopt evidence-based policies to reduce random gun violence."

An introduction (excerpt below) explains how misconceptions have complicated the policymaking process.  The full article is FREE ONLINE, click here.


The massacre of schoolchildren in Newtown, Connecticut, in late 2012 stirred a wrenching national conversation at the intersection of guns, mental illness, safety, and civil rights.  In the glare of sustained media attention and heightened public concern over mass shootings, it seemed that policymakers had a rare window of opportunity to enact meaningful reforms to reduce gun violence in America.  And yet, the precise course of action was far from clear; competing ideas about the nature and causes of the problem -- and thus, what to do about it -- collided in the public square.

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.  more...   


Title:  Mental illness and reduction of gun violence and suicide: bringing epidemiologic research into policy   (Article in Press)

Jeffrey W. Swanson, Duke University
E. Elizabeth McGinty, Johns Hopkins University
Seena Fazel, University of Oxford UK
Vickie M. Mays, Univerity of California at Los Angeles

July 15, 2014 - News of the Week


Article Source: The Independent, July 15, 2014  http://www.independent.co.uk

For article and a video, click title:
SCHIZOPHRENIA: the most misunderstood mental illness?

By Rachel Hobbs

"While mental health stigma is decreasing overall ... people
with schizophrenia are still feared and demonised."

Earlier this year Jonny Benjamin set up a nationwide search to #findmike, the stranger who
talked him out of taking his own life on Waterloo bridge. People told him he ‘didn’t look like a
schizophrenic’ - so what do people imagine?

Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be
overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, googled
the phrase ‘schizophrenics should...’ when researching a potential campaign, we were so
distressed by the results, we decided to drop the idea completely. I won’t go into details,
but what we found confirmed our worst suspicions.

Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised
and misunderstood of all mental illnesses. While mental health stigma is decreasing overall,
thanks in large part to the Time to Change anti-stigma campaign which we run with Mind,
people with schizophrenia are still feared and demonised.

Over 60 per cent of people with mental health problems say the stigma and discrimination
they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives.
It means people end up suffering alone, afraid to tell friends, family and colleagues about
what they’re going through. This silence encourages feelings of shame and can ultimately
deter people from getting help.

Someone who knows first hand how damaging this stigma can be is 33 year-old Erica
Camus*, who was sacked from her job as a university lecturer, after her bosses found out
about her schizophrenia diagnosis, which she’d kept hidden from them.

Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open
about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was
blatant discrimination.”

She says that since then, she’s become even more cautious about being open. “I’ve
discussed it with lots of people who’re in a similar position, but I still don’t know what the
best way is. My strategy now is to avoid telling people unless it’s comes up, although it can
be very hard to keep under wraps.”

Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of
schizophrenia can have a direct impact on patients. “Some people definitely do internalise
the shame associated with it. For someone already suffering from paranoia, to feel that
people around you perceive you as strange or dangerous can compound things.
“I think part of the problem is that most people who have never experienced psychosis, find
it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of
us struggle to empathise with people affected by schizophrenia.”

Another problem is that when schizophrenia is mentioned in the media or portrayed on
screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers
and fictional characters in film or on TV are often no better. Too often, characters with
mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re
supposed to be frightened of, not empathise with. This is particularly worrying in light of
research by Time to Change, which found that people develop their understanding of mental
illness from films, more than any other type of media.

These skewed representations of mental illness have created a false association between
schizophrenia and violence in the public imagination. In reality, violence is not a symptom of
the illness and those affected are much more likely to be the victim of a crime than the

We never hear from the silent majority, who are quietly getting on with their lives and pose
no threat to anyone. We also never hear about people who are able to manage their
symptoms and live normal and happy lives.

That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny
Benjamin set up a nationwide search to find the stranger who talked him out of taking his
own life on Waterloo bridge, was such an incredible experience. Jonny, who has
schizophrenia, wanted to thank the man who had saved him and tell him how much his life
had changed for the better since that day.

The search captured the public imagination in a way we never could have predicted. Soon
#Findmike was trending all over the world and Jonny was making headlines. For me, the best
thing about it was seeing a media story about someone with schizophrenia that wasn’t linked
to violence and contained a message of hope and recovery. Jonny is living proof that things
can get better, no matter how bleak they may seem. This is all too rare.

LINK   http://www.independent.co.uk/life-style/health-and-families/features/schizophrenia-the-most-misunderstood-mental-illness-9546654.html

June 15, 2014 - News of the Week


In 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.

On 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.

Following 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 Information)

Excerpt: "Imminent Danger" portrays individuals diagnosed with schizophrenia as people with hopeless futures whose primary life options are hospitalization, homelessness, or incarceration.  The segment provides no indication that individuals with schizophrenia can and do live fulfilling lives, start their own families, work, live independently, and participate fully in their communities.  Instead, such individuals are painted as consigned to a life of misery and as ticking time bombs with the potential to become violent at any time." 

"Imminent 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,

"It's time to get another 'reporter' to do some real investigation and offer a balanced story rather than what seems like a personal mission by Mr. Croft to further disenfranchise people who have received psychiatric diagnoses.  Ten years ago in October 2002 and June 2003, Mr. Croft did a story called "Armed and Dangerous" that, like this segment, relied mostly on the singular opinion of Dr. Torrey ... he's obviously not done any more real research in the past decade as this piece is as uninformed, biased and journalistically irresponsible as the last one... "

Steve 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." 

Oddly, Dr. Torrey's collection of well over 3,000 "Preventable Tragedies" holds some surprises.  After downloading the collection's homicide summaries years ago, the National Stigma Clearinghouse found that medication failed to deter homicide in many cases.  Further, a New York Times series analyzing 50 years of mass murders (April 2000) reported that among the 24 slayers who had been prescribed medication, nearly half (10) were taking medication at the time of their rampage.

And 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)

"Imminent Danger's" lack of balance is easily confirmed in its online transcript.  The over-emphasis on schizophrenia was particularly misleading.

An 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."

What effect has Dr. Torrey's 20-year over-emphasis on violence had on public opinion?

For more information, read a New York Times 4-part series on "Rampage Killers" (link is below)

April 9, 2000 -News of the Week

"Rampage Killers Chart a Well-marked Course to Their Unraveling"

A New York Times 4-part series on "Rampage Killers," launched on Sunday, April 9, [2000] attempts to replace opinions and hype with what is actually known about multiple murderers. After scouring 50 years of records, the Times investigators found 102 rampage killers and 425 victims of mass homicide. (Military style weapons had not become commonplace.)

The first article of the Times series is crammed with food for thought. It provokes several quick observations.
  • Contrary 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.)

  • Of the 102 "rampage killers," 24 were individuals who had been prescribed medication for a mental illness. Only 14 of these were not taking their prescribed meds. The fact that 10 out of the 24 diagnosed mentally ill "rampage killers" were taking their medication surely calls into question any quick-fix solutions based on medication.

  • Easy 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.

  • People 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.

    The Times series is well worth saving for study. Click www.nytimes.com/library/national/040900rampage-killers.html 

    May 2, 2014 - News of the Week


    Recent articles and briefing papers by supporters of forced treatment assume that patients who refuse psychiatric treatment do so because of  structural brain abnormalities that block awareness. They say nearly 50 percent of people with schizophrenia and bipolar disorder require forced anti-psychotic medication to combat the assumed cause of treatment refusal.  Although the faulty brain lesions have not been found and their response to anti-psychotic medication is unknown, supporters expect these hurdles to be cleared by advanced brain imaging techniques within a few  years.
    A 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..


    by Larry Davidson, Ph.D.
    Yale University School of Medicine

    February 6, 2012

    But what about people who won't accept having a mental illness?

    How can a person recover if he or she won't even acknowledge being ill?

    How is recovery relevant for people who say there is nothing wrong with them?

    But what about people who won't accept any treatment, who deny they need any help? How does recovery-oriented care apply to them?

    These questions—and others like them—are frequently posed by frustrated practitioners and distressed family members trying to assist people who appear not to want help. One concern, or assumption, about these questions is that they point to a key limitation of the recovery paradigm, implying recovery and recovery-oriented practices are only for people who readily acknowledge having a mental illness. After all, how can a person be "in recovery" if he or she has nothing to recover from? One of the major differences between mental illnesses and other medical conditions is the issue of insight. People with diabetes know they have diabetes; people with asthma know they have asthma, etc., but some will argue that most people with serious mental illnesses (or at least those with schizophrenia) lack insight into having the illness. Therefore, they will not participate in the treatments needed to manage their conditions. Such perceptions lead some people to argue that coercion and involuntary treatments are necessary, at least for those who refuse any or all treatments. The lack of insight also poses a major challenge to person-centered care planning and recovery-oriented practice, if both presume the person will take responsibility for driving his or her own care and overall recovery process. Is not insight, therefore, required for recovery?

    While it may sound contradictory at this point, I intend to show in the following two sections not only that recovery-oriented practice is possible for people who appear to lack insight, but that it may also be precisely these people who most need recovery-oriented care. (Click for full article)


    February 24, 2014 - News of the Week


    Visit http://www.madnessnetworknews.com
    to view samples of the MNN archive, and more...

    Madness 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 observation. 

    A recurring theme throughout the 45 issues is angry protest against dehumanizing psychiatric practices and the loss of civil rights. Today, those grievances are legitimized by experts such as journalist/activist Robert Whitaker (www.madinamerica.com) and Dr. Thomas Insel, Director of the National Institute of Mental Health (Q& A: Dr. Insel and Dr. Suzanne Koven, The Boston Globe, 12/16/2013), to name just two of many critics of current psychiatric practices. 

    In the summer of 2013, two determined long-time activists, David Gonzalez (Brooklyn NY) and Ron Schraiber (Los Angeles CA), received the support and approval from MNN's co-founder, Leonard Roy Frank, to reprint the complete set of original issues.  Working from home due to medical problems, David first re-sized the original 11"x17" newsletter format to 8.5"x 11", then assembled the complete collection of 45 issues into seven handsome soft-cover 8.5"x 11" books.  Each of these, on average, contains approximately 170 pages of resized original material (6 MNN issues) except for Volume 1, which combines MNN's first and its final issues (9 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 and the digitized e-books are undeway. 

    Suggestions are welcome!  Please visit http://www.madnessnetworkinews.com , click "Misc."  and scroll to the "Questions and/or Comments" box.

    The project's two sponsors hope to recover the considerable expense of preserving this unique moment in cultural history.  Please visit http://www.madnessnetworknews.com for more information about how to purchase all, or parts of the Madness Network News archive.

    January 18, 2014 - News of the Week


    Dr. E. Fuller Torrey's latest book. "American Psychosis," begins by describing the events, shortsighted decisions, and inertia that led to the present quagmire we call the nation's mental health system.  The book's main message, however, promotes Dr. Torrey's solution: more psychiatric hospitals and court-ordered medication. This is Torrey's mantra.  What's galling is his continuing reliance on lurid stories to win public support for his controversial - many say regressive - agenda.  A book revue by Michael A. Friedman, M.D. notes that Dr. Torrey "does not shy away from recounting one horror story after another."

    National Stigma Clearinghouse files show that for at least twenty years, Dr. Torrey has relied on the fear of violence to win new laws forcing psychiatric treatment.  In 1994, D.J. Jaffe, an advertising executive and Torrey supporter, wrote: "From a marketing perspective, it may be necessary to capitalize on the fear of violence to get the law passed."  This was not a passing comment.  Five years later, Mr. Jaffe advised a national NAMI audience, "Laws change for a single reason, in reaction to highly publicized incidents of violence."  And later that year, 1999, the passage of NY's Kendra's Law proved Jaffe right.  (It didn't matter that Kendra Webdale's assailant was the opposite of a 'treatment refuser', a label he carries to this day as he serves his prison term).

    Just as disturbing is the Torrey/Jaffe team's "ends justify the means" approach.  After advising his NAMI audience to use violence to attain their goals, Jaffe added, "I am not saying it is right, I am saying this is the reality."  The media welcomed the Torrey/Jaffe team's sensational approach, and from the 1990s onward,  Dr.Torrey enjoyed a lion's share of media coverage concerning mental illnesses.  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 it.

    A tragic example:  "Dad! Dad! Learning from the Kelly Thomas Tragedy" 


    Source: NYAPRS (New York Association for Psychiatric Rehabilitation Services)

    An Orange County California jury’s acquittal last week of Fullerton police officers charged with causing the brutal death of Kelly Thomas, a homeless man with a mental health history, has set off a national uproar amongst human rights and mental health advocates.  In the wake of the court’s action, the County DA’s courage to prosecute the case has been cited and the FBI has opened an investigation to see if Thomas’ civil rights were violated.

    Kelly Thomas had struggled for years with mental health issues and homelessness. His pointless, tragic death has devastated his family, community, and the national and international mental health community. His death also brings attention to the misconception that people with a psychiatric diagnosis are violent, whereas evidence shows that they are far more likely to be the victims of violence than the perpetrators of it.

    Sunday’s 7 pm Albany vigil has been getting a lot of national attention and support as advocates from around the country call for justice and accountability of our law enforcement to the rights and protection of each and every citizen.  (Vigil Announcement:  Mental health and human rights advocates gather to grieve and decry police killing, First Unitarian Church, Albany, NY, 7:00 pm, Sunday, January 18, 2014)

    Relevant Links:


    January 11, 2014 - News of the Week



    NYTimes columnist David Brooks recently expressed misgivings concerning recreational marijuana use, based on his own experiences.  A displeased pro-marijuana advocate, Joe Dolce, was quick to counter Mr. Brooks online.  For his takedown, Mr. Dolce interviewed Dr. Lester Grinspoon, a well-known longtime promoter of smoking cannabis.  The interview gives an enticing glimpse of Dr. Grinspoon's idyllic view of marijuana, while dissing David Brooks as uninformed.  

    May I suggest a bit of balance.

    While there is little conclusive research on pot's hazards, many studies done over the past decade, mostly in the UK and Europe, have found brain changes among young users.  Findings from British researchers ten years ago are now being confirmed by studies in the US.  CBS News "Marijuana use linked to schizoprenia risk in teens" 

    A quote in 2008 from the UK's Guardian indicated pot's harmful potential.  "Last year, a review of all the studies to date, published in The Lancet, was able to assert that even having tried cannabis once can be shown to increase the risk of developing schizophrenia.  And it is estimated by Murray [Robin Murray, a British researcher] that at least 10 percent of all people with schizophrenia in the UK would not have developed the illness had they not smoked cannabis."   "My brother's first joint and his descent into a mental war zone"

    Many families with a 'seriously mentally ill' family member will attest that pot-smoking has led to family tragedies.  Last week, a NYTimes editorial stated that "Roughly 36 percent of 12th graders reported having used marijuana in 2013." "The Marijuana Experiment," NYTimes 1/3/2014


    "Smoking Pot Doubles Mental Illness Risk" (Christchrch New Zealand

    "Marijuana linked to brain-related memory woes, schizophrenia risk in teens" (CBS News)

    "The Marijuana Experiment" (New York Times editorial)

    "Continued Cannabis Use and Risk of Incidence...10 Year Follow-Up Cohort Study" (Medscape signup needed)

    December 15, 2013 - News of the Week


    A proposed Congressional Bill is described as helping families in mental health crisis.  Unfortunately, the bill includes onerous provisions that would halt effective wellness programs designed by patients and ex-patients.  This alarming Bill would "slash funding for recovery oriented services--including peer-run services and family supports--in exchange for regressive and involuntary treatment" (NYAPRS).   Further, it would "restructure federal funding to heavily encourage the use of force and coercion..." (NDRN).   
             (NYAPRS, New York Association for Psychiatric Rehabilitation Services;  NDRN, National Disability Rights Network)

    The "Helping Families in Mental Health Crisis Act" was introduced on December 12 by Rep.Tim Murphy of Pennsylvania. 

    Read the following links and learn more about this threat to progress.


    "Mental Health America Faults Rep. Tim Murphy's Legislation..."
    Statement of David Shern, Ph.D., president and CEO, Mental Health America

    Mental Health Advocates Blast Murphy Bill as Regressive
    USNewswire 12/12/13

    GOP Rep. Murphy rolls out mental health legislation
    By David Sherfinski, The Washington Times, 12/12/13

    Alert: Urge Congress to Protect SAMHSA and Consumer Programs!

    NYAPRS News: This comes from the National Coalition for Mental Health Recovery, an organization that NYAPRS supports. We urge you to contact your representatives to demand that budget cuts do not impact mental health recovery services that keep people engaged and working toward their well-being. Along with the Congressional deal to tighten the budget and restrict mental health spending, an act submitted by Representative Tim Murphy would favor involuntary services and reduce funding for rehabilitation services, including peers and family support. Contact your representative today, sign the petition at change.org, and get on the NCMHR action list!

     SAMHSA Grants for State Networks, The Alternatives Conference and  the 5 Mental Health Technical Assistance Centers Are At Risk!


    YOU can help.

    Educate your Senators and your Representative about these vital programs.

    They need to hear from YOU now.

    Here’s why:

    Budget negotiators in Congress just reached a deal that squeezes dollars for all health funding including mental health. Most members of Congress don’t know about the life-saving work and value of state mental health consumer networks and national TA centers.  It is up to you to educate them.

    Yesterday, Representative Tim Murphy of Pennsylvania released a mental health bill that—among many other disturbing changes-- would reorganize SAMHSA and end funding for state networks, the Alternatives conference and technical assistance centers.

    What to do now:

    Right now, send emails and make phone calls to you members of the House and Senate appropriations committees telling them why they should protect funding for state mental health networks, the Alternatives conference and the five mental health technical assistance centers and how important they have been in your life, the life of people you love and for citizens of your state.  (See How to do it below and the attached document on what to say).

    NextSign our petition on Change.org:  Go to http://ncmhr.org and look for the Action Alert with a link to the petition and more background.

    Stay tuned for instructions on how counter Tim Murphy’s bill that you will be receiving in a few days.

     How to do it:

    1.     FIND your U.S. Senators at  http://www.opencongress.org/people/zipcodelookup.  Click the name of each Senator, scroll down to “ Contact Webform” to send them an email. Before sending, copy and save your message. Request a reply.  You can also call their office and leave a message.

    2.     The attached document includes a list of Senators and Congressmen on Appropriations Committees. If they represent you it’s doubly important to educate them.  If your Senators/Congressman is not on this list, don’t worry--It’s still vital that contact them.

    3.     TELL your Senators to RESTORE the 20 percent cut in funding for  SAMHSA grants for statewide mental health consumer networks that the Senate Appropriations Committee agreed to.  ASK them to resist any further cuts. TELL them these grants, which total just $2.5 million now, teach people with serious mental health conditions to stay well and recover. TELL them how YOUR state network (and the local peer-run centers it supports) have changed your life as a person with a serious mental health condition and how you now help others. If your state doesn’t have a mental health consumer network yet tell them you need one.

    4.     TELL your member of the House of Representatives to fully fund SAMHSA grants for statewide mental health consumer networks, mental health technical assistance centers, the Alternatives conference, and protection and advocacy programs.  TELL them state network grants, which total just $2.5 million now, teach people with serious mental health conditions to stay well and recover. TELL them how YOUR state network (and the local peer-run centers it supports) have changed your life as a person with a serious mental health condition and how you now help others. If your state doesn’t have a mental health consumer network yet tell them you need one.

    5.     If your representative is listed on the attached document, it is doubly important that they hear from you.

    6.     Email 
    raymond.bridge@ncmhr to get on our action list. Like us on Facebook (National Coalition for Mental Health Recovery)   Find us at http:ncmhr.org -

    Note from Jean Arnold: I regret that the lists (referred to above) of  Congressional Committee members did not transfer to this posting.

    November 20,  2013 - News of the Week

    Tanya M. Luhrmann's opinion piece "The Violence in Our Heads" (NYTimes, 9/19/13) is a thought-provoking discussion of the effects of culture on auditory hallucinations.  Deserving wide attention is her description of intriguing and effective ways to relieve distressing symptoms of psychosis.   For example, the 'hearing voices' movement in Europe has discovered ways to alleviate voices that "flies in the face of much clinical practice in the United States."  Luhrmann's piece begins, however, with two troubling assumptions: (1) that people who hear voices have schizophrenia, and (2) that schizophrenia carries a risk of violence "significantly greater than it is in the broader population."  

    Professor Luhrmann, an anthropologist at Stanford University, begins by speculating about recent mass murderers, Adam Lanza and Aaron Alexis.  (Neither, to my knowledge, has been given a professional diagnosis.)  She suggests that these assailants were fueled by tormenting 'voices' and concludes that they were suffering from schizophrenia. 

    But auditory hallucinations occur in conditions other than schizophrenia.  Several readers' comments posted by clinicians explain that 'voices' are not confined to schizophrenia. Their lists include bipolar disorder, psychotic depression, PTSD, seizure disorders, brain tumors, hallucinogenic drugs, multiple personality disorder...and one clinician wrote that 'voices' occur most often during manic episodes with psychotic symptoms.

    Further, 'schizophrenia' is not a descriptive diagnosis like 'depression' or 'chronic lymphocyctic leukemia'.  The public's perception depends largely on context.  For years, schizophrenia's violent image has been shaped by sensationalist images in the media, and by advocates who have promoted a forced-medication agenda by fanning public fear.  Few people know that violence rates for people diagnosed with schizophrenia (minus complications) are similar to, or lower than violence rates for the general population.  Schizophrenia affects 1% of the population (NIMH) and of this one percent, 99.97% will not be convicted of serious violence in a given year (Walsh et.al. 2002 and Wallace et.al, 1998).

    Balanced portrayals of schizophrenia are rare; help from authoritative spokespeople is badly needed.

    NIMH (National Institute of Mental Health), "Schizophrenia, 12-month prevalence," website (2013)
    Wallace et al. "Serious criminal offending and mental disorder," British Journal of Psychiatry, 172, 477-484. (1998)
    Walsh et al. "Violence and schizophrenia: examining the evidence," British Journal of Psychiatry, 180: page 494 (2002)

    Link to Luhrmann article:  http://www.nytimes.com/2013/09/20/opinion/luhrmann-the-violence-in-our-heads.html?_r=0

    October 12, 2013 - News of the Week


    A recent 60 MINUTES segment hosted by Steve Croft focused on a national disgrace -- the nation's undisputed neglect of Americans who are diagnosed with serious psychiatric conditions.  Ignoring an opportunity to discuss the scarcity of user-friendly treatments, the segment focused on  psychotropic medications and forced treatment.  The coercion proponents' marketing strategy,  "fear of violence," dominated the segment -- note its (shortened) title, "Imminent Danger".

    Below is a letter from the Bazelon Center for Mental Health Law to 60 MINUTES protesting "Imminent Danger's" harmful bias.  The letter is signed by 36 mental health organizations, and it joins many other protests from individuals and organizations.  (E-mail: 60m@cbsnews.com  and  audsvcs@cbs.com)


    NYAPRS Note: This week, the Bazelon Center for Mental Health Law drafted a letter to the Executive Producer of CBS 60 Minutes, in regards to the September 29 segment “Imminent Danger”. The views expressed in that program were regressive; the segment falsely portrayed persons with mental health diagnoses as hopeless, futureless individuals at high risk for committing violence. NYAPRS—as well as numerous other organizations indicated below—have signed this letter in protest of the unacceptable and misguided views expressed in the show that not only go against our mission, but also the consensus priorities of our mental health services system. Please read the full letter below.

    Dear Mr. Fager:

    The undersigned organizations, together representing tens of thousands of individuals with psychiatric disabilities, family members, service providers, and advocates, write to express our great disappointment that CBS’ 60 Minutes chose to offer a dismal and inaccurate portrayal of individuals with psychiatric disabilities in the September 29, 2013, segment “Untreated Mental Illness an Imminent Danger?” We call on 60 Minutes to devote a future segment to presenting a different perspective than that offered by E. Fuller Torrey, the psychiatrist whose highly controversial views are featured in “Imminent Danger.”

    Imminent Danger” portrays individuals diagnosed with schizophrenia as people with hopeless futures whose primary life options are hospitalization, homelessness, or incarceration.The segment provides no indication that individuals with schizophrenia can and do live fulfilling lives, start their own families, work, live independently, and participate fully in their communities. Instead, such individuals are painted as consigned to a life of misery and as ticking time bombs with the potential to become violent at any time.

    The segment perpetuates false assumptions that there is a significant link between mental health conditions and violence. Indeed, the point of the segment seems to be that mass shootings would be preventable if it were easier to hospitalize individuals with psychiatric disabilities. Apparently relying on Dr. Torrey’s inaccurate statement that half of mass killings are committed by individuals with serious mental illness, the report states: “It's becoming harder and harder to ignore the fact that the majority of the people pulling the triggers have turned out to be severely mentally ill—not in control of their faculties—and not receiving treatment.” Research shows that this is far from accurate. One survey of mass shootings between 2009 and 2013 found that perpetrators had a known mental health condition in only 11 percent of these incidents.1 A recent study of the psychiatric characteristics of homicide defendants found that psychiatric factors do not appear to predict whether a homicide defendant used a firearm or killed multiple victims.2

    Imminent Danger” also inaccurately suggests that the primary need in our mental health system is for more involuntary hospitalization. In fact, we have a long history of national and state reports—including the Surgeon General’s Report on Mental Health in 1999 and the 2003 report of the President’s New Freedom Commission on Mental Health—indicating that our mental health system is broken because we are failing to invest in effective community services (such as supported housing, supported employment, mobile crisis services, peer supports, and mobile community support teams).6Dr. Torrey’s focus on hospitalization and forced treatment as the primary need in mental health systems is at odds with a virtual national consensus that the focus should be community services.

    Finally, the segment incorrectly suggests that the requirement that individuals be dangerous before they can be involuntarily committed to a psychiatric hospital is a significant barrier to treatment. Dr. Torrey states in the segment that due to this requirement, in most states, it is “almost impossible” to commit people. This is a gross misstatement of fact. In fact, more than 52,000 individuals were involuntarily committed to psychiatric hospitals last year. Moreover, the vast majority of individuals who come before courts on involuntary commitment petitions are committed.7

    These inaccuracies and omissions in “Imminent Danger” create a harmful portrayal of Americans diagnosed with schizophrenia and other psychiatric disabilities. This portrayal is likely to lead to further discrimination and scapegoating of these individuals and to suggest misguided policy solutions. Moreover, this segment misses the opportunity to highlight the need for greater investment in effective community services. We hope that 60 Minutes will devote a segment to presenting a different perspective and we stand ready to work with you on making that happen.


    American Association of People with Disabilities

    American Association on Health and Disability

    Anti-Bias Home Page/National Stigma Clearinghouse

    Arbor Housing and Development

    Association of Programs for Rural Independent Living

    Autistic Self Advocacy Network

    Baltic Street AEH Inc.

    Bazelon Center for Mental Health Law

    Clubhouse of Suffolk

    Community Access

    Compeer Programs

    Connecticut Legal Rights Project

    Delaware Consumer Recovery Coalition

    Disability Rights Education and Defense Fund

    Disability Rights International

    Equip for Equality

    Little People of America

    Maine Center, Inc.

    Mental Health America

    Mental Health Association of Nebraska

    Mental Health Association Orange County, Inc.

    Mental Health Association Suffolk County

    National Association for Rights Protection and Advocacy

    National Coalition for Mental Health Recovery

    National Council for Community Behavioral Healthcare

    National Council on Independent Living

    National Disability Rights Network

    National Mental Health Consumers’ Self-Help Clearinghouse

    New York Association for Psychiatric Rehabilitation Services, Inc.

    Parsons Family and Consumer Services

    Sacred Creations

    Suffolk County United Veterans


    Venture House

    Witness Justice

    Yale Program for Recovery and Community Health

    October 4, 2013 - News of the Week


     Study Finds Psychiatric Factors Not Linked To Multiple Homicide Victims

    Article:  Clinical and Research news; Mark Moran; September 17, 2013
    Source:  Thank you Briana Gilmore, NYAPRS

    Psychiatric Characteristics of Homicide Defendants” is posted at http://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.

    Psychiatric Factors Not Linked to Multiple Victims” is posted at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096

    Though more than a third of the defendants had prior psychiatric treatment, few received treatment in the three months preceding the crime of which they were accused.

    Psychiatric factors do not appear to predict whether a homicide defendant used a firearm, killed multiple victims, or is convicted of the crime, a finding that would seem to counter the popular notion—prevalent in the wake of recent mass killings that have made the news—that perpetrators of mass gun violence are invariably mentally ill.

    The finding is from a study appearing in the SeptemberAmerican Journal of Psychiatry that assessed the association between homicide and a wide range of demographic and clinical variables.

    Key Points

    • 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.

    It is notable that clinical variables, such as Axis I diagnoses, were not associated with offense characteristics or case outcomes when demographic and historical characteristics of the cases were included in the models,” wrote lead author Edward Mulvey, Ph.D., of the University of Pittsburgh Medical Center, and colleagues. “In particular, while age and race were significantly related to the use of a firearm, the addition of clinical variables to demographic and historical variables did not improve model fit. Furthermore, a model including demographic/historical and clinical variables did not significantly predict a guilty verdict, suggesting that case-specific factors were more salient in these determinations.”

    In the study, defendants charged with homicide in a U.S. urban county between 2001 and 2005 received a psychiatric evaluation after arrest. Demographic, historical, and psychiatric variables as well as offense characteristics and legal outcomes were described. The researchers examined differences by age group and by race; they also looked at predictors of having multiple victims, firearm use, guilty plea, and guilty verdict.

    Fifty-eight percent of the sample had at least one Axis I or II diagnosis usingDSM-IV criteria, most often a substance use disorder (47 percent). Axis I or II diagnoses were more common (78 percent) among defendants over age 40. Although 37 percent of the sample had prior psychiatric treatment, only 8 percent of the defendants with diagnosed Axis I disorders had outpatient treatment during the three months preceding the homicide.

    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 violence.”

    Steven Hoge, M.D., says that study findings showing low rates of treatment in the period prior to a crime suggest that crime-prevention strategies relying on psychiatrists’ reports regarding treatment encounters will not be effective.

    Steven Hoge, M.D., chair of APA’s Council on Psychiatry and Law, reviewed the report. “Individuals with an Axis I disorder were overrepresented among homicide defendants,” he told Psychiatric News, “but this was due to the high rate of substance use disorders found. The relationship between substance use and serious criminal behavior is well established. The study identified only 15 individuals—just 5 percent of the sample—who had a mental disorder and no co-occurring substance use disorder. Identification and treatment of substance use disorders are important not only to alleviate individual suffering, but also to improve public safety.

    The study findings address current concerns regarding gun use and mass killings by those with mental illnesses,” he continued.“There is widespread belief that mental illness is an important cause of firearm violence and mass murder. In fact, the researchers found no relationship between the presence of psychiatric disorders and the use of firearms. Nor did the presence of a psychiatric disorder relate to offenses involving multiple victims. These findings suggest that policies designed to keep firearms out of the hands of individuals with a history of mental illness will not prove to be effective as a targeted strategy.”

    Hoge also said the study underscores the need for better access to psychiatric treatment, particularly substance use treatment. However, crime-prevention strategies that rely on psychiatrists’ reports are likely to be ineffective because most of this population is not in treatment or getting timely treatment.

    Psychiatric Characteristics of Homicide Defendants” is posted athttp://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.

    Psychiatric Factors Not Linked to Multiple Victims” is posted athttp://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096

    October 1, 2013 -  News of the Week


    (See more information below)

    "Imminent Danger" is the now-shortened title of a recent "60 MINUTES" segment about violence and mental illnesses.  The segment aired on September 29th and was followed by an onslaught of online viewer comments and criticism.

    Most mental health advocates are seeking expansion of high-quality community programs and safe housing.  They deplore "Imminent Danger's" sole emphasis on a national disgrace that no one disputes.  The program reminds us of  the "walking time bomb" imagery often used in CBS features during the 1990s.  The segment's original title, "Untreated mental illness an imminent danger?", implied an open-minded, solution-seeking approach -- but no balance was seen, and there was an appalling over-emphasis on "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.


    A commentary by Linda Rosenberg
    President and CEO,  National Council for Community Behavioral Healthcare 

    LINK: http://www.thenationalcouncil.org/lindas-corner-office/2013/09/60-minutes-highlights-need-for-excellence-in-mental-health-act/

    A Commentary and Source Materials from Susan Rogers
    Director,  National Mental Health Consumers' Self-Help Clearinghouse

    I find it surprising that “60 Minutes,” which has a history of serious investigative journalism, would do such a slipshod job on the segment “starring” E. Fuller Torrey.

    The producers apparently saw no reason to include the fact that people diagnosed with schizophrenia can and do recover. Significantly, a decades-long study by the World Health Organization found that individuals diagnosed with schizophrenia usually do better in countries in the developing world – such as India, Nigeria and Colombia – than they do in such Western nations as Denmark, England and the United States. According to an analysis of results, “Patients in developing countries experienced significantly longer periods of unimpaired functioning in the community, although only 16% of them were on continuous antipsychotic medication (compared with 61% in the developed countries). . . . The sobering experience of high rates of chronic disability and dependency associated with schizophrenia in high-income countries, despite access to costly biomedical treatment, suggests that something essential to recovery is missing in the social fabric.

    Nor did they include any information about the Hearing Voices movement, which helps people learn to cope effectively with the experience of hearing voices.

    In addition, in a small British pilot study, 16 individuals diagnosed with schizophrenia were able to control their auditory hallucinations with an experimental treatment called “avatar therapy.” The treatment involves creating a computer-based representation – including a face and a voice – of the entity they believe is talking to them. The individual’s therapist is then able to speak through the avatar, encouraging the individual to counter the voice and to take control of the hallucinations. Three of the 16 people who participated in the study completely stopped hearing their voices as a result of the therapy, and almost all of the participants reported a reduction in frequency and in the severity of distress the voices caused, according to a published report. Because of the pilot’s success, The Wellcome Trust will fund a larger study, to be led by researchers at King’s College London’s Institute of Psychiatry. Thomas Craig, the psychiatrist who will lead the larger trial, said that if the study is successful, the therapy could be widely available within a few years.

    Although Dr. Torrey believes that individuals diagnosed with mental health conditions should be force-medicated if they refuse to take medication voluntarily, award-winning journalist Robert Whitaker believes that medication contributes to chronicity. In the era that followed the introduction of Thorazine in 1955, there has been an exponential rise in the numbers of individuals disabled by mental health disorders, he reports in his book “Anatomy of an Epidemic.” Whitaker told Behavioral Healthcare, “. . . [U]nfortunately I’m afraid psychiatry no longer knows how to get back on track with honest reporting of what it does and does not know, and honest investigations of psychiatric medications. . . . Ultimately, I think we need a new paradigm built on the framework of psychosocial and recovery practices.”

    The “60 Minutes” producers made a serious error in relying upon Dr. E. Fuller Torrey as its main source. Torrey admits to fabricating “evidence” to further his goal of making it easier to lock up people who have psychiatric diagnoses. Toward this end, he has for years engaged in “an intensive public relations campaign linking mental illness with violence.” 

    To the contrary, according to a NY Times article, only about 4 percent of violence in the United States can be attributed to people with mental illness.” And the 4 percent statistic is about violence of any kind – which, according to the study cited, would include something as relatively innocuous as threatening threatening behavior – as opposed to just homicides. Also, since the fears of the general public largely focus on strangers with mental health conditions, it is significant to report another study, which estimated that there is only one stranger homicide per 14.3 million peopl year.

    60 Minutes” should do a follow-up piece in which it strives for accuracy, as opposed to sensationalism.

    Susan Rogers, Director
    National Mental Health Consumers’ Self-Help Clearinghouse
    Director of Special Projects
    Mental Health Association of Southeastern Pennsylvania
    1211 Chestnut Street, 11th Floor
    Philadelphia, PA 19107

    267-507-3812 (direct)
    800-553-4539, ext. 3812
    800-688-4226, ext. 3812

    Fax: 215-636-6312

    The National Mental Health Consumers’ Self-Help Clearinghouse
    is a consumer-run national technical assistance center funded in part by
    the Substance Abuse and Mental Health Services Administration.


    The views, opinions, and content on the Clearinghouse website and in anything posted on the website or in these e-mails or attached to these e-mails donot necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

    September 23, 2013 - News of the Week

    CRISIS INTERVENTION TEAMS : Will New York City Act At Last?

    Communities for Crisis Intervention Teams in NYC

    Welcome to the online home of Communities for Crisis Intervention Teams (CCIT-NYC). If you’d like to share this website with others,
     the web address is: http://www.ccitnyc.org.

    Our Aim:

    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.

    Shereese Francis
    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 threatening.

    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 three parts:

    1. 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 crisis.

    2. Training
    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.

    3. Oversight/Development Committee
    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 compliance.

    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

    (1) 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.

    (2) 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:

    Carla Rabinowitz
     Community Organizer, Community Access
     (212) 780-1400, ext. 7726

    August 19, 2013 – News of the Week


    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 video:


    Mental Illness At Work: My Schizophrenia Helped Me Find A Job (VIDEO)


    July 5, 2013 - News of the Week


     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

                                         HOME      PHILOSOPHY      AR T      QUOTATIONARY

    July 5, 2013 - News of the Week


    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



    (Thanks 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 in Vermont")


    "Nearly 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)

    The need 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 committals.

    "We are 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 difference."

    June 16, 2013 - News of the Week 
             (Changes made on June 20)


    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 have the ability to lighten such unwarranted penalties.  But simply mentioning the rarity of violent acts is not enough. 

    One way to help is to support patients and ex-patients.  Dr. Satel and 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 diseases -- 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 addictions.)

    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 Deegan, Daniel Fisher, Elyn Saks, and David Oaks, who were diagnosed and hospitalized for schizophrenia in their teens or early 20s.  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 both appealing 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'.


    Recovery From Schizophrenia: With Vews of Psychiatrists, Psychologists,
    and Others Diagnosed With This Disorder.  

    by Frederick J. Frese, Edward L Knight and Elyn Saks

    Schizophrenia Bulletin (2009) Vol. 35, Issue 2, pp 370-380

     Click for full article.. http://schizophreniabulletin.oxfordjournals.org/content/35/2/370.full#sec-4

    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

    BAZELON CENTER ALERT: Stigma Wins, Privacy Loses in HHS Proposal

               Source:   Judge David L. Bazelon Center for Mental Health Law   www. bazelon.org     Washington DC

    HHS Proposal Would Diminish Privacy Protections

    June 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.

    We 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.

    What You Can Do

    · Submit comments to HHS here on or before Friday, June 7.

    · You can use our comments as a template.

    Thank you!

    May 7, 2013 - News of the Week


    Countless millions of Americans suffer from their diagnostic label more than from symptoms that can often be dealt with.  Helped by self-awareness and supporting communities, many become experts at coping with their symptoms.  Unfortunately, the popular misuse of psychiatric labels over many years has a penalizing effect on those who seek help. 

    The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), often called the psychiatists' bible, will be in book stores within weeks. Key leaders of the psychiatric establishment say the DSM lacks scientific validity; still, most will continue to accept its clinical usefulness for diagnosing patients.  Plans for the next decade will shift NIMH research funds to a search for biological underpinnings of 'mental illnesses'.  If successful, the project is likely to require new diagnostic terms.

    Today's psychiatric labels lead to exclusion and rejection.  Will the discovery of biological markers end the prejudice that too often deters people from seeking help?


     Click   Psychiatry in Crisis..." (by JOHN HORGAN, SCIENTIFIC AMERICAN, May 4, 2013)

    ARTICLE: New York Times, May 7, 2013  (reprint protected by Fair Use Standard)

    Psychiatry’s Guide Is Out of Touch With Science, Experts Say


    Published: May 7, 2013

    Just weeks before the long-awaited publication of a new edition of the so-called bible of mental disorders, the federal government’s most prominent psychiatric expert has said the book suffers from a scientific “lack of validity.”
    The expert, Dr. Thomas R. Insel, director of the National Institute of Mental Health, said in an interview Monday that his goal was to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience so that scientists can define disorders by their causes, rather than their symptoms.

    While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.
    “As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”
    The revision, known as the D.S.M.-5 and the first since 1994, has stirred unprecedented questioning from the public, patient groups and, most fundamentally, senior figures in psychiatry who have challenged not only decisions about specific diagnoses but the scientific basis of the entire enterprise. Basic research into the biology of mental disorders and treatment has stalled, they say, confounded by the labyrinth of the brain.
    Decades of spending on neuroscience have taught scientists mostly what they do not know, undermining some of their most elemental assumptions. Genetic glitches that appear to increase the risk of schizophrenia in one person may predispose others to autism-like symptoms, or bipolar disorder. The mechanisms of the field’s most commonly used drugs — antidepressants like Prozac, and antipsychosis medications like Zyprexa — have revealed nothing about the causes of those disorders. And major drugmakers have scaled back psychiatric drug development, having virtually no new biological “targets” to shoot for.
    Dr. Insel is one of a growing number of scientists who think that the field needs an entirely new paradigm for understanding mental disorders, though neither he nor anyone else knows exactly what it will look like.

    Even the chairman of the task force making revisions to the D.S.M., Dr. David J. Kupfer, a professor of psychiatry at the University of Pittsburgh, said the new manual was faced with doing the best it could with the scientific evidence available.
    “The problem that we’ve had in dealing with the data that we’ve had over the five to 10 years since we began the revision process of D.S.M.-5 is a failure of our neuroscience and biology to give us the level of diagnostic criteria, a level of sensitivity and specificity that we would be able to introduce into the diagnostic manual,” Dr. Kupfer said.
    The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

    Dr. Hyman, Dr. Insel and other experts said they hoped that the science of psychiatry would follow the direction of cancer research, which is moving from classifying tumors by where they occur in the body to characterizing them by their genetic and molecular signatures.
    About two years ago, to spur a move in that direction, Dr. Insel started a federal project called Research Domain Criteria, or RDoC, which he highlighted in a blog post last week. Dr. Insel said in the blog that the National Institute of Mental Health would be “reorienting its research away from D.S.M. categories” because “patients with mental disorders deserve better.” His commentary has created ripples throughout the mental health community.

    Dr. Insel said in the interview that his motivation was not to disparage the D.S.M. as a clinical tool, but to encourage researchers and especially outside reviewers who screen proposals for financing from his agency to disregard its categories and investigate the biological underpinnings of disorders instead. He said he had heard from scientists whose proposals to study processes common to depression, schizophrenia and psychosis were rejected by grant reviewers because they cut across D.S.M. disease categories.
    “They didn’t get it,” Dr. Insel said of the reviewers. “What we’re trying to do with RDoC is say actually this is a fresh way to think about it.” He added that he hoped researchers would also participate in projects funded through the Obama administration’s new brain initiative.
    Dr. Michael First, a psychiatry professor at Columbia who edited the last edition of the manual, said, “RDoC is clearly the way of the future,” although it would take years to get results that could apply to patients. In the meantime, he said, “RDoC can’t do what the D.S.M. does. The D.S.M. is what clinicians use. Patients will always come into offices with symptoms.”
    For at least a decade, Dr. First and others said, patients will continue to be diagnosed with D.S.M. categories as a guide, and insurance companies will reimburse with such diagnoses in mind.

    Dr. Jeffrey Lieberman, the chairman of the psychiatry department at Columbia and president-elect of the American Psychiatric Association, which publishes the D.S.M., said that the new edition’s refinements were “based on research in the last 20 years that will improve the utility of this guide for practitioners, and improve, however incrementally, the care patients receive.”
    He added: “The last thing we want to do is be defensive or apologetic about the state of our field. But at the same time, we’re not satisfied with it either. There’s nothing we’d like better than to have more scientific progress.”


    April 12, 2013 - News of the Week


    The New York Safe Act Mental Health Section Should Be Suspended and Reconsidered

    Kendra's Law (Assisted Outpatient Treatment)
    Why extend a law that is not due to expire until 2015?  Why are Kendra's Law's creators still quoting outcome statistics gathered in 2003, a decade ago?  Where are the Assisted Outpatient Treatment (AOT) program's original recipients now, ten years later?  Is a longitudinal study underway so that concrete lessons can be learned?  What evidence supported moving the law's expiration date to 2017 instead of 2015? 

    In 2003, a Kendra's Law interim report showed the progress of 2,745 AOT participants after six months in the program. Issued by the NY Office of Mental Health, the in-house report analyzed outcomes from Kendra's Law's first six months of operation, based on interviews with multiple stakeholders including staff and AOT recipients. Two years later, that outcome data was reused in a "Final Report 2005."  More recently, three independent evaluations found a widely variable pattern of statewide use and program design. Although the independent research teams noted the benefits of priority access to scarce programs and housing, questions about involuntary participation were unanswered.  (See Kendra's Law Updates for more...)

    New York SAFE Act Mental Health Section
    Clarification is urgently needed concerning the New York SAFE Act's sweeping new statute that assigns an informant role to the entire New York mental health system and related agencies.  The loosely-defined new rules have already spawned a wrongful accusation and a buck-passing response.  In Erie County this week a man was mistakenly targeted under the SAFE Act provision by police but responsibility for the error is unclear.  See news reports below.

    "Attorney Claims State Officials Intentionallhy Violated HIPPA to Enforce SAFE Act"  more...
     "State Police Mistakenly Enforce SAFE Act Provision" more...
     "NY SAFE Act notification under fire" more...   


    March 29, 2013 - News of the Week


    Have independent evaluations of Kendra's Law been ignored?

    Fourteen years have passed since the terrible day in January 1999 when Kendra Webdale was pushed onto the track of an oncoming Manhattan subway train by a man who had been recently discharged from a psychiatric facility with a one-week supply of medication. A recent opinion piece by Patricia and Ralph Webdale in the NY Daily News, "Our Daughter Did Not Die in Vain," is a moving statement explaining the family's resolve to end such tragedies. Left unsaid, though, is that the man in the subway, Andrew Goldstein, had searched in vain for services now on the Webdales' poignant "if only" list of life savers.  He had even requested a supervised treatment setting.

    A quote from the Webdales' opinion piece: "If only he had received followup by a caseworker. If only he had been able to stick with his medication without supervision. If only... Kendra would be alive and he would not be in prison."

    A quote from a New York Times investigation by Michael Winerip: "What I found most haunting about Goldstein's 3,500 page file was his repeated pleas for services that had no vacancies."

    Reading the Webdales' article took me back to 1999 when a deluge of inflammatory publicity spurred the speedy passage of Kendra's Law, a statute allowing the mandatory medication of psychiatric outpatients. Its creators now call the law flawed and recommend strengthening it. But the flaws may be insurmountable. A trial now in progress in Manhattan involves a homicide committed in 2008 by a Kendra's Law participant. According to his father (New York Times, 2/20/2008), the assailant simply eluded the caseworkers assigned to him. This case raises questions about compulsory medication's inherent monitoring problems.

    A major culprit in the fatal subway encounter, mostly ignored in 1999, was New York State's downsizing policy that derailed Andrew Goldstein's repeated tries to get the help he knew he needed. The true story of Goldstein's futile search for help was detailed by Michael Winerip in the New York Times Sunday Magazine cover story, May 23, 1999.

    The Webdales' commentary confirms their compassionate intentions and moral credibilty, but it fails to show that Kendra's Law can put a dent in the crisis of funding and services we face today. New options include non-coercive ways to engage people who have 'given up'. Just a few promising examples are Emotional CPR promoted by the National Coalition for Mental Health Recovery; the WRAP program developed by Mary Ellen Copeland; and a deceptively simple program that helps patients make best use of today's typical 15-minute medication consult, created by Patricia Deegan, the founder of Common Ground.

    Let us hope that with constructive input from open minds, progress is possible.


    Kendra's Law Updates: 2006-2013

    In a whirlwind response to the killing of 26 people (20 children) in Newtown CT, Governor Andrew Cuomo signed a new package of firearm and mental health regulations, the NY SAFE Act on January 15, 2013, intended to control gun violence.  The act extends Kendra's Law from 2015 to 2017, expands some aspects of the law, and adds rules requiring professionals to inform authorities when one of their patients exhibits signs of potentially harmful behavior. The Safe Act has raised questions so far unanswered and treatment barriers such as patient/professional trust.  Further, the extension of Kendra's Law is premature, considering the cautionary findings of independent evaluations in 2009 and 2010.  A new independent evaluation is needed to update the in-house report of 2003 which the Legislature found insufficient.  Ten-year-old outome data from 2003 and repeated in "Final Report 2005, quoted often as though current, is misleading.

    March 11, 2013 - News of the Week


    The Harvard Crimson recently ran a student's account of his failed search for mental health services.  For months after seeking help for disabling symptoms, the student was met by a series of stone walls while his or her 'voices' worsened.  If there is a bright side to this disturbing story, it's the student's courage in recounting the experience with the hope of saving others from succumbing to the spirit-breaking obstacles he or she faced.  Kudos to The Harvard Crimson for airing this important issue and for provoking a discussion of solutions.

    "You do not become schizophrenic overnight.  When I began to hear voices, I told myself that it was some peculiar coping mechanism that was benign and would soon go away....(more(Article forwarded by Bill Lichtenstein, LCMedia.com)

    March 7, 2013 - News of the Week

                                 RECOVERY IS FOR EVERYONE!  (Conference Announcement)

    Thursday, April 4, 2013

    The Marriott, Albany, NY

    Recovery is about doing things differently. It’s about having hope and making changes.

    This free conference, “Recovery is for Everyone!,” will include information that persons in recovery, providers, and others can use to make recovery “real.” Speakers will discuss recovery principles and concepts and how they can be put into practice, what a recovery facilitating system looks like, measures for recovery-promoting environments, and tools that support recovery.

    The conference is intended for people in recovery from mental health conditions and/or addiction as well as their families, educators, social workers, psychologists, psychiatrists, peer specialists, community staff, and other behavioral health stakeholders. This conference is offered free of charge. Continuing education credits will be available.

    You can register for “Recovery is for Everyone!” by Friday, March 22, 2013 using the form included in the attached brochure (link is below).

    Sponsored by: Community Care Behavioral Health Organization and Western Psychiatric Institute and Clinic of UPMC.   

    For more information, please visit www.ccbh.com  --  and/or view the descriptive brochure linked below.

    February 18,  2013 - News of the Week


    Tragic mass shootings have led to a welcome national focus on violence prevention.  It is troubling, though, to see the diagnostic term 'schizophrenia' used as a catchall word for violent behavior.  Schizophrenia affects just over 1% (1.1 percent) of the adult population (National Institute of Mental Health, NIMH website) and of these people, 99.97% of them will not be convicted of serious violence in a given year (Walsh et al, 2002 and Wallace et al, 1998).  Also noteworthy is a research finding that violence rates for those who did not abuse substances were indistinguishable from their non-substance-abusing neighbors.   With misuse of mind-altering substances (found to double violence rates), those with schizophrenia had "the lowest occurrence of violence over the course of a year" compared with bipolar disorder or major depression.   (Stuart, 2003)

    How did schizophrenia acquire its inflated link to violence?  Experts point to decades of media misrepresentation. Its catchy name and air of mystery were a gift to the advertising and entertainment media, and confusion with "split personality" added to its allure.  An example is a tabloid column about flip-flopping politicians, headlined, "The Schizophrenics Are Loose -- Public Nuisances," (The New York Post, 1991). 

    The media's persistent misrepresentation of 'schizophrenia' has clearly influenced public opinion. Twenty years have passed since a public awareness booklet noted that "violence has been exaggerated in movies and television, increasing irrational fears of persons with schizophrenia." ("Facts About Schizophrenia")  The media's active role in shaping opinion was best summed up by a Robert Wood Johnson Foundation survey: "Mass media is, far and away, the public's primary source of information about mental illnesses." (Yankelovich, 1990)

    It is possible that 'schizophrenia' filled a void in psychiatry's diagnostic jargon when the term 'psychopath' was dropped by psychiatrists.  Psychopathy (as it was called) is a psychiatric condition that has a known association with violent behavior. This condition has most recently been labeled 'antisocial personality disorder', a diagnosis mired in confusion and controversy. Lacking a usable word, the mass media may be using 'schizophrenia' as a fallback choice when reporting unexplained violence.  If so, it's a terrible mismatch.  'Antisocial personality disorder' and 'schizophrenia' are not the same, and the terms are not interchangeable.

    With few exceptions, a 'schizophrenia' label penalizes forever the life of the person who receives it. One would expect such a punishing label to be based on scientific evidence, but there is no such evidence.  Calls for a name change come and go.  An excellent discussion of this idea is Phyllis Vine's "Should the term schizophrenia be changed?"

    Our vocabulary shapes attitudes, policies, and even laws.  Surely we can head off further distortion of 'schizophrenia' by protesting its use as a blanket term in violent contexts.

    "Facts About Schizophrenia". A booklet issued by NYS Office of Mental Health, Gov. Mario Cuomo's administration (1983-1994)
    National Institute of Mental Health, "Schizophrenia, 12-month prevalence," website (2013)
    Stuart, Heather, "Violence and mental Illness, an overview," policy paper, pages 122-123, Queens University, Ontario Canada, (2003)
    The New York Post. "The schizophrenics are loose - public nuisances," R. Emmett Tyrrell Jr. October 8, (1991)
    Vine, Phyllis. MIWatch.org  "Should the term schizophrenia be changed?, website (2009)
    Wallace et al.  "Serious criminal offending and mental disorder," British Journal of Psychiatry, 172, 477-484. (1998)
    Walsh et al. "Violence and schizophrenia: examining the evidence," British Journal of Psychiatry, 180: page 494 (2002)
    Yankelovich (DYG, Inc.). "Public Attitudes Toward People with Chronic Mental Illness," prepared for Robert Wood Johnson Foundation, April (1990)

    February 8, 2013 - News of the Week


    Article Source: The Seattle Times  (http://seattletimes.com)
    Link: http://seattletimes.com/html/opinion/2020216226_alantayloroped.html

    Op-ed: Changing how we talk about mental illness  (originally published January 25, 2013)
       (reprinted with protection of  Fair Use standard)

    As a society, we don’t talk about mental health in the personal ways that raise awareness, foster advocacy, and lead to meaningful change, writes guest columnist Alan Taylor.

    By Alan Taylor

    IN 2012 a string of mass shootings shook America. Ian Stawicki took five lives at Cafe Racer in Seattle, James Holmes opened fire in a crowded Colorado theater and, most disturbing, Adam Lanza killed 26 people, including 20 children, in Newtown, Conn.

    The mental health of each of these perpetrators was immediately questioned, which has led to a renewed call for better mental-health treatment.

    I’m afraid that no substantive change will occur because we are discussing mental health in the abstract sphere of politics rather that in the intimate communities where we live day to day — places like our homes, jobs, schools, faith communities and social gatherings. 

    As a society, we don’t talk about these issues, at least not in the personal ways that raise awareness, foster advocacy and lead to meaningful change. We talk about the dangers of mental health in a way that causes those who are actually living with mental-health challenges to gather in hushed circles and share their struggles, wisdom and perspective with only a select few. 

    Their stories, front-line experiences and insights are the key to a more holistic societal understanding. But they don’t speak because they are scared of losing respect, trust and relationships, and being viewed as another mentally ill person who might go on a violent rampage. 

    In 2003 I was diagnosed with bipolar disorder, type 1. I’ve felt the cold exclusion of stigma. In the months after my first manic episode many of my friends withdrew; one friend told me that her boyfriend didn’t feel it was safe for her to be around me. There are times when I hesitate to reveal my diagnosis for fear that new people I meet will subtly distance themselves from me — the shifty look of distrust, unsure what erratic thing the guy with bipolar might do. 

    Most times, though, I share my story, because I don’t want their picture of mental illness to be a mad man with a gun.

    Change begins with education and conversation. Most people know very little about mental health. Society at large seems to be mostly ignorant, informed predominantly by popular media and gruesome news stories. Rather than a disease of the brain — the same way diabetes is a disease of the pancreas — we see a disease of character. 

    We speak in language that perpetuates stigmas, referring to moody people as “being bipolar.” We foster fear by putting the word “schizophrenia” in print most often with the words “violence,” “untreated” and “risk to themselves and others.” We discourage transparency by removing trust and responsibilities from those who choose to speak openly about their depression or anxiety.  

    I believe that for real change to occur, our communities must push against the flood of bigotry and misunderstanding. fear and labeling.  We must initiate space for safe conversation that invites those living with mental health challenges to share their stories of struggle and survival.

    What might this look like?  Religious leaders might consider devoting time in their services to educate their members.  Medical and nursing schools might consider providing more robust mental-halth training that includes firsthand testimony from those who live with mental-health challenges.  Business owners might make mental-health education a part of new-hire orientation.

    School administrators might build mental-health education into the curriculum.  Media outlets might produce positive stories about mental health that expose society to a more balanced and accurate view of this issue.  Those who live with a brain disease might share their story, accepting the invitation to discuss and educate.

    Undoubtedly, we need better funding for mental-health treatment, but we also need a shift in the basic way we talk and think about matters of mental health.  This shift won't take place in Olympia or Washington, D.C.  It will take place in our office, our favorite retaurant, our church, mosque, or temple and our family gatherings.

    Alan Taylor works as a peer counselor at a community mental-health clinic in Puyallup.

    January 15, 2013 - News of the Week

    Let's Stop Blaming The Mentally Ill
    By Lollie Butler Arizona Daily Star January 15, 2013
                                              (courtesy of NYAPRS.org)
    There is a bloody war being waged in America; gun advocates versus those who would ban guns. This "civil" war may go on for a long time.
    Meanwhile, those suffering from mental illnesses unfairly shoulder the blame for atrocities committed against the innocent.
    This is an unreasonable situation. Armed persons firing into crowds, whether at schools or shopping malls, defies reason and causes all of us to feel vulnerable. It also takes its toll on those with mental illnesses. Words like "crazy" and "deranged" fly across the front pages, and the mentally ill in treatment, saddled with severe funding cuts and ongoing social stigma, take it on the chin.

    A 2009 study in the Archives of General Psychiatry states, "If a person has severe mental illness without substance abuse and a history of violence, he or she has the same chance of being violent during the next three years as any other person in the general population."

    "It's unproductive to besmirch a whole group of people recovering from (mental) illnesses as if they are all dangerous - when in fact, they're not," says Duke University medical sociologist Jeffery Swanson.

    Who kills? Do guns kill or do people kill? The NRA would have us believe that the Newtown murderer could have carried out his massacre of 26 people including 20 children with any weapon, and that a semiautomatic rifle is no more effective in a crowd than a cleaver. They would have us believe that video games have created a cadre of psychotic individuals and that the proliferation of combat rifles has no bearing on these murders.

    Our focus of late has been on mass murders, but every day in this country people are killed by gunfire either by others, by their own hand or by accident. When a child finds an unlocked gun and through natural curiosity fires it - accidentally killing himself - the argument that it is people, not guns who kill, falls flat.
    In every human drama, someone profits and someone loses. In this regrettable situation, the NRA and its members and manufacturers profit while the public at large and those in and out of mental-health recovery lose.

    In the aftermath of the recent tragedy that sent 20 children to their early graves and killed teachers and others at the school who attempted to defend them, the sales pitch of gun advocates that "freedom equals a gun placed in the hands of every American" will probably continue.

    Though we cry "never again!" from the rooftops, unless we stop criminalizing everyone with a mental illness and lift the burden of too many guns from our shoulders, America's war with itself will continue and the body count will increase.

    Lollie Butler is the director of the program Heart to Heart, through the National Alliance for Mental Illness of Southern Arizona.

    October 9, 2012 - News of the Week

    Have you heard about MindFreedom International's new website, 'I GOT BETTER' ?
    This campaign has the potential to 'go viral –  imagine first dozens, then hundreds, even thousands of people sharing their videos...Celebrities and other public figures coming out of the 'mad closet'...This could not only bring hope to people in pain, but also change attitudes toward us...” 

    With your help, people will get the message that there is hope, even in situations of extreme mental and emotional distress... or even when someone feels trapped forever in a mental health system with no exit, say Sophie Faught and John Abbe, MindFreedom's Communications Co-Coordinators.  Read on for how-to!


    Now it's up to you -- do you have a story about discovering and nurturing hope while in and out of the mental health system, and mental and emotional problems?

    Sharing your story could make a huge difference to someone in the depths of their own struggle, especially young people.

    Getting a psychiatric label can feel isolating. When they see you and others sharing your stories about how you found hope and defined recovery and wellness for yourself, you will encourage them and give them ideas about how to make their own lives better.

    Whether or not you share your story, think about people in your life who may have such a story, and see if they would like to share it.


    One of the best ways to really reach people today is with video, so they can see your face and hear your voice. Try to keep it short. Go ahead and share the worst of your struggles, but make sure to follow that up with your recovery from hopelessness and positive information about how you're achieving wellness in your life.

    You don't have to be "fully recovered" (however that's defined!) to participate. Whatever steps you've taken towards wellness, and to get out of any oppression in the mental health system, you've got a story to tell and we want to hear it!

    Here's how to make and submit a video:

    We are also accepting written stories:

    See those new video stories with a link to more videos here:

    Thanks for your support in making I GOT BETTER a success!

    Please email us with questions, feedback, or anything else about I GOT BETTER at igb@mindfreedom.org

    In support,
    Sophie and John
    MindFreedom International

    August 26, 2012 - News of the Week


    Years ago, David Oaks, the founder and director of MindFreedom International, urged the mental health community to stop using the term mental illness  He believes (and I agree) that the term spawns the public's misperception of little-understood human conditions, and supports the medical model's undeserved domination of the mental health field  As David explains it, My call is about opposing domination by any model in this complex field.  My call is about opposing bullying in mental health care.   

    To explore language options, David created an open-forum online website, "Lets Stop Saying "Mental Illness"!  He emphasizes this is not about political correctness or finding the perfect words, but sending a message of respect about the diversity of perspectives in mental health.

    In an email this week, David wondered why I (Jean Arnold) continue to use mental illness on my website.  At first I thought he must be overstating. To check it out, I did a word-search of www.stigmanet.org by pressing ctrl+f (at the same time), then entering mental illness in the FIND box that popped up. There were 143 finds for mental illness/illnesses on my home page alone. (A number of these were in articles by other people.) I intend to replace my use of mental illness/illnesses with language that doesn't presume that the etiology of human behaviors has been discovered.

    "Let's Stop Saying "Mental Illness"! is an informative and thought-provoking online essay-in-progress about the pitfalls of  language inaccuracy and bias.  David welcomes feedback suggestions regarding this "living essay." Email: news@mindfreedom.org 





    August 20, 2012 - News of the Week

    "If we continue as a society to let the media define mental illness, the cycle of stigma and fear will only compound the problem." These words are from Devan Munn, a Canadian who is a member of the Community Editorial Board of GuelphMercury.com
    Mr. Munn's insightful editorial ,"Media's approach to mental illness doesn't help us understand it" (8/18/2012), drew the following response from a concerned reader.

    Comment by: NormalLikeYou
    Aug 18, 2012 12:38 PM

    Great Editorial
    It saddens me that the only time Mental Health gains much traction in the media is in the event of a horrible tragedy. After such times, we usually do get calls to address the systemic problems that are symptoms of our failure as a society to prioritize getting help to something that affects one in five Canadians. However, often what is overlooked is that many people who have serious mental illnesses do not get help because they fear being identified as mentally ill. Not only that but our society has a particular picture of those with mental illnesses.

    When someone says the words "paranoid schizophrenia" they tend to think of someone like Vincent Li rather than someone like me: A multiple scholarship winner who was told that his illness would prevent him from returning to university but defied such odds to pursue his education. One of the reasons I struggled so much in the beginning with my diagnosis was that I thought that my life would be spent on a couch because that was one of the better expected outcomes.
    Instead, after more than a few false starts and much hardship, I discovered that I may not be able to control all my symptoms, but I chould choose whether I accepted my fate or not. A few years after such an epiphany, I am near complete my M.Sc. in Mathematics. There is great pain and sorrow with mental illness, but there is also hope in such darkness. It is my hope that the media and we as a society do a better job at encouraging such hope for those that may so desperately need it.
    End of reader's comment

    July 28, 2012 - News of the Week


    Article Reprinted using Fair Use Protection

    Link: http://www.thenewstribune.com/2012/07/27/2229396/open-dialogue-can-tear-down-walls.html

    The News Tribune

    Open dialogue can tear down walls of misunderstanding about mental illness
    Last updated: July 27th, 2012 12:27 AM (PDT)
    Our communities are filled with people who are living silently with mental illness, and most of us are terrified to share our stories. We are afraid of being judged and labeled, relegated to the edges of society.

    We fear that we will be locked out of the inner circle of community, the place where life is shared over good food, camping trips, church events and baseball games. The place where meals are brought to those experiencing tragedy, where money is raised for those experiencing catastrophe, and where community support surrounds those in need of healing. We fear that we will be on the outside looking in.

    We are afraid that if we talk about our illness we will be the subject of rumors questioning our stability, integrity, worth and competency. We fear that when we share our diagnoses – bipolar, depression, schizophrenia, obsessive compulsive disorder, anxiety disorder or something else – we will be held at arm’s length and will no longer be trusted to participate in the responsibilities of the community; to teach young people; to manage the finances of our local church; to organize the community benevolence program; or to hold our position as accountant, city councilman, barista or CEO.

    Our community must do better than this, and I believe we will. We will do better when we have eyes to see, eyes to see that they are us. Who among us doesn’t have a mental illness or know someone who has a mental illness? We will do better when our communities hold forums and town halls where we can talk openly about mental illness and stop speaking in language that evokes fear. There is great power in sitting in a room with someone and taking the time to hear that person’s story.
    Until we make this a priority, people living with mental illness will continue to be cast as unstable villains, teetering on the edge of some violent explosion, fit only to be locked away, pushed out of the life of our community. As a community, we have an opportunity to grow, to bring to light a group of illnesses that are misunderstood, whose treatment and research is underfunded, and whose effect reaches into nearly every home. It’s time to inform the misunderstanding, better fund the treatment and research, and open the lines of communication that will lead to reconciliation and healing.

    Allow me to start the conversation.

    I have bipolar disorder, type 1. In 2003, I ran through Lakewood in my boxers carrying an American flag. I received inpatient treatment at the psychiatric unit of St. Francis Hospital and outpatient treatment Greater Lakes Mental Health. I attempted suicide. I spent weeks, on two different occasions, wrapped in a world of delusions that caused erratic behavior. That’s a piece of my story. I have also been the valedictorian of my high school, leader in my church youth group, a server at Red Lobster, an employee of Merrill Lynch, a minister and a graduate student at the University of Washington. I’m a father, a husband, a resident of Pierce County. These are also pieces of my story.
    What’s your story?

    Alan Taylor owork program at the University of Washington Tacoma in the fall.f Milton is a state-certified peer counselor who works in the behavioral health field in Pierce County as a peer specialist. He will start a master’s of social

    Link: http://www.thenewstribune.com/2012/07/27/v-printerfriendly/2229396/open-dialogue-can-tear-down-walls.html

    Read more here: http://www.thenewstribune.com/2012/07/27/v-printerfriendly/2229396/open-dialogue-can-tear-down-walls.html#storylink=cpy

    Link: http://www.thenewstribune.com/2012/07/27/v-printerfriendly/2229396/open-dialogue-can-tear-down-walls.html

    June 14, 2012 - News of the Week


    New Campaign Defies Hopelessness In Mental Health Care

    Immediate Release: contact news@mindfreedom.org

    Today, MindFreedom International launches the "I Got Better" campaign with an invitation for you to participate in this "Survey on Hope in Mental Health": https://www.surveymonkey.com/s/mfi-igb-intro

    This brief, confidential introductory questionnaire takes less than five (5) minutes to complete.

    "I Got Better" is an ongoing project defying the all-too-common message that recovery from mental and emotional distress is impossible. The "I Got Better" campaign will make stories of recovery and hope in mental health widely available through a variety of media.

    Your Participation Could Save a Life

    Any and everybody with a stake in mental health in our society is welcome to participate, including people who have used mental health services, psychiatric survivors, as well as their friends, family members, colleagues, and mental health workers. Please share the survey link - https://www.surveymonkey.com/s/mfi-igb-intro - freely via email, facebook, twitter, blogs, etc.

    Respondents to the survey wishing to share additional knowledge will be invited to take an optional follow-up survey about impressions of hope and hopelessness in mental health care, and successful strategies for recovery. Some survey respondents will be asked to share their story on video.

    David Oaks, Director of MindFreedom International, said, "When I was in psychiatric care in college, I was told it was forever. Your experience of hope and hopelessness in mental health care could help youth and young adults receiving a psychiatric diagnosis for the first time. Hope could save a life."

    The Story Behind "I Got Better"

    The title of the campaign is inspired by the successful "It Gets Better" viral media effort led by columnist Dan Savage that "shows LGBT youth the levels of happiness their lives will reach." While these two campaigns are independent, Dan Savage has enthusiastically endorsed "I Got Better."


    The "I Got Better" campaign is funded by a grant from the Foundation for Excellence in Mental Health Care to MindFreedom International. MFI is an independent nonprofit coalition founded in 1986 to win human rights and alternatives in mental health. For more information contact  news@mindfreedom.org, or call the MFI office at 541-345-9106.

    To take the brief, confidential introductory "I Got Better" survey, which will be active through 15 October 2012, click here now:  https://www.surveymonkey.com/s/mfi-igb-intro

    Clickable version of above news alert with links here:


    May 20, 2012 - News of the Week


    Recovery in Acute Care
    "Before Healing Can Occur, People Must Feel Safe"
    by Maggie Bennington–Davis, M.D., MMM

    Source: Recovery to Practice Highlights April 26, 2012


    There is an old medical school adage that says "first, do no harm." In acute hospital settings, people describe all-too-frequent experiences of fear and panic, loss of control, loss of self-determination, seclusion, restraint, and unwanted medications. Inpatient units can seem downright dangerous, not only to those hospitalized, but to staff as well. Before healing can occur, people must feel safe.

    During my tenure as the medical director of psychiatry at Oregon's Salem Hospital, I was part of the miraculous transition to a trauma-informed environment. Seclusion and restraint were eliminated, and there was a substantial decline in the administration of involuntary medications (as well as a 30 percent decline in the use of routine medication). People became more involved in psychoeducational groups and therapeutic exchanges with staff. Injuries sustained by staff and those hospitalized dropped dramatically, lengths of stay decreased, and financial performance improved. It was a wonderful example of parallel process—recovery for those coming into the hospital and for the hospital itself.

    (Highlight added)
    Recently, I had a phone call from a psychiatrist who specialized in organizational consultation. He asked me, "After you quit doing restraint, what did you do when someone was really upset and out of control?"

    I had to pause before I answered, because there wasn't a simple way to respond. Staff in the program were never told not to use seclusion, restraint, medication, or other means of control. Restraint went away because it was no longer necessary, not because it was "banned." If a situation required restraint or seclusion to prevent serious harm, appropriate measures would be taken. But the environment had drastically changed, and those situations didn't occur very often.

    We included the people we served as we began our transformation and philosophical shift. We immersed ourselves in understanding the neurobiology of trauma, fear, fight-or-flight response, and the realization that traumatized people perceived our clumsy attempts at "safety" as predatory and controlling. We were astonished to learn virtually everyone who came (or was brought) to us had suffered through difficult childhood experiences. It humbled us to think about our past reactions to these folks and the pejorative language we had used to explain what suddenly seemed like perfectly rational behavior (manipulative, aggressive, help-seeking, belligerent, difficult, etc.). Suddenly, power struggles made a lot of sense, disengagement seemed self-preserving, and the minor events that precipitated catastrophic reactions didn't seem so minor after all. When we changed the lens to one that was trauma informed and started asking "What happened to you?" instead of "What is wrong with you?", everything else changed too.  (highlighting added by ja)

    In essence, when we changed ourselves and the hospital to be really, truly "safe," the people we were serving also felt safe. Independent of diagnosis, symptoms, age, sex, or history, we were by far the most significant variable.

    Then the fun really began. We started using our environment to regulate certain physiological responses of people at the hospital. We used drumming techniques to normalize heart rates, music to soothe, colors to evoke calm, and artwork to inspire (instead of posted rules forbidding balloons and knives). We asked ourselves and those we were serving, "What helps us feel safe?" The answers were friendly greetings, calm voices, beauty in our surroundings, constant information, sharing meals, and talking openly about upsetting events. We changed our language, our assumptions about recovery, and our expectations, and made a point of including families and friends. We educated ourselves about customer service. Putting people's fears to rest as soon as possible became our business.

    We also realized that staff interactions completely set the tone for everyone else, so we became mindful about communicating and working with one another.

    Dr. Sandra Bloom, creator of the Sanctuary Model, taught us how to hold daily community meetings to discuss safety with those we were serving as well as staff (doctors, administrators, janitors, cooks, security, etc.). The twice-daily meetings became the anchors of our serenity. If something happened that shook our sanctuary, we spent the next community meeting determining how to return to safety. We knew when something frightening happened to one person in the community, everyone was affected.

    Every now and then, we still experienced an upsetting event. I will never forget the woman who repeatedly banged her head against the hospital wall. She had been restrained many times before, always to keep her from harming herself. We mulled over how we could help her in our new environment. In a community meeting, another hospitalized woman told the newcomer, "Honey, when you bang your head like that, it hurts my head." The group suggested we move the bed to the center of the room, away from the walls that facilitated her head banging. Finally, the banging stopped and the woman began to heal.

    There was the man who paced the unit's perimeter, talking frenetically to himself and occasionally banging his fist on the wall. During a community meeting, folks who had been in the hospital for a few days kindly told him they were frightened of him. He looked shocked and apologized, saying he would never hurt anyone. His pacing stopped, his fear and anger seemed to subside, and he began to pursue the opportunities we offered to support his healing process.

    We learned to have a different threshold for upsetting behavior. Staff were constantly encouraged by managers to do what was necessary to keep things safe, but the word "safe" became much more inclusively defined. Our staff created an environment where everyone really did feel safe, and the outbursts, anger, and violence mostly melted away.

    All of these changes created completely different roles for staff—jobs that focused less on maintaining order and policing the unit, and much more on healing and partnering with people to initiate and support their recovery journeys. The transformation exemplified recovery more than any treatment plan I have ever witnessed. It was truly a highlight of my career.

    Dr. Bennington–Davis is the Chief Medical and Operating Officer at Cascadia BHC in Portland, Oregon.

    May 7, 2012 - News of the Week


    The trouble-prone, eight-year-long court case concerning Kendra Webdale's terrible death at the hands of Andrew Goldstein ended abruptly when both sides agreed to avert a third agonizing trial. It wasn't a perfect closure, but an understandable one.  However, the two earlier failed trials spurred lawyer/advocate Patricia Warburg Cliff, then a board member of national NAMI, to express her dismay in a thought-provoking article, "The Railroading of Andrew Goldstein."  This informative commentary (below) was published in the Journal of California AMI, vol.11, September 2000.

    Questions remain.  Key among them: Why does the press often call Andrew Goldstein a 'treatment refuser'?  Doesn't this libel a man who knew his diagnosis was severe schizophrenia with uncontrolled violent outbursts, and for two years had requested a supervised treatment setting?  Looking back, it is also clear that Kendra's Law proponents missed an opportunity to point out that rare disasters are more likely to occur when insufficient mental health services are the norm. Instead, they focused their call-to-action on a man trapped by and ultimately destroyed by draconian policy decisions. 

    And still the myth goes on. Just last week, Albany's Legislative Gazette reported a new push to make Kendra's Law permanent, wrongly describing Andrew Goldstein as "a man diagnosed with, but not seeking treatment for, schizophrenia." 

    When fading facts become harder to verify, the insights, observations, legal experience, and personal views of a witness can be a valuable resource.  Thank you, Patricia Warburg Cliff, for "The Railroading of Andrew Goldstein"

    For an investigative report of Goldstein's downward spiral, click:  "Bedlam on the Streets" New York Times, by Michael Winerip, May 23, 1999  (This Times Magazine cover story appeared 5 months after Kendra Webdale's death.  New York's Kendra's Law passed 3 months later, despite then-known circumstances)
    by Patricia Warburg Cliff 

    Source: (with publisher's permission)
    The Journal 
    V.11,1.3 (September 2000)

    The failure of the legal profession, the court system and the public to grasp the vital concepts involved in the two trials of Andrew Goldstein further reinforce the fact that we at NAMI have much work to do.

    In January 1999, Andrew Goldstein, an unmedicated, delusional person with paranoid schizophrenia who had been unsuccessfully seeking help at various hospital emergency rooms, pushed Kendra Webdale to her death on the tracks of the New York City subway. Unfortunately the terrible tragedy of this young woman's death clouded public perception of the situation which allowed this to occur: the failure of the public system to offer the required state-financed housing with day services, clinic visits and an intensive case manager, to this seriously ill young man.

    It was, however, not the system which was on trial, but the other "victim" of this tragedy, Andrew Goldstein himself. The first trial ended in a hung jury, because two jury members had had some limited experience with the mental health system and consequently understood the nature of Goldstein's illness and his inability to form the necessary intent to commit murder in his psychotic state. The public's outcry for revengeful punishment did not, however, cease.

    In late February, 2000, a second trial was commenced. After hearing the evidence, the judge instructed the jury that they had the option of convicting the defendant of manslaughter in lieu of the second degree murder charges, if they found that he had acted with "depraved indifference," but without the requisite intent necessary for a conviction of second degree murder. It took the jury only two hours to reach the verdict of second degree murder.

    The irony of the situation should not be overlooked: Andrew Goldstein was being held at Bellevue Hospital following his arrest where he was willingly receiving treatment for his illness and consequently would not be able to appear sufficiently psychotic at his trial to demonstrate to the jury the disabling effect of this illness on his judgment. The defense pinned its hopes on taking Mr. Goldstein off his antipsychotic medication and putting him on the stand, to better show the jurors his mental state at the time of the attack. This novel concept was thwarted when Mr. Goldstein struck a social worker, further indicating his violent state of mind when unmedicated. Judge Berkman insisted that Mr. Goldstein be offered the choice of taking his antipsychotic medication, which he chose to do. The result was that the jury was able to see a passive, sedated individual and not the person whose delusions caused his violent behavior.

    NAMI's suggestions to the defense counsel to utilize the virtual reality videos produced by pharmaceutical companies which demonstrate the psychotic state of mind, as well as comparisons to the diminished capacity suffered by individuals who are experiencing the onset of a diabetic coma or an epileptic seizure, fell on deaf ears. The subsequent result demonstrates the ignorance of the judge, jury and defense counsel with respect to paranoid schizophrenia. Andrew Goldstein never got a fair chance.

    At the conclusion of the trial, the jurors were convinced that punishment, not treatment, was warranted. Mrs. Webdale, the victim's mother spoke at the sentencing hearing: "It is my contention that if Andrew Goldstein had been held responsible many incidents ago, there would not have been 13 assaults and one homicide committed by him. His ongoing aggression was tolerated and acceptable." The presiding judge concurred saying that the attack stemmed from the state mental health system's failure to punish Mr. Goldstein for past assaults.

    On May 5, 2000, Judge Berkman gave Andrew Goldstein the maximum sentence of 25 years to life in prison for the murder of Kendra Webdale. What is wrong with this picture? Has the "justice system" reverted to a witch hunt to punish the violent mentally ill whom the public system has dismally failed? Are we, as a society, going to be content with the gross misunderstandings of mental illness which were demonstrated in this trial? How are we going to educate the judiciary about these issues?

    The ultimate irony is that the New York State legislature, ever reluctant to provide sufficient funding for treatment for the mentally ill, hastily passed a bill, commonly referred to as "Kendra's Law," allowing for court ordered treatment or commitment of the mentally ill under certain circumstances. Andrew Goldstein who is now rotting in the state prison system, had tried repeatedly to get help before the attack. He even sought his own commitment when he realized that he was out of control. The misnomered "Kendra's Law" would not have prevented this tragedy.

    PATRICIA WARBURG CLIFF, an attorney and mental health advocate in New York City, serves on the national board of NAMI as well as on the board of NAMI-NYC Metro. Her only child, Kenneth Johnson, succumbed to depression in 1995, as a result of the private health care system's failure to adequately diagnose and appropriately care for his illness.
    End of article

    September 26, 2011 - News of the Week


    September 14, 2011, was International Hearing Voices Day!
    To celebrate, the USA network of voice-hearers launched their new website, ( http://www.hearingvoicesusa.org ) Already the site offers a wealth of information including resources and links to a network of websites across the globe -- in Australia, Greece, England, Wales, Denmark, the Netherlands and more.
    In growing numbers, people who hear voices are breaking a silence imposed by negative social attitudes (stigma). This breakthrough movement, aided by the Internet, eases the pain of misunderstanding and isolation. Learn more with a visit to About Us: Hearing Voices USA http://www.hearingvoicesusa.org/about-us.html
    Below is an excerpt from the National Empowerment Center press release: What is World Hearing Voices Day?
    From the Intervoice Website (http://www.intervoiceonline.org): World Hearing Voices Day celebrates hearing voices as part of the diversity of human experience, increasing awareness of the fact that you can hear voices and be healthy. It challenges the negative attitudes towards people who hear voices and the incorrect assumption that hearing voices, in itself, is a sign of illness.

    And Don’t Forget to Join the Hearing Voices Network USA on Facebook, too…

    In addition to the new Hearing Voices USA website, we’ve also found a home on Facebook so come join us there as well and take part in making the Hearing Voices USA Facebook page an informative and interesting place to be! Click here to join the Hearing Voices Network USA on Facebook.

    September 2, 2011 - News of the Week


    "A factoid is a questionable or spurious - unverified, incorrect, or fabricated - statement
    formed and asserted as a fact but with no veracity. The word appears in the
    Oxford English
    as 'something which becomes accepted as fact, although it may not be true.'" Quote is from Wikipedia, the free encyclopedia

    Dr. E. Fuller Torrey is perhaps psychiatry's most visible spokesperson. He is also the nation's most active proponent of forced psychotropic medication for psychiatric outpatients. Unfortunately, Dr. Torrey has often stretched or misquoted outright the research findings of others to win support for his controversial agenda.
    The most recent example of Dr.Torrey's self-serving work appears in an article, Stigma and Violence: Isn't It Time To Connect the Dots, which first appeared in July in the advance publication of Schizophrenia Bulletin (SB), and is now in the September 2011 issue.

    In the SB article, Dr. Torrey contends that actual acts of violence are the basis of stigma against people who are labeled mentally ill. Torrey says this cause of prejudice and discrimination can be eliminated by accepting and acting upon his assumptions about violence (named 'dots'). In discussing these assumptions, Torrey cites studies to support his views.
    Interestingly, some of the studies quoted in Torrey's SB article are on file at the National Stigma Clearinghouse. In every one, Torrey has either cherry-picked, or worse, altered the study findings to suit his purpose.

    Some examples of errors in the connect-the-dots article:

    (1) Dr. Torrey misstates former Surgeon General David Satcher's conclusions about stigma and violence described in Dr. Satcher's groundbreaking report on mental health in 1999 (page 8). Dr. Torrey mistakes "perception of violence" to mean "evidence of violence" and thus twists Dr.Satcher's conclusions to agree with his own opinion that violence causes stigma. In fact, Dr. Satcher concludes that the public's fear is disproportionate the the low risk of violence; his report states: "Because most people should have little reason to fear violence from people with mental illness, even in its most severe form, why is fear of violence so entrenched?"

    (2) Dr. Torrey misrepresents research findings (article 1996) of Matthias C. Angermeyer and Herbert Matschinger, University of Leipzig to support his view that violence committed by mentally ill people is a major cause of stigma. In fact, the researchers concluded that media coverage of mental illnesses promotes stigma by focusing selectively on incidents of violence. They noted that such selective coverage has a detrimental effect on public opinion and “important implications for public policy issues," and to correct this they proposed that "Having demonstrated the detrimental effects of selective reporting, we must focus our attention on the inevitable question of how to counteract such reports."

    In sharp contrast, the Torrey article's opening paragraphs deride advocates' attempts to balance the media's coverage of mental illnesses. For 20 years, Torrey's focus on "walking time bombs" has taken precedence over features that could show voluntary treatment programs that work for hard-to-treat individuals, and articles that reflect a growing recognition that despite serious psychiatric conditions, people can achieve fulfilling lives.

    In a later paper (International Journal of Law and Psychiatry, 2001 Vol. 24, pp 469-486) Dr. Angermeyer and Beate Schulze state that "deviance is a prime component of 'newsworthiness'. The marked over-representation of forensic cases in press reporting about mental health is clearly the product of impact-maximizing and complexity-reducing selection routines in news production."

    (3) Dr. Torrey implies that his views are confirmed by a study by Jason C. Matejkowski et al (2008). This study does not support and is not relevant to Dr. Torrey's opinion that violence is increasing among people who have a serious mental illness. In fact, the reseachers' findings discredit the familiar stereotype that Dr. Torrey has so often promoted. The article by Matejkowski et al is an analysis of violence committed by persons who have a mental illness, and is free online. “Characteristics of Persons With Severe Mental Illness Who Have Been Incarcerated for Murder”, The Journal of the American Academy of Psychiatry and the Law, 36:74-86, 2008.

    Could the public's unwarranted fear of people labeled with mental illnesses, described by Surgeon General David Satcher and others, be fallout from Dr. Torrey's 20-year public focus on violence to attain his medication goals?


    December 30, 2007 News of the Week (National Stigma Clearinghouse)

    Last week, the Treatment Advocacy Center, the nation's leading proponent of compulsory neuroleptic medication, issued a list of ten "under-reported stories of 2007." Eight of the ten stories involve crime or dangerousness. Clearly, http://www.psychlaws.org intends to continue its pattern of fanning fear to win public support for its controversial agenda.

    Also troubling are errors of fact. For example, by lifting a phrase out of a research study published by Jeffrey Swanson et.al. (Archives of General Psychiatry, May 2006), TAC created an astounding rate of violence for patients with schizophrenia, 10 times greater than the general public, (or 19.1% vs 2%).

    Acts considered violent by TAC range from a brief threatening gesture to a physical assault causing injury. TAC fails to mention that the Swanson team found two levels of violence: only 3.6% of research participants were involved in serious violence. This rate is similar to the general population rate of 2% (ECA data circa 1980).

    For the public, violence means danger. But Swanson's research team uses the word to mean involvment in a fight whether or not the respondent was the aggressor or defending himself. The researchers called such fights assaults by the respondents. The fights involving 15.5% were called "minor violence" (no injury and no use of threat or knife). The remaining 3.6% were called "serious violence" (a weapon was used or there was some injury, at least a bruise.) Quoting from Heathcote W. Wales, Georgetown U., letter to the Washington Post, "Hype Won't Help The Mentally Ill," 6/4/06.

    The Treatment Advocacy Center also ignored the Swanson team's finding that the odds of violent behavior varied with factors other than psychotic symptoms. Further, the data used for the Swanson study was designed for a different project, the Catie study on medications. This raises questions about the data's findings

    Read interesting comments by Dr. John Grohol about pitfalls and variations that plague research on violence. Go to
    End of excerpt from NSC Archive (Dec 30, 2007)

    August 9, 2011 - News of the Week


    Benedict Carey continues his remarkable New York Times series on mental illnesses with "Learning to Cope With the Mind's Taunting Voices" (Times Front Page, August 7, 2011). The series' first article ("Expert on Mental Illness Reveals Her Own Fight,” June 23) described in detail a therapist's successful battle against against suicidal impulses.

    Clearly, Mr. Carey is attuned to a growing willingness among psychiatric survivors to explain their experiences of living with disabling psychiatric conditions.

    It's worth noting that many Europeans do not automatically link hearing voices to schizophrenia -- a common assumption in the US. Below are links to more information.
    Can You Live With the Voices in Your Head?, by Daniel B. Smith March 25, 2007

    Voices of the Heart Facilitator Training
    Coverage of Mental Illness Provides Good Cheer , by Robert David Jaffee, August 9, 2011
    Learning to Cope With the Mind's Taunting Voices, by Benedict Carey, August 7, 2011

    Expert on Mental Illness Reveals Her Own Fight. by Benedict Carey, June 23, 2011

    Wikipedia: Hearing Voices Movement

    July 18, 2011 - News of the Week

    Article Source: NYAPRS Enews

    Addressing Metabolic Conditions In People Diagnosed With SMI

    by Ed Knight, Ph.D., Mental Health Weekly From the Field July 18, 2011
    Metabolic conditions like weight gain, hypertension and diabetes, are common in populations with serious, persistent mental illnesses. People are dying 25 years younger than average, mostly from cardiovascular illnesses. This problem is made worse by the most common side effect of psychiatric medications: weight gain, diabetes, high blood pressure and high cholesterol. There are two related issues in prescribing: off-label use against FDA recommendations; and unnecessary use of multiple psychiatric medications (documented by Lloyd Sederer, M.D., medical director at the New York State Office of Mental Health, in journal articles and blogs).

    Despite widespread knowledge, addressing metabolic side effects beginning with monitoring is low among mental health practitioners and providers. Well-researched psychiatric rehabilitation strategies to increase wellness and reduce the number and doses of psychiatric medications tend not to be followed much. Even very obvious strategies like changing medications to medications that cause fewer metabolic complications are not widely practiced. Why? Mental health providers are not financially incentivized to prevent costly side effects that are causing a Medicaid funding crisis and increased mortality. Changing medications or implementing medical or psychosocial practices create costs for mental health organizations. To address this issue, some mental health organizations are becoming licensed to bill for medical services. This provides funding for metabolic management. However, this extra billing creates no disincentive for causing metabolic problems in the first place and to date does not lessen them.

    Attempts were made to solve this issue of perverse incentives for over a year within ValueOptions where I served as vice president of recovery. Those attempts failed. At one small Colorado clubhouse 30 people on psychiatric medications have died in the last three years below the age of 62. Three were suicides likely due to their friends dying. Research shows increased suicide rates associated with metabolic side effects.

    Advocacy Pursuits

    I resigned from ValueOptions to devote my time to solving this crisis with advocacy, research and consulting on managed care issues. Unless these issues are solved recovery is unlikely. In advocacy, I am providing information to Medicaid authorities and actively lobbying. If providers were accountable for pharmacy costs, mental health costs and medical costs for their clients, this would financially incentivize providers to detect and prevent metabolic side effects and lower medical costs. Savings could then be used to provide the evidence-based psychiatric rehabilitation practices needed to reduce the number and doses of medications. Accountable Care Organizations (ACOs) could be structured to address the metabolic side-effects. There is now a division between acute and well care and long-term care. A disease caused in the acute treatment could then be billed in long-term care. This would carry perverse financial incentives driving side effect disease into health care reform [efforts]. Extending the period of acute and well care to include sufficient time to make ACOs responsible for the side effects from improper use of psychiatric medications would create incentives to lessen them and save monies which could be used to pay for medical monitoring and rehabilitation interventions.

    I am working with a UCLA team led by Alex Young, M.D., psychiatrist and health services researcher, to address the prescribing issues with simple shared decision-making techniques and the lifestyle issues with some new psychosocial interventions to deal with symptoms and concrete skillful means to motivate change. The lowering of doses and numbers of medications is interrelated with lifestyle issues in complex ways. We have developed a “stages of change” model moving from learned helplessness to a healthy lifestyle which may allow for medication reductions. The UCLA pilot is about Mindfulness Based Self-Directed Rehabilitation (MBSDR). We are seeking grants to support this work. In consulting I am working with Peer Links, a peer-run technical assistance center funded by the SAMHSA at the Mental Health Association of Oregon to bring MBSDR in webinars to the larger peer recovery movement. I am available to consult about managed care to advocate for wellness and recovery.

    Ed Knight, Ph.D., is a national consumer leader. He resigned in May as vice president of recovery and resiliency at ValueOptions. For more information on MBSDR visit www.professored.com . Knight can reached at daiguangy@hotmail.com .

    - End of Article -


    Hopes were high when Ed Knight joined Value Options in 2001. At the time, Mental Health Weekly, December 3, 2001, wrote, "What Ed Knight has demonstrated is that you can give people new medication and they will have fewer symptoms, but their lives won't change until you change the approach to treatment.." As it happened, efforts to point the delivery system toward recovery and mutual support lost favor after a Goldman Sachs company, Crestview Investments, gained the controlling interest.

    Read Full Article

    July 6, 2011 - News of the Week

    In the July issue of Schizophrenia Bulletin, Dr. E. Fuller Torrey, founder of the Treatment Advocacy Center and chief proponent of compulsory psychotropic medication, proposes a way to reduce stigma. Dr. Torrey outlines his plan in an article titled, "Stigma and Violence: Isn't It Time to Connect the Dots?"

    For those who are unfamiliar with Dr. Torrey's views concerning stigma, he believes that a primary cause of stigma is violence committed by mentally ill individuals. A basic flaw in Dr. Torrey's argument concerns his merging of perception and evidence. The public's perceptions may not accurately reflect reality – as any advertiser knows.

    Dr. Torrey suggests six 'dots' as follows: (quote - bold type added)

    Stigma against individuals with mental illnesses has increased over the past half century.
    (2) Violent acts committed by mentally ill persons have increased over the past half century.
    (3) The perceptions of violent behavior by mentally ill persons is an important cause of stigma.
    (4) Most episodes of violence committed by mentally ill persons are associated with a failure to treat them.
    (5) Treating people with serious mental illnesses significantly decreases episodes of violence.
    (6) Reducing violent behavior among individuals with mental illnesses will reduce stigma.
    (Note: 'Treat' and 'Treatment' are code words for antipsychotic medication. ja)

    Unfortunately, Dr. Torrey misinterprets the findings of researchers to promote his plan.

    (1) Dr. Torrey misstates former Surgeon General David Satcher's conclusions about stigma and violence described in Dr. Satcher's groundbreaking report on mental health in 1999 (page 8). Dr. Torrey mistakes "perception of violence" to mean "evidence of violence" and thus twists Dr.Satcher's conclusions to agree with his own opinion that violence causes stigma. In fact, Dr. Satcher concludes that the public's fear is disproportionate the the low risk of violence; his report states: "Because most people should have little reason to fear violence from people with mental illness, even in its most severe form, why is fear of violence so entrenched?"

    (2) Dr. Torrey misrepresents research findings (article 1996) of Matthias C. Angermeyer and Herbert Matschinger, University of Leipzig to support his view that violence committed by mentally ill people is a major cause of stigma. In fact, the researchers concluded that media coverage of mental illnesses promotes stigma by focusing selectively on incidents of violence. They noted that such selective coverage has a detrimental effect on public opinion and “important implications for public policy issues," and to correct this they proposed that "Having demonstrated the detrimental effects of selective reporting, we must focus our attention on the inevitable question of how to counteract such reports." In sharp contrast, the Torrey article's opening paragraphs deride advocates' attempts to balance the media's coverage of mental illnesses. For 20 years, Torrey's focus on "walking time bombs" has taken precedence over features that could show voluntary treatment programs that work for hard-to-treat individuals, and articles that reflect a growing recognition that despite serious psychiatric conditions, people can achieve fulfilling lives.

    In a later paper (International Journal of Law and Psychiatry, 2001 Vol. 24, pp 469-486) Dr. Angermeyer and Beate Schulze state that "deviance is a prime component of 'newsworthiness'. The marked over-representation of forensic cases in press reporting about mental health is clearly the product of impact-maximizing and complexity-reducing selection routines in news production."

    (3) Dr. Torrey implies that his views are confirmed by a study by Jason C. Matejkowski et al (2008). This study does not support and is not relevant to Dr. Torrey's opinion that violence is increasing among people who have a serious mental illness. In fact, the reseachers' findings discredit the familiar stereotype that Dr. Torrey has so often promoted. The article by Matejkowski et al is an analysis of violence committed by persons who have a mental illness, and is free online. “Characteristics of Persons With Severe Mental Illness Who Have Been Incarcerated for Murder”, The Journal of the American Academy of Psychiatry and the Law, 36:74-86, 2008.

    June 28, 2011 - News of the Week


    For decades people with mental illnesses have been unjustly blamed for the nation's extraordinary amount of gun violence. The truth about violence, long distorted by violence-prone media and forced-medication advocates, is the topic of an article by Jonathan Metzl of Vanderbilt University, Focus on mental illness in gun debate is misleading.

    The entire essay has been published on the website of The Lancet (www.thelancet.com)

    PREVIEW ARTICLE by Jim Patterson

    ENTIRE ESSAY by Jonathan M. Metzl

    for even more, click here

    The excerpt below, from the National Stigma Clearinghouse archive, is just one example of distortion by the media and forced-treatment advocates. Ignoring protests, CBS aired this 60 Minutes segment for a second time in 2003 when Congress was considering changes to the National Instant Criminal Background-check System.

    October 13, 2002 - News of the Week


    Assumes unknown "sniper on a killing spree" has a mental illness

    Using bogus homicide numbers and a bumbling choice of archive materials, "Armed and Dangerous," (a 60 Minutes segment on October 13), tried to link a proposed federal gun law amendment, a series of sniper murders, and mental illness. Not enough time was spent on opposing facts and views, and people with mental illnesses were made to seem like one of society's most dangerous populations.

    This is just the latest example of "walking time bomb" stories aired by CBS on 48 Hours, 60 Minutes, and 60 Minutes II. The earliest example in our CBS News file is a report in 1987 by Bernard Goldberg. Mr. Goldberg mentioned some form of "killing" 20 times in the 4-minute "news" piece, which concerned five violent incidents committed by "deranged" people over an unspecified number of years.

    Last night, "Armed and Dangerous" tried to weave together stories about the present sniper killer in Maryland; a proposed gun law to add involutarily-committed psychiatric patients to federal criminal databases; and high-profile shootings by Colin Ferguson (1993), Russell Weston (1995) , Michael McDermott (2000), and Peter Troy (2002). Only Mr. Weston and Mr. Troy had any history of involuntary institutionalization, meaning that the gun law amendment would not have red-flagged the other two men for gun checks.

    The important story missed is that Weston and Troy are prime examples of dismal mental health system failure. Mr. Weston was known both to the system and the FBI as someone who desperately needed help. Mr. Troy was also well-known as deeply disturbed and needing intensive care. Both cases show negligence at all levels of government to fund the required programs.

    Most outrageous were the lead-in statements by Steve Croft: "Why is it so hard to stop deranged gunmen from terrorizing American communities, like the sniper who has terrorized Maryland?" And, "Every year across the United States, nearly 1,000 homicides are committed by people with severe mental illness."

    The initial statement has two flaws. First, it assumes that the Maryland sniper is "deranged," at a time when there is absolutely no evidence to that effect. The killer could equally as plausibly be a sociopath, or an El Queda terrorist, or simply an angry boy of the Columbine type. Secondly, it implies that such activity is going on almost routinely across America, when anyone who reads the newspapers knows it is not.

    The second statement includes the infamous "1,000 homicides" statistic that originated in the imagination of Dr. Fuller Torrey, and is unsupported by any scientific evidence.

    In addition, the program failed to stress the existence of various sub-populations in this country that are far more violence-prone than people with mental illnesses.

    One has to express dismay at such a sloppy, misshapen piece of journalism. It certainly falls far below the standards we have come to expect from 60 Minutes.

    This segment must not be repeated. Contact 60 Minutes and executives at CBS.

    E-mail: 60m@cbs.com
    E-mail Viewer comment: audsvcs@cbs.com

    Telephone comment: 212-975-3247

    Mail: Don Hewitt, 60 Minutes, CBS News, 524 West 57th Street, New York, NY 10019

    David F. Poltrack, Senior V.P., Research & Planning, CBS, Inc., 51 West 52nd St., New York, NY 10019

    For a transcript ($9 + $3 fee for tel.), call 1-800-777-8398

    End of excerpt from NSC archive (Oct. 13, 2002)

    June 16, 2011 - News of the Week


    Ten mental health organizations in the UK have joined in launching a beautifully-designed, well-organized new website, WordsMatter. Their aim is to establish a systematic process for encouraging people to praise good, and challenge poor, reporting on mental health issues.

    To guide their work, the group has chosen simple criteria that are in keeping with standards set by the UK's Press Complaints Commission. American mental health advocates should check out the Commission's Code of Practice guidelines concerning Accuracy and Discrimination. To our knowledge, the US lacks a similar national standard for the press, and media entities here 'self-regulate' their content using their own standards of practice.

    This innovative response system shows vitality, determination, and ingenuity. KUDOS TO ALL INVOLVED!

    Link to WordsMatter

    June 2, 2011 - News of the Week


    A New York Times column ("Translation Matters In Choices On Data" (5/31/2011) by Nicholas Bakalar reports a recent study of how treatment choices are typically made by health professionals, patients, students and the general public.

    Dr. Elie A. Akl, University of Buffalo, who led the researchers, cautioned journalists to "be careful about press releases with 'new' or 'groundbreaking' studies presenting a relative risk reduction." Relative risk differs from absolute risk in important ways seldom understood by the public, and the difference between them is a major source of confusion.

    For example, a "50 percent reduction" in relative risk could mean a drop from "20 percent to 10 percent," (impressive), but it could also mean a reduction from "2 percent to 1 percent," (unimpressive). This curious fact can be important in making treatment decisions.

    According to the researchers' plain language summary (Cochrane Reviews), "there are strong logical arguments for not reporting relative values alone, as they do not allow a fair comparison of benefits and harms as absolute values do."

    It may be necessary to right-click the link, then click "open in new window"

    May 11, 2011 - News of the Week


    Offensive language is bias having a good time (paraphrasing Michael Wood, 1995)

    Society's attitudes toward any minority group can be measured by how willingly the public accepts discrimination against that group. But surely an equally valid measure of public attitudes is everyday language. The idea that the way we talk about people is the way we treat them seems self-evident. Take the case of derisive words like "faggot" and "nigger." They have become off-limits to everyone except the members of the group involved. But similar progress has eluded the mental health community.

    Psychiatric slurs are so common that they go unnoticed in our everyday speech. Even a standard-setter for language, the New York Times, lets columnists vent their frustration by calling opponents "crazies," and "certifiables."

    It would be comforting to think that psychiatric slurs have taken on such broadened usage that they no longer denigrate mental illnesses. Sadly, that hasn't happened. Take for example Alfred Hitchcock's use of the prefix "psycho" (the original meaning is "mind") as a movie title. Hitchcock would surely be pained to know that his creation is a lucrative favorite of product merchandisers who twist the word to mean violence. A recent example is the 2011 calendar cover of Psycho Donuts in Silicon Valley.

    To the detriment of the mental illness community, "psycho" has become so popular that dictionaries now list as its colloquial meanings "psychotic" and "psychopathic." This causes major confusion since clinically these are very different conditions.

    Is there a solution? Suggestions are welcome. For starters, the following quote is from Michael Wood, historian and educator. Source: "We Are What We Write," New York Times, May 21, 1995.

    Offensive language is more than bias; it's bias having a good time.
    One reason we can't get rid of it is that people like to be offensive.


    Just received, May 15: An astute and thought-provoking essay on language by David Oaks, Director, MindFreedom International, click "LET'S STOP SAYING "MENTAL ILLNESS" !



    Announcing a new peer-reviewed open access Journal

    Stigma Research and Action is an open-access not-for-profit journal with no article-processing charge. It provides immediate open access to its papers on the principle that making research freely available to the public supports a greater global exchange of knowledge.

    SRA's online journal is a multi-disciplinary forum for the dissemination of information advancing both research and practice as applied to any stigmatizsed condition or group.

    To learn more and to read the first issue, visit http://www. stigmaj.org

    April 8, 2011 - News of the Week


    By M. J. Bright, The Daily News, Nanaimo (British Columbia, Canada)
    April 4, 2011

    Source: Canada.com via Google Alerts

    Re: 'Councillors waffle on housing plan' (Daily News, March 31)

    I am a senior who volunteers three times a week on the psychiatry in-patient unit. I have been doing that volunteer work for over three years and have never felt concern for my safety.

    The truth is that the vast majority of people with a mental illness are not threatening or dangerous. Rather, they are much more likely to be victims of crime.

    It saddens me that so many people have stigmatized those with a mental illness as being bad or weak-willed, or scary or dangerous. That simply is just not true. People with mental illnesses are just like you and me. Chances are, someone you know has a diagnosed or undiagnosed mental illness.

    Councillors need to educate themselves on the realities of mental illness and become true leaders in Nanaimo. They must allow the housing for people with mental illness to proceed.

    M. J. Bright

    © Copyright (c) Postmedia News

    Reprinted using Fair Use standard

    Jauary 23, 2011 - News of the Week


    In brief videotaped portraits, seven courageous young people open their lives to the public, showing that self-understanding can be both rewarding and distressing.

    This is a timely, must-see segment in a New York Times health series titled Patient Voices.

    The Voices of Schizophrenia was created by Tara Parker-Pope (September 15, 2010).

    Link to video: http://www.nytimes.com/interactive/2010/09/16/health/healthguide/te_schizophrenia.html

    January 16, 2011


    It is now clear that forcibly medicating psychiatric outpatients will not prevent mass murders. When rare rampages have occurred, very few assailants had predictive histories that would have qualified them for involuntary outpatient commitment (IOC). IOC laws give the public a false sense of security rather than protection.

    Kendra's Law, said to be the nation's model IOC statute, was quickly passed in August 1999 by the New York State Legislature and signed by Governor George Pataki following an intense campaign of scare tactics and false information. There was never doubt that Andrew Goldstein was guilty of Kendra Webdale's death on January 3, 1999, in a Manhattan subway. But for two previous years Goldstein had searched in vain for the help and supervision he knew he needed. Yet the forced-treatment proponents, ignoring Goldstein's 13 voluntary admissions to psychiatric facilities, proclaimed him a "treatment refuser." Anger overwhelmed facts and an outpatient forced-treatment statute (Kendra's Law) was enacted with record speed.

    Thus was lost a singular opportunity to focus public attention on New York's dangerously broken system and scarcity of effective programs.

    Has Kendra's Law met its promise to successfully treat patients who have histories of violent behavior (description not available) ? An internal report in 2005 showed that 85% of the program's participants had NO such history. A brutal murder in Manhattan (2008) was commited by a man who, according to his father, was in treatment under Kendra's Law. The Arizona version of Kendra's Law failed to deter the Tucson tragedy. And although the Treatment Advocacy Center claims spectacular success, a close look at the figures (elevated by basing outcome results on percentages-of-percentages) show a self-serving interpretation of the program's outcomes. Two recent independent evaluations found that the program's flaws are serious enough to postpone its expansion or permanence.

    Oddly, forced treatment proponents say next to nothing about the well-known dangerous combination of alcohol, street drugs, and psychiatric diagnoses. One would expect the Treatment Advocacy Center to be in the forefront of developing and promoting integrated treatment programs aimed at treating a population whose rates of violent behavior far exceed those who have a mental illness alone. The Treatment Advocacy Center's narrow focus on medication for close to 20 years is inexplicable when safer, more acceptable treatment methods are available but lack the resources to expand.


    Below are excellent selected links:

    Media Ignore Key Perspective About Arizona Tragedy A statement by David Oaks, Director, MindFreedom International

    Advocates Warn Against Stigmatizing Mental Illnesses A video interview with Harvey Rosenthal, Director, New York State Association of Psychosocial Rehabilitation Services (NYAPRS)

    Link to Rosenthal video, in case of a problem...

    Challenge the Stigma That Deters Mentally Ill From Seeking Services by Eduardo Vega, Executive Director, Mental Health Association of San Francisco. Source: San Francisco Chronicle (Jan 14, 2011)

    January 12, 2011


    For Immediate Release:

    National Coalition of Individuals with Mental Health Conditions Calls for Reasonable Response to Arizona Tragedy

    WASHINGTON (1/10/11) – The National Coalition for Mental Health Recovery (NCMHR), an organization of statewide networks of persons in recovery from mental health conditions as well as individual members, joins the nation in grieving the shooting of Rep. Gabrielle Giffords and other Arizonans. “We especially understand the impact of violence because, contrary to popular belief, research has shown we are no more violent than the general population and in fact are 11 times more likely to be victims of violence,” said NCMHR steering committee member Daniel B. Fisher, M.D., Ph.D.

    “Let’s not scapegoat and stigmatize an entire group for the actions of a single individual,” Fisher said. “A literature review has shown that the homicide of a stranger by a person with severe mental health issues occurs to 1 in 14 million persons. This is so rare that the authors concluded it was impossible to predict violence by individuals with mental health issues (Nielssen et al., Schizophrenia Bulletin, 2009).”

    The NCMHR urges decision makers to focus as much on Arizona’s and the nation’s climate of violent discourse and the need for gun control as on controlling persons labeled with mental illness. “We know from our personal experience that recovery from trauma is nurtured by respectful dialogue and blocked by vitriolic diatribe such as we see today,” Fisher continued. “We have developed the values and skills to heal the anger we believe causes much of our discord. We have learned that anger and hopelessness can be transformed to a passion for life when people are listened to and understood, especially by peers,” he said.

    “As usual, there are calls for forced treatment,” he continued. “Yet Arizona already has involuntary outpatient commitment (IOC)” – which allows the compulsory treatment of individuals with mental health conditions who live in the community – “and that did not prevent this violence. In fact, IOC makes people afraid to seek treatment, fearing services that are stigmatizing and coercive.”

    The NCMHR supports the provision of hopeful, compassionate services and support, and research into holistic, non-pharmaceutical approaches instead of the system’s over-reliance on psychotropic treatment. “We know from experience that peer support can reach isolated, frightened persons,” Fisher said. “So we call for a national initiative to provide peer support services at colleges and high schools to help troubled students through respectful, mutual assistance. We need to infuse recovery and support into our mental health care systems, our first responders and the criminal justice system through innovative programs such as emotional-CPR (a preventative public health program) and peer-run alternatives to hospitalization.”

    NCMHR member Harvey Rosenthal, a leading spokesperson for the peer movement, was Rep. Giffords’ classmate in 2003 at Harvard's Kennedy School for Policy Leadership. “Gabby has a long record of fighting against discrimination on behalf of Americans diagnosed with mental health issues,” said Rosenthal. “We don’t believe she’d want stigma and discrimination to be fueled by this shooting."

    In March 2008, Giffords praised passage of the parity legislation designed to end discrimination against persons seeking treatment for mental health issues. "Discrimination has no place in our society," said the Tucson lawmaker.

    NCMHR supports the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which works to promote hope and recovery for individuals with even the most severe mental health conditions. “We appreciate the groundbreaking work SAMHSA is supporting to expand innovative outreach and engagement services, to improve service responsiveness and raise standards of care,” said NCMHR director Lauren Spiro.


    Daniel B. Fisher, M.D., Ph.D., cell: 617-504-0832, info@ncmhr.org

    Lauren Spiro, info@ncmhr.org, 877-246-9058

    Harvey Rosenthal, executive director, New York Assoc. of Psychiatric Rehabilitation Services, harveyr@nyaprs.org, 518-527-0564

    National Coalition for Mental Health Recovery, 877-246-9058, info@ncmhr.org

    January 10, 2011 - News of the Week

    Excellent Article from Slate.com


    Arizona shooter's psychiatric condition reveals little about propensity or motive for criminal behavior

    by Vaughn Bell, Slate.com

    Shortly after Jared Lee Loughner had been identified as the alleged shooter of Arizona Rep. Gabrielle Giffords, online sleuths turned up pages of rambling text and videos he had created. A wave of amateur diagnoses soon followed, most of which concluded that Loughner was not so much a political extremist as a man suffering from "paranoid schizophrenia."

    For many, the investigation will stop there. No need to explore personal motives, out-of-control grievances or distorted political anger. The mere mention of mental illness is explanation enough. This presumed link between psychiatric disorders and violence has become so entrenched in the public consciousness that the entire weight of the medical evidence is unable to shift it. Severe mental illness, on its own, is not an explanation for violence, but don't expect to hear that from the media in the coming weeks.

    Seena Fazel is an Oxford University psychiatrist who has led the most extensive scientific studies to date of the links between violence and two of the most serious psychiatric diagnoses -- schizophrenia and bipolar disorder, either of which can lead to delusions, hallucinations, or some other loss of contact with reality. Rather than looking at individual cases, or even single studies, Fazel's team analyzed all the scientific findings they could find. As a result, they can say with confidence that psychiatric diagnoses tell us next to nothing about someone's propensity or motive for violence.

    A 2009 analysis of nearly 20,000 individuals concluded that increased risk of violence was associated with drug and alcohol problems, regardless of whether the person had schizophrenia. Two similar analyses on bipolar patients showed, along similar lines, that the risk of violent crime is fractionally increased by the illness, while it goes up substantially among those who are dependent on intoxicating substances. In other words, it's likely that some people in your local bar are at greater risk of committing murder than your average peson with mental illness.

    Of course, like the rest of the population, some people with mental illness do become violent, and some may be riskier when they're experiencing delusions and hallucinations. But these infrequent cases do not make "schizophrenia" or "bipolar" a helpful general-purpose explanation for criminal behavior. If that doesn't make sense to you, here's an analogy. Soccer hooligans are much more likely to be violent when they attend a match, but if you tell me that your friend has gone to a soccer match, I'll know nothing about how violent he is. Similarly, if you tell me your friend punched someone, the fact that he goes to soccer matches tells me nothing about what caused the confrontation.

    This puts recent speculation about the Arizona suspect in a distinctly different light: If you found evidence on the Web that Jared Lee Loughner or some other suspected killer was obsessed with soccer or football or hockey and suggested it might be an explanation for his crime, you'd be laughted at. But do the same with "schizophrenia" and people nod in solemn agreement. This is despite the fact that your chance of being murdered by a stranger with schizophrenia is so vanishingly small that a recent study of four Western countries put the figure at one in 14.3 million. To put it in perspective, statistics show you are about three times more likely to be killed by a lightening strikc.

    The fact that mental illness is so often used to explain violent acts despite the evidence to the contrary almost certainly flows from how such cases are handled in the media. Numerous studies show that crimes by people with psychiatric problems are over-reported, usually with gross inaccuracies that give a false impression of risk. With this constant misrepresentation, it's not surprising that the public sees mental illness as an easy explanation for heartbreaking events. We haven't yet learned all the details of the tragic shooting in Arizona, but I suspect mental illness will be falsely accused many times over.

    Original article:

    Reprinted using Fair Use protection

    January 7, 2011 - News of the Week


    Associating mental illness with violent behavior creates a huge barrier to funding services adequately ... a larger concern is about the long-term consequences of stigma aroused by the report [see below], especially when reinforced by prevailing media images of mental illness. Stigma sets up barriers to housing, jobs, forming relationships -- it really sets people back. And individuals who are ill won't seek help because they don't want to be considered one of 'those' people. Jennifer Stuber, Washington State Coalition to Improve Mental Health Reporting. From article by Judy Lightfoot, Crosscout.com, Jan 05, 2011

    Bad news came this week from Washington state. Facing cuts to mental health services, a healthcare union hoped to win more funds from the state legislature by playing a violence card. Union spokespeople told protesting advocates that tight competition for scarce funds drove them to use a violent cover image and caption on a report they submitted to the legislature.

    The downside is that fearmongering results in less public support, not more. (Study Finds Fear Tactics Win Public Support for Coercion, Segregation, and Avoidance -- But No Increase in Resources) Source: Patrick Corrigan et.al., Implication for Educating the Public on Mental Illness, Violence, and Stigma, Psychiatric Services 55-577-580 May 2004

    See the crude and deeply stigmatizing report cover, and read the excellent article by Judy Lightfoot concerning the advocates' vehement protest, Can scare tactics sell the state on mental health funding

    December 18, 2010 - News of the Week


    From a marketing perspective, it may be necessary
    to capitalize on violence to get the law passed
    Memo from D.J. Jaffe to NAMI advocates, 1993

    D.J. Jaffe, an advertising executive, worked for seventeen years to secure state laws permitting the forced psychotropic medication of psychiatric outpatients. Eventually, his fearmongering strategy delivered New York's Kendra's Law after just six months of intense publicity.

    Jaffe told a national NAMI audience in July of 1999 that "laws change for a single reason, in reaction to highly publicized incidents of violence." He urged his audience to focus their advocacy on law enforcement agencies. Looking for help from their state's mental health systems, he said, was a waste of time.

    That fearmongering leaves lasting effects on public attitudes was clearly not Jaffe's concern. Jaffe first took his coercive medication law to the law enforcement sector and won its support. Then on January 3, 1999, a fatal encounter between Andrew Goldstein and Kendra Webdale gave Jaffe the highly publicized violent incident he needed. The anguish of a shocked and grieving family was transformed into a threat to every New Yorker. Andrew Goldstein was *railroaded into the role of "treatment refuser." (*term used by a former NAMI board member)

    Jaffe's strategy worked. As he described it, he approached the Webdale family a few days after Kendra's death and told them that "her killer was mentally ill, and that her death happened because he wasn't getting treatment, and we've been working to get treatment, and why don't you come and join us... And what happens is the media goes and interviews these people and because we've seen them first, they are telling our story."

    But has the end justified the means?

    During its first three years of operation Kendra's Law drained vital resources from new York's scarce community programs. The public-safety selling point that won Kendra's Law seemed hollow when a participant committed a brutal murder, and even more hollow when statistics showed that only 15% of program participants had committed a violent act before entering the program.

    The upside is that many families have been able to negotiate alternatives to court orders, putting their family members first in line for scarce enriched programs. For others, Kendra's Law is a way to obtain a beneficial discharge plan (a prior law exists but is often broken for lack of community services).

    Three evaluations of the law are available online.

    Despite a strong push by supporters of Kendra's Law to make it permanent, New York's lawmakers voted in June 2010 to extend the law for five years and further test its effectiveness. The most recent evaluations (see list below) of the controversial law found that the key issue of voluntary vs. involunary psychiatric medication was far from resolved due to insufficient data. Researchers also found troubling disparities in the law's implementation across the state.

    Click for:

    1st evaluation of Kendra's Law:
    Final Report on the Status of Assisted Outpatient Treatment
    Issued March 2005 by the New York State Office of Mental Health. The findings of this internal report did not justify making the law permanent.

    2nd evaluation of Kendra's Law:
    New York State Assisted Outpatient Treatment Program Evaluation

    An independent evaluation issued June 30, 2009 by the New York State Office of Mental Health.
    This independent evaluation, led by Marvin S. Swartz et. al, was required by the New York State Legislature when it extended the law in 2005.

    3rd evaluation by Jo C. Phelan et. al, published in Psychiatric Services:
    Effectiveness and Outcomes of Assisted Outpatient Treatment in New York State
    This independent evaluation was published in February 2010 after its initial presentation at the annual conference of the Internationals Association for Forensic Mental Health Services, Vienna, Austria, July 14-16, 2009. The article abstract is free. The full article might be free for a first-time request (it was for me-j.arnold).