June 4, 2016 - News of the Week
ARTICLE from HUFFPOST BLACK VOICES,
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
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
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
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
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
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
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
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.
January 28, 2016 - News of the Week
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.
You Should Never Use the Term "The Mentally Ill"
Jeff Grabmeier MedicalXpress.com January 26, 2016
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
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."
results were found among college students and non-student adults
- and even professional counselors who took part in the study.
findings suggest that language choice should not be viewed just as
an issue of "political correctness," said Darcy Haag Granello,
co-author of the study and professor of educational studies at The Ohio
"This isn't just about saying the right thing for appearances," she
said. "The language we use has real effects on our levels of tolerance
for people with mental illness. 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.
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.
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,"
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."
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.
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).
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."
questionnaires had four subscales looking at different aspects of
how people view those with mental illnesses. The four subscales (and
sample questions) are:
"The mentally ill (or "People with mental illness") need the same kind
of control and discipline as a young child."
"The mentally ill (or "People with mental illness") have for too long
been the subject of ridicule."
restrictiveness: "The mentally ill (or "People with mental illness")
should be isolated from the rest of the community."
mental health ideology: "Having the mentally ill (or "people with
mental illness") living within residential neighborhoods might be good
therapy, but the risks to residents are too great."
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.
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.
because this was an exploratory study, Granello said it is too
early to draw conclusions about the differences in how each group
responded on the four subscales.
important point to take away is that no one, at least in our study, was
immune," Granello said. "All showed some evidence of being affected by
the language used to describe people with mental illness."
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
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 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.
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
DUBIOUS DIAGNOSIS, ANOSOGNOSIA, AND A FEAR-FOCUSED CAMPAIGN
"anosognosia" tripled in ten years?
The diagnostic term
created in 1914 by Joseph Babinski, a French-Polish
neurologist. The diagnosis is primarily given to stroke
who have lost awareness of a body part, a condition attributed to brain
In 2000, intense lobbying by Dr. E. Fuller Torrey and Dr.
Amador convinced psychiatrists to add anosogosia to the psychiatrists'
diagnostic bible, the DSM-IV. Anosognosia can be used to
coercive treatment; this and the uncertainty of its
relevance to mental illnesses raises moral and ethical concerns among
Before "ansognosia" became a psychiatric diagnosis, psychiatrists had
relied on a "lack of insight" concept that allowed patients
least some voice concerning their treatment and
medications. Now, the Treatment Advocacy Center in Arlington,
reportedly conflated "lack of insight" with anosognosia.
It's worth noting that in 2004, Anthony S. David and Dr.
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
supporters also consider potential violence to be a hallmark of
An even further escalation of anosogosia has come from promoters of
Congressional bill #HR 2646. When asked by a radio
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
How times have changed since 2000. In Dr. Amador's book.
"I Am Not Sick, I Don't Need Help," he considered
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
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.
Check out a new blog titled "IS AN OMINOUS NEW ERA OF DIAGNOSING
PSYCHOSIS BY BIOTYPE ON THE HORIZON?"
1, 2015 - News of the Week
KENDRA'S LAW GO NATIONWIDE ?
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
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
necessity, Kendra's Law was approved with unheard-of speed by
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
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
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
- 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
of coercion turns away people in need. HR 2646's
-- 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
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,
percent of Kendra's Law participants had no history of violence to
others during the 3 years prior to entering the
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
Instead, the fear-focused publicity transformed patients into imminent
threats to every New Yorker.
It's been twenty-two years since the New York Post's "Let's Turn Back
the Clock" editorial, and HR 2646 would make it happen.
Links to the largest studies of Kendra's Law's effectiveness are posted
1st independent evaluation of
New York State Assisted Outpatient Treatment Program Evaluation
2009. This evaluation,
led by Marvin S. Swartz et. al,
required by the New York State Legislature when it
extended the law in 2005. (The "Duke Report")
Phelan et. al, published in
Psychiatric Services 2010
Effectiveness and Outcomes
Outpatient Treatment in New York State
published in February 2010 after its
initial presentation at the annual conference of the Internationals
Association for Forensic Mental Health Services, Vienna, Austria, July
independent evaluation by Pamela Clark
Robbins, et.al, published in Psychiatric
Outpatient Treatment in New York: Regional Differences in New York's
includes several charts to illustrate
the uneven implementation of Kendra's Law from 1999-2006 .
August 14, 2015 -
News of the Week
A CRISIS AND STABILIZATION CENTER
A highly respected and successful 100% peer-run
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
the leadership of executive director Steve Miccio, PEOPLe,
brings hope and renewal to New Yorkers diagnosed with mental
illnesses and to those whose conditions are complicated by
mind-altering substance use. The program has been acclaimed and
copied by activists here and abroad, despite derision of its
user-friendly approach from advocates of forced treatment.
READ MORE ABOUT PEOPLE,
MORE ABOUT STEVE MICCIO in
article that is also about the recovery movement.
July 1, 2015 - News of the Week
THE MURPHY-JOHNSON BILL, HR2646, HELP STRUGGLING FAMILIES
Or will it arrest progress and turn back the clock on mental healthcare
Congressman Tim Murphy
(R-PA) has vowed to conquer a thorny
national disgrace: the public's neglect -- many would say abandonment
-- of psychiatrically-labeled Americans and their families.
Rep. Murphy and Rep. Eddie Bernice Johnson (D-TX) have proposed a bill,
HR 2646, titled "Helping Families in Mental Health Crisis Act of 2015,"
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
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.
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
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
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
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
culminates an ongoing attack on SAMHSA led by Dr. E. F. Torrey and D.
J. Jaffe who have for years disparaged SAMHSA's encouragement
former patients who favor recovery-oriented
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
strips Protection & Advocacy agencies of their ability to
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
rejection of people with psychiatric labels. This fact was
most strongly by former Surgeon General David Satcher in his
groundbreaking mental health report of 1999: "Because most
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
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
as neighbors and co-workers? Will they even try,
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
nation's excessive violence is linked to mental illness. At
$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)
ACTIVIST STATES GOALS
Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!
storyteller, mental health advocate, and coordinator of the Recovery
June 12, 2015
"May is Mental Health Month" has come and gone, and it is time to build
on years of awareness campaigns and move into action to promote whole
health and recovery. People with serious mental health conditions are
dying on average
25 years earlier than
the general population, largely due to preventable physical health
conditions, so why do we still focus on mental health separately from
physical health? And when we know that people with serious mental
health conditions face an 80
percent unemployment rate,
why do we largely ignore the role of poverty, economic and social
inequality, and other environmental factors in mainstream discussions
about mental health?
Decades of public
health research have
clearly shown that access to the social determinants of health --
affordable housing, educational and vocational opportunities, and
community inclusion -- are far more important to mental and physical
health than access to health care alone. As one recent article explained:
"For many patients, a prescription for housing or food is the most
powerful one that a physician could write, with health effects far
exceeding those of most medications." Yet this wisdom does not
generally guide policymaking in the U.S. Among nations in the
Organization for Economic Co-operation and Development (OECD), the U.S.
ranks first in health care spending, but 25th in spending on social
services. Is there something wrong with our very concept of "care"?
This question is not just theoretical for me. As an adolescent, I
attempted suicide several times. I found myself in the back of a police
car more than once and was frequently hospitalized. At age 16, I was
diagnosed with bipolar disorder. Two years later, I found myself
sitting in a squalid group home, where I was told I needed to remain
for life. I had no high school diploma and no job. My hopelessness and
despair were all-encompassing.
I managed to get on a different path when I obtained access to safe and
stable housing, education, and social support. Today, I am living life
as a mother and a mental health advocate. I train human service
providers in suicide prevention, recovery, trauma-informed approaches,
and person-centered health care. Every day, I'm grateful that I was
able to regain my life, and I want everyone to have this opportunity.
To help promote a paradigm shift in mental health care, I've been part
of starting a new, nonpartisan public awareness campaign called Recovery
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.
is possible for all.
vast majority of people living with mental health conditions, even
people diagnosed with serious mental illness, can enjoy a high quality
of life in the community with access to the right kinds of services and
supports. Dr. Richard Warner, clinical professor of psychiatry at the
University of Colorado, noted:
"It emerges that one of the most robust findings about schizophrenia is
that a substantial proportion of those who present with the illness
will recover completely or with good functional capacity." A slew
of other studies have
found similar results.
An argument used against recovery is that there are some who can't or
won't voluntarily seek treatment or services. Yet there are plenty of
evidence-based ways to reach people, such as motivational
interviewing, or employing peer-to-peer support
or community health workers to do homeless
outreach or to
engage with persons with complex mental and physical health needs. But
these kinds of strategies are vastly underutilized.
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?
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
should clearly address the social determinants of health. Policy should
seek to end deadly cycles of poverty, homelessness and incarceration in
ways that are culturally appropriate, rehabilitative rather than
punitive, and community-based. We can't talk about more hospital beds
without talking about supportive housing and other programs that will
actually help people to stay out of the hospital and out of prison. We
need legislation that tackles disparities in access to education and
employment, and funds proven programs that prevent crisis and
We need sound policies that promote recovery for all Americans affected
by mental health conditions. We don't have the luxury of continuing to
get this wrong. Too many individuals, families, and systems are in
crisis, and it doesn't have to be this way. We need recovery, and we
need it now.
Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and
Briana Gilmore, March 2015
That is how Ron
Manderscheid, PhD, opened his address last month at the Together
Against Stigma: Each Mind Matters
conference in San Francisco. Manderscheid joined other mental health
experts in a symposium to discuss how stigma can be reduced or
eradicated through policies that support mental health promotion,
prevention, and early intervention strategies.
opening remarks aren’t hyperbolic. People with mental health and
substance abuse conditions die an average of 25 years before other
citizens. Less than half of those with needs receive any care at all,
and it takes an average of a decade before people access the treatment
they need. Suicide rates are also at the historic high of 40,000 people
a year, exacerbated by the economic
insecurity and reduction in services brought on by the great
recession. And as Manderscheid and this USA Today article
elucidate, people often only receive care when their experiences have
become severe enough that they have turned into complex, illness- and
symptom-based disabilities. Advocates liken this to only admitting a
cancer patient into treatment when they reach stage four of their
how can policy reduce stigmatization that prevents people from
accessing care, living successfully in the community, and sustaining
recovery? Ron Manderscheid advocates for a five-point reform plan that
Leveling the insurance playing field through parity laws is a first
step to affording equitable treatment for mental health and substance
abuse. Many states and insurance companies are just at the beginning of
implementing successful parity reforms, because they necessitate
sweeping financial, regulatory, and programmatic changes that take time
to adopt. They are also not fully applicable to Medicaid and Medicare
recipients in most states, thus further exacerbating stigma for people
and families experiencing poverty. Parity is now also only available
when a person receives specific treatments. Dr. Manderscheid indicates
that if we want true reform through parity, we need to extend it to
equal housing, equal jobs, equal supports, and equal pay.
Practice is moving rapidly toward fully integrated care through
team-based practice approaches and integrated funding models. True
practice integration, however, must integrate behavioral health clients
with all other clients in health and medical homes. Stigmatization can
sustain practices of exclusion that separate people with behavioral
health needs out and away from their peers and people experiencing
other health-related concerns. “Separate but equal” cannot remain a
valid practice strategy if our system aims to achieve parity.
Achieving the benefits outlined in the Affordable Care Act includes
utilizing resources toward health promotion and prevention. Activities
that sustain these opportunities are also ones that can pay for
resources in the community that help clients recover, experience
wellness, and live full lives. Promoting recovery through
means that states and counties need to swiftly invest in integrated
practice that promotes and rewards early intervention and
wellness-based strategies. These types of services have been minimally
financed since psychiatric hospitals started closing decades ago.
Integrating these services into mainstream financing mechanisms and
incorporating them into discharge planning and whole-health treatment
plans is essential to promoting community recovery.
Developing a peer workforce can only enhance parity reforms and promote
dignity and community-based recovery. People with lived experience can
actively reduce stigmatization by gaining employment, and helping
consumers and family members understand that behavioral health is not
something to be feared or diminished. Peers should work across the
health system, not just with behavioral health clients, to offer a wide
range of experiences, values, and capacity to people in recovery across
the wellness spectrum.
Moving “out of the office” toward inclusive participation doesn’t only
include outreach and engagement in services. Participative,
community-based action includes public demonstrations, legislative
hearings, key meetings with public leaders and executives, and
coalition building among organizational leaders. Raising the visibility
of a recovery-based movement is essential to reducing the stigma
associated with mental health and substance abuse treatment.
If we begin with a human rights based approach to equality, and
capitalize on the gains made in the Affordable Care Act, we can achieve
measurable reductions in stigmatization through incorporation of the
“five-P’s” outlined above. Defeating stigma demands civil rights and
social justice actions at every level, including transparency of
effective policy leadership in state and local governments. We are all
responsible for reducing stigma, and we can all create opportunities
for growth and change from policy to practice.
information about how policy can reduce stigma, contact Ron
Manderscheid, PhD at firstname.lastname@example.org or visit
the National Association of County Behavioral Health and Developmental
Disabilities Directors at www.nacbhdd.org
News report (7/7/15) Mad in
Study Finds Gun Violence Not Linked to Mental Illnesses
another study -- this one published in Psychiatric Services
-- 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.
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
later committed gun violence was almost twice as high as the prior
arrest rate of the overall sample (89% and 49%, respectively)," added Psychiatric
"When public perceptions and policies
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
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)
20, 2015 - News of the Week
THERAPY CAN HELP WITH HALLUCINATIONS
Article forwarded by NYAPRS E-News
Note: Thank you to RECOVER-e Works and their April, 2015 newsletter
authors for the two excellent articles below on CBT for people
experiencing extreme states and with serious diagnoses.
schizophrenia? You don't know Jack.
Strubel, MA, LCSW, CASAC
met Jack in a dual diagnosis/re-entry program for parolees. All had
fascinating stories about survival in prison (Got a little tinfoil? You
can make a decent grilled cheese sandwich in a holding cell with a
radiator). Most were symptomatic, because the policy was to take people
off their medication as they neared release and were transferred to
told our admission coordinator his voices had advised him to skip
intake. However, wary of returning upstate, he endured the appointment
and met me. "I think I'll be able to work with you," he said. "You have
did he, along with a glorious James Brown-esque pompadour. Jack was
meticulous about his appearance. “Even when I was shooting ten bags of
heroin a day, I made sure to shave, bathe, and wear clean clothes.”
"Ten bags a
day?" I asked.
the voices stop," he told me. "Better than any medication I ever tried."
Jack entered my
office one day in a funk.
went to public assistance, and I know that lady's going to mess up my
case," he said. "I could tell by how she looked at me. She made this
face"—he pursed his lips and narrowed his eyes—"and the voices started
saying, 'She hates you, she's not going to help you—she's going to get
you all twisted.'"
wasn't there," I responded. "I don't know how she looked at you or what
she thought. But there may be another way to interpret her
expression—it could have been about something that happened before you
even came into her office, or maybe she thought about something going
on in her personal life.
"So the way she
acted wasn't because of me?" he asked.
I said. "If you're right and she tries to mess with your case, you know
I'll go to bat for you, make sure you get what you need. But it's
possible something else was going on."
then cocked his head to the side, listening. "The voices don't believe
you," he said.
me tell you about 'automatic thoughts,'" I said, and explained how
almost everyone experiences a barely conscious stream of thoughts
throughout the day. Some thoughts are positive, but many are negative.
We can train people to become aware of their negative thoughts, and
then dispute them.
voices," I said, "are just a louder version of automatic thoughts.
They're not real people; they're your own fears and doubts. When a
voice says something negative, you can disagree. Ask, 'How likely is it
that the welfare lady hated me on sight and wanted to make my life
miserable? Could she have been having a bad day, and taking it out on
me? If she did try to mess up my case, can my counselor help me
straighten it out?'"
thought that over. "You know," he said, "that makes a lot of sense.
Because sometimes I can tell the voices are wrong right off the bat."
you might need to think about it a little more," I said, "or discuss it
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.
Behavior Therapy (CBT) for Recovery: The Cutting Edge
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
discovery was three years ago. What have CBT researchers done for us
Here are some
advances from the last six months.
CBT as an
Alternative to Drugs: A Proof-of-concept Study
it comes to schizophrenia, the British seem to make a habit of
upsetting the medical model. First they rejected auditory
hallucinations as psychopathology, set up a hearing voices movement, and
imported the concept to the US. Now researchers across the pond suggest
in The Lancet: Psychiatry, the British journal of
record, that CBT might get rid of persecutory delusions.
small study focused on people with schizophrenia spectrum disorders.
All had persecutory delusions, and had not taken antipsychotic drugs
for at least six months. Researchers randomly assigned subjects to
treatment as usual, or to a package of brief therapy including four CBT
sessions focused on the subject’s specific delusions.
goal of this package was to change people’s reasoning about their
delusions. Investigators taught subjects to become more aware of their
thinking processes, and to identify and inhibit jumping to conclusions.
Researchers also encouraged subjects to be more analytical. These
interventions increased subjects’ sense that they might be mistaken
about their persecutory beliefs.
results indicate that people were comfortable with therapy, and the
intervention worked. Follow up data collected two months afterwards
suggested the model was definitely useful.
frequently use CBT as an adjunct to psychopharmacology for delusions,
but they rarely use CBT alone. If further research confirms the results
of this proof-of-concept study, perhaps people with schizophrenia will
have more choices in the future. Given the common, generally
unpleasant, side effects of antipsychotic drugs—such as weight gain,
metabolic problems, movement disorders, and an increased risk of
cardiac death—having a meaningful treatment choice in the journey
toward recovery would be most welcome.
with Other Evidence-based Treatments
recent tendency to mix and match evidence-based therapy has led to
instances where CBT has been successfully merged with other
psychosocial treatments. Here are three examples.
CBT material, such as that described above, can be presented using
social skills training techniques, for example, waving a big flag in
group to identify ("flag") beliefs that do not have evidence to support
them. This treatment merger helps clients with cognitive and social
deficits improve their negative (but not positive) symptoms, and is
helpful for clients regardless of the severity of their cognitive
impairments. Further, because the treatment is repetitive, new clients
can join the group at any point.
Data strongly show that CBT with family psychoeducation
stress, increases medication adherence, and decreases
re-hospitalization. Modules are available that teach parents how to use
CBT techniques with clients in recovery, and in other areas of their
CBT can help clients improve coping skills and challenge distorted
beliefs about their vocational abilities. CBT is now being melded with
supported employment to test the effectiveness of the combination.
Preliminary results suggest people who received CBT in addition to
supported employment might be more likely to work more hours per week.
March 29, 2015 - News of the Week
TIMELY "TALKING POINTS" WORTH REMEMBERING
Kudos to the Huffington Post's Healthy Living Staff for giving us a
concise, doable and user-friendly list of "do's" for talking about a
Germanwings airline crash that killed all who were aboard a flight to
Dusseldorf on March 24.
"When tragedy strikes, it's a natural human inclination to want an
explanation to help get closure for our feelings of anger and loss.
When such information is unavailable to us, our grief remains in this
limbo of sorts -- or worse, we search for our own answer to help us
Way We Talk About Mental Illness After Tragedies Like Germanwings Needs
Huffington Post / By Healthy Living Staff
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,
While headlines like U.K. tabloid The Sun's "Madman In Cockpit"
are hardly surprising, such sensational links between mental illness
and horrific tragedies can have an undesired outcome when it comes to
Here are five ways to have a more
conversation about the complex interplay between mental health,
violence and tragedies such as this one.
doesn't cause violence.
The public's perception of mental
illness -- which is
largely fueled by movies featuring mentally-ill individuals turned
violent and news headlines that thread mental illness into every story
about mass killings -- needs a readjustment.
People who are depressed are not likely
to be violent. If they were, we'd all be in trouble: One in five of
us will experience a serious mental health issue at some point in our
lives, but only 3-5 percent
of violent acts in the United States are committed by an individual
with serious mental illness -- a tiny fraction of the country's violent
"If we were able to magically cure
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.
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.
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.
illness disclosure policies can push people further into the closet.
Lubitz was seeking treatment for an
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
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
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
But just because the FAA requires full
to an FAA-designated Aviation Medical Examiner doesn’t mean that pilots
may feel completely safe disclosing their conditions, according to Ron
Honberg, director of policy and legal affairs at National Alliance On
“If a person feels that it’s safe to
disclose, and that
they’ll have an opportunity to get help -- that there won’t
automatically be adverse consequences like being prohibited from ever
flying again -- then they’re going to be more likely to disclose [a
mental illness],” said Honberg. “But I think historically pilots have
known that if they admitted it, they’d never be able to fly again.”
Generally speaking, barring industries
where a person
may be responsible for public safety (like a pilot or a police
officer), one is not obligated to disclose any of this information to
his or her employers in the U.S. Just as people don’t have to tell
their bosses about diabetes, cardiac disease or HIV diagnoses,
employees can’t be forced to discuss their mental health history beyond
anything that may interfere with a person’s function at the job,
explained Honberg. And employers can’t ask job candidates about their
medical records or medical history except to ask about whether
something might impact a person’s functional limitation in a job.
“It has to be focused on if they’re
capable of doing the
job,” said Honberg. “Are there physical or mental health factors that
may preclude them from being able to do that?”
The FAA does not track rates of
dismissal for pilots who
disclose mental illnesses versus other conditions, or the number of
pilots who continue to fly after disclosing a mental illness. But until
we have all the facts about Lubitz’s situation, it’s important to hold
off on any policy changes that might attempt to close up perceived
loopholes, he said.
“It’s really important to have all the
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."
conversation surrounding mental illness and mass violence reveals our
ingrained ethnic and racial biases.
Lubitz allegedly committed mass murder
and, as many people have
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
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
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
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
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
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
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
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
to work the day of the flight, and instead of sharing that information
with Germanwings, Lubitz disposed of the note and boarded the plane.
But even in light of such information, it's highly unlikely that we
will ever know exactly what was going on in the mind of this pilot, and
it is far from our place to speak as though we have a definitive
In the words of Gourevitch, we are left
with a sense of
"cosmic meaninglessness and bewilderment" when horrific events such as
this one occur, and while that is one of the toughest collections of
emotions to grapple with, there is no credible alternative in cases
ARTICLES (The Atlantic and The Boston Globe)
, 2015 - News of the Week
ALARMS EXPERIENCED ADVOCATES
Return to Asylums? Let’s not!
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
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
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
“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
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.”
Rogers is the Director of the National Mental Health Consumers'
the Director of Special Projects, Mental
Health Association of Southeastern Pennsylvania
18, 2014 - News of the Week
STORIES SHATTER STEREOTYPES
San Francisco Honors
Psychiatric Survivor Carmen Lee
accounts tell us how Winston Churchill and Abraham Lincoln battled
disabling depression even as they made history. But before we can
truly understand and empathize with people who have psychiatric
vulnerabilities, we need people of our own time and environment to
tell us what they experience.
easy access to videos and social media allows the general public
unprecedented views of how mental illnesses affect a life. Every
story is unique. A recent example comes from Carmen Lee, a
Californian whose suicide attempts in her early 20s prefaced 20 years
of hospitalizations. In a remarkable 6-minute video on Facebook. "No
Longer Pretending..." (https://vimeo.com/105064330)
Lee explains the essence of her survival. Put most simply, Lee used
her positive energy to refute the stereotypes that misrepresent the
mental health community, thereby aiding progress toward social
1985 Carmen Lee began the Peninsula Network of Mental Health Clients,
and in 1990 she developed the Stamp Out Stigma program (SOS)
Traveling throughout the bay area and beyond, SOS teams have
delivered over 2,600 presentations to organizations and agencies of
every description, having directly reached well over 500,000 people
and many more by ripple effect. Lee's advocacy includes participation
in statewide planning forums.
Lee's video premiered on September 25th for a large crowd in San
Francisco's new Levi Stadium, home of the 49ers. It was a gala event
honoring mental health activism and educational outreach in Northern
California and beyond. The event was sponsored by Caminar, a San
Francisco Bay Area mental health agency that helped Carmen Lee
recognize her strengths and encouraged her work.
11, 2014 - News of the Week
GUN VIOLENCE AND SUICIDE
misperceptions must be replaced with facts
new study by an international team of leading researchers suggests
that an infusion of evidence-based data could jump-start a reduction
in U.S. gun violence. The study focuses on gun assaults
involving suicide and people with behavioral disorders. It
proposes that effective, fair, and feasible policies can be applied
to the tiny portion of the U.S. population where gun violence and
mental illness intersect. Forbes correspondent Todd Essig
describes the research as a "comprehensive, critical survey of
the available data ... that pulls together the facts we need to
consider if we really want to adopt evidence-based policies to reduce
random gun violence."
introduction (excerpt below) explains how misconceptions have
complicated the policymaking process. The full article is FREE
ONLINE, click here.
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
the precise course of action was far from clear; competing ideas
about the nature and causes of the problem -- and thus, what to do
about it -- collided in the public square.
the one side, public health experts focused on the broader complex
problem of firearms-related injury and mortality in the United
States, where each year approximately 32,000 people are killed with
guns -- about 19,000 of them by their own hand -- and another 34,000
are injured in nonfatal gunshot incidents. more...
illness and reduction of gun violence and suicide: bringing
epidemiologic research into policy (Article
W. Swanson, Duke University
Elizabeth McGinty, Johns Hopkins University
Fazel, University of Oxford UK
M. Mays, Univerity of California at Los Angeles
15, 2014 - News of the Week
SURVIVOR CHALLENGES SCHIZOPHRENIA'S BAD RAP
Article Source: The Independent, July 15, 2014 http://www.independent.co.uk
For article and a video, click title:
the most misunderstood mental illness?
By Rachel Hobbs
"While mental health
stigma is decreasing overall ... people
schizophrenia are still feared and demonised."
Earlier this year Jonny Benjamin set up a nationwide search to
#findmike, the stranger who
talked him out of taking his own life on Waterloo bridge. People told
him he ‘didn’t look like a
schizophrenic’ - so what do people imagine?
Let’s face it, when most people think about schizophrenia, those
thoughts don’t tend to be
overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness,
the phrase ‘schizophrenics should...’ when researching a potential
campaign, we were so
distressed by the results, we decided to drop the idea completely. I
won’t go into details,
but what we found confirmed our worst suspicions.
Schizophrenia affects over 220,000 people in England and is possibly
the most stigmatised
and misunderstood of all mental illnesses. While mental health stigma
is decreasing overall,
thanks in large part to the Time
to Change anti-stigma campaign which we run with Mind,
people with schizophrenia are still feared and demonised.
Over 60 per cent of people with mental health problems say the stigma
they face is so bad, that it’s worse than the symptoms of the illness
itself. Stigma ruins lives.
It means people end up suffering alone, afraid to tell friends, family
and colleagues about
what they’re going through. This silence encourages feelings of shame
and can ultimately
deter people from getting help.
Someone who knows first hand how damaging this stigma can be is 33
Camus*, who was sacked from her job as a university lecturer, after her
bosses found out
about her schizophrenia diagnosis, which she’d kept hidden from them.
Erica was completely stunned. “It was an awful feeling. The dean said
that if I’d been open
about my illness at the start, I’d have still got the job. But I don’t
believe him. To me, it was
She says that since then, she’s become even more cautious about being
discussed it with lots of people who’re in a similar position, but I
still don’t know what the
best way is. My strategy now is to avoid telling people unless it’s
comes up, although it can
be very hard to keep under wraps.”
Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative
schizophrenia can have a direct impact on patients. “Some people
definitely do internalise
the shame associated with it. For someone already suffering from
paranoia, to feel that
people around you perceive you as strange or dangerous can compound
“I think part of the problem is that most people who have never
experienced psychosis, find
it hard to imagine what it’s like. Most of us can relate to depression
and anxiety, but a lot of
us struggle to empathise with people affected by schizophrenia.”
Another problem is that when schizophrenia is mentioned in the media or
screen, it’s almost always linked to violence. We see press headlines
about ‘schizo’ murderers
and fictional characters in film or on TV are often no better. Too
often, characters with
mental illness are the sinister baddies waiting in the shadows, they’re
the ones you’re
supposed to be frightened of, not empathise with. This is particularly
worrying in light of
research by Time to
Change, which found that people develop their
understanding of mental
illness from films, more than any other type of media.
These skewed representations of mental illness have created a false
schizophrenia and violence in the public imagination. In reality,
violence is not a symptom of
the illness and those affected are much more likely to be the victim of
a crime than the
We never hear from the silent majority, who are quietly getting on with
their lives and pose
no threat to anyone. We also never hear about people who are able to
symptoms and live normal and happy lives.
That’s why working on the Finding Mike campaign, in which mental health
Benjamin set up a nationwide search to find the stranger who talked him
out of taking his
own life on Waterloo bridge, was such an incredible experience. Jonny,
schizophrenia, wanted to thank the man who had saved him and tell him
how much his life
had changed for the better since that day.
The search captured the public imagination in a way we never could have
#Findmike was trending all over the world and Jonny was making
headlines. For me, the best
thing about it was seeing a media story about someone with
schizophrenia that wasn’t linked
to violence and contained a message of hope and recovery. Jonny is
living proof that things
can get better, no matter how bleak they may seem. This is all too rare.
15, 2014 - News of the Week
A "60 MINUTES"
BIAS HARMS MILLIONS
September of last year, 60 Minutes infuriated many viewers by
portraying people with schizophrenia and similar conditions as
individuals at high risk of committing violence. Viewers deluged CBS
with angry protests.
Sunday, June 8, the feature, "Imminent Danger" was aired for the second
time. Clearly, 60 Minutes showed bias by repeating a one-sided feature
that was full of inaccuracies.
the September broadcast, the Bazelon Center for Mental Health Law
outlined the viewers' objections and pointed out the segment's
inaccuracies in a letter to CBS (for the full letter skip down to More
"Imminent Danger" portrays individuals diagnosed with schizophrenia as
people with hopeless futures whose primary life options are
hospitalization, homelessness, or incarceration. The segment
provides no indication that individuals with schizophrenia can and do
live fulfilling lives, start their own families, work, live
independently, and participate fully in their communities.
Instead, such individuals are painted as consigned to a life of misery
and as ticking time bombs with the potential to become violent at any
Danger" was hosted by Steve Croft and featured Dr. E. Fuller Torrey,
the nation's leading proponent of compulsory antipsychotic medication
and preventive hospital commitment. Both men showed a strong
commitment to coercive treatment, and both were willing to distort
facts to win public support for regressive
one angry viewer wrote,
time to get another 'reporter' to do some real investigation and offer
a balanced story rather than what seems like a personal mission by Mr.
Croft to further disenfranchise people who have received psychiatric
diagnoses. Ten years ago in October 2002 and June 2003, Mr.
did a story called "Armed and Dangerous" that, like this segment,
relied mostly on the singular opinion of Dr. Torrey ... he's obviously
not done any more real research in the past decade as this piece is as
uninformed, biased and journalistically irresponsible as the last
Croft's flowery introduction made clear that Dr. Torrey had determined
the program's direction. Dr. Torrey and Dr. Jeffrey
leading proponents of compulsory antipsychotic medication, used the
time to convince viewers that meds, forced if necessary, will end
Dr. Torrey's collection of well over 3,000 "Preventable Tragedies"
holds some surprises. After downloading the collection's
summaries years ago, the National Stigma Clearinghouse found that
medication failed to deter homicide in many cases. Further, a
York Times series analyzing 50 years of mass murders (April 2000)
reported that among the 24 slayers who had been prescribed medication,
nearly half (10) were taking medication at the time of their rampage.
regarding violence, Dr. Torrey's guesstimates have media appeal, but
more to the point are figures from authoritative sources.
Schizophrenia affects just over 1% of the adult population (National
Institute of Mental Health-NIMH) and of these people, 99.97% of them
will not be convicted of serious violence in a given year (Walsh et.al.
2002. "Violence and Schizphrenia: Examining the Evidence," British
Journal of Psychiatry, 180: page 494)
Danger's" lack of balance is easily confirmed in its online
transcript. The over-emphasis on schizophrenia was
insightful observation was made by Tom Dart, the Cook County Sheriff,
after he described the petty offenses of most incarcerated mentally ill
"This is a
population that people don't care about and so as a result of that
there are not the resources out there for them."
effect has Dr. Torrey's 20-year over-emphasis on violence had on public
more information, read a New York Times 4-part series on "Rampage
Killers" (link is below)
THE NEW YORK TIMES ATTEMPTS
TO UNDERSTAND "RAMPAGE KILLERS"
April 9, 2000 -News of the Week
"Rampage Killers Chart a
Well-marked Course to Their Unraveling"
New York Times 4-part series on "Rampage Killers," launched on Sunday,
April 9,  attempts to replace opinions and hype with what is
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
to the popular assumption that mass murders are the work of people with
mental illness, of the 102 "rampage killers" recorded over a span of 50
years, only 25 were diagnosed with mental illness before the murderous
incident; another 23 were diagnosed in hindsight. (Troubling questions
about mis-diagnosed schizophrenia in earlier decades will perhaps be
examined later in the series.)
who commit mass murders are always caught, says the Times, mainly
because they want to be. They signal their intent in many ways before
acting. This series may well heighten public interest in recognizing
the precursors of violence.
"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
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.
Times series is well worth saving for study. Click www.nytimes.com/library/national/040900rampage-killers.html
May 2, 2014 - News
of the Week
A CLOSER LOOK AT "LACK OF INSIGHT"
articles and briefing papers by supporters of forced treatment assume
that patients who refuse psychiatric treatment do so because
structural brain abnormalities that block awareness. They say nearly 50
percent of people with schizophrenia and bipolar disorder require
forced anti-psychotic medication to combat the assumed cause of
treatment refusal. Although the faulty brain lesions have not
been found and their response to anti-psychotic medication is unknown,
supporters expect these hurdles to be cleared by
advanced brain imaging techniques within a few years.
thought-provoking article below addresses the "lack of insight" concept
and approaches to treatment. This analysis is a valuable
for understanding the variety of ways to view "lack of insight.".
With pressure building for a major expansion of forced meds,
informed public is crucial..
THE ISSUE OF
by Larry Davidson, Ph.D.
Yale University School of Medicine
February 6, 2012
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
what about people who won't accept any treatment, who deny they need
any help? How does recovery-oriented care apply to them?
questions—and others like them—are frequently posed by frustrated
practitioners and distressed family members trying to assist people who
appear not to want help. One concern, or assumption, about these
questions is that they point to a key limitation of the recovery
paradigm, implying recovery and recovery-oriented practices are only
for people who readily acknowledge having a mental illness. After all,
how can a person be "in recovery" if he or she has nothing to recover
from? One of the major differences between mental illnesses and other
medical conditions is the issue of insight. People with diabetes know
they have diabetes; people with asthma know they have asthma, etc., but
some will argue that most people with serious mental illnesses (or at
least those with schizophrenia) lack insight into having the illness.
Therefore, they will not participate in the treatments needed to manage
their conditions. Such perceptions lead some people to argue that
coercion and involuntary treatments are necessary, at least for those
who refuse any or all treatments. The lack of insight also poses a
major challenge to person-centered care planning and recovery-oriented
practice, if both presume the person will take responsibility for
driving his or her own care and overall recovery process. Is not
insight, therefore, required for recovery?
While it may sound contradictory at this
point, I intend to show in the following two sections not only that
recovery-oriented practice is possible for people who appear to lack
insight, but that it may also be precisely these people who most need
recovery-oriented care. (Click
for full article)
- News of the Week
NETWORK NEWS" RETURNS
to view samples of the MNN archive, and more...
Network News (1972-1986) began as an open forum for young people people
facing the social isolation that comes with a psychiatric
Happily, these historic quarterly publications have now been re-issued
in two formats: seven hard copy books averaging 170 pages each and 45
digital e-books. Each decades-old issue of MNN teems with
personal experiences, commentary, poems, letters, cartoons, photos, and
calls for action -- resulting in a kaleidoscope of artwork, emotion,
A recurring theme throughout the 45 issues
is angry protest against dehumanizing psychiatric practices and the
loss of civil rights. Today, those grievances are legitimized by
experts such as journalist/activist Robert Whitaker (www.madinamerica.com)
and Dr. Thomas Insel, Director of the National Institute of Mental
A: Dr. Insel and Dr. Suzanne Koven, The Boston Globe,
12/16/2013), to name just two of many critics of current psychiatric
In the summer of 2013, two determined
long-time activists, David Gonzalez (Brooklyn NY) and Ron Schraiber
(Los Angeles CA), received the support and approval from MNN's
co-founder, Leonard Roy Frank, to reprint the complete set of original
issues. Working from home due to medical problems, David
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,
approximately 170 pages of resized original material (6 MNN issues)
except for Volume 1, which combines MNN's first and its final issues (9
To further enhance access, David then
turned each of MNN's 45 issues into a high-quality e-book.
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"
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.
18, 2014 - News of the Week
FIXATION ON VIOLENCE FUELS FEAR AND DISCRIMINATION
Dr. E. Fuller Torrey's latest book. "American Psychosis," begins by
describing the events, shortsighted decisions, and inertia that led to
the present quagmire we call the nation's mental health
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
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
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
team's sensational approach, and from the 1990s onward,
enjoyed a lion's share of media coverage concerning mental illnesses.
Blame for the nation's horrific amount of gun violence now falls on a
minority with little means of defense. Injustice against innocent
people is condoned. And many who need help are afraid to ask
A tragic example: "Dad!
Dad! Learning from the Kelly Thomas Tragedy"
(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
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
Kelly Thomas had struggled for years with
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
Mental health and human rights advocates gather to grieve and decry
police killing, First Unitarian Church, Albany, NY, 7:00 pm, Sunday,
January 18, 2014)
January 11, 2014 -
News of the Week
TAKES HEAT FOR HIS VIEWS ON MARIJUANA
THE PUBLIC NEEDS FACTS ABOUT POTENTIAL HARM
columnist David Brooks recently expressed misgivings
concerning recreational marijuana use, based on his own
experiences. A displeased pro-marijuana advocate, Joe Dolce,
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
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'
member will attest that pot-smoking has led to family
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
Pot Doubles Mental Illness Risk" (Christchrch New Zealand)
linked to brain-related memory woes, schizophrenia risk in teens" (CBS
Marijuana Experiment" (New York Times editorial)
Cannabis Use and Risk of Incidence...10 Year Follow-Up Cohort Study"
(Medscape signup needed)
December 15, 2013
- News of the Week
CONSUMER NETWORKS ARE IN JEOPARDY
A proposed Congressional Bill is described as helping families in
mental health crisis. Unfortunately, the bill includes
provisions that would halt effective wellness programs designed by
patients and ex-patients. This alarming Bill would "slash
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).
York Association for Psychiatric Rehabilitation Services; NDRN, National Disability Rights
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.
Health America Faults Rep. Tim Murphy's Legislation..."
of David Shern, Ph.D., president and CEO, Mental Health America
Health Advocates Blast Murphy Bill as Regressive
GOP Rep. Murphy
rolls out mental health legislation
By David Sherfinski, The
Washington Times, 12/12/13
Urge Congress to Protect SAMHSA and Consumer Programs!
News: This comes from the National Coalition for Mental Health
Recovery, an organization that NYAPRS supports. We urge you to contact
your representatives to demand that budget cuts do not impact mental
health recovery services that keep people engaged and working toward
their well-being. Along with the Congressional deal to tighten the
budget and restrict mental health spending, an act submitted by
Representative Tim Murphy would favor involuntary services and reduce
funding for rehabilitation services, including peers and family
support. Contact your representative today, sign the petition at change.org, and get on the NCMHR action list!
Grants for State Networks, The Alternatives Conference and
Mental Health Technical Assistance Centers Are At Risk!
your Senators and your Representative about these vital programs.
need to hear from YOU now.
negotiators in Congress just reached a deal that squeezes dollars for
all health funding including mental health. Most
members of Congress don’t know about the life-saving work and value of
state mental health consumer networks and national TA
centers. It is up to you to educate them.
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.
to do now:
Right now, send emails and make
phone calls to
you members of the House and Senate appropriations committees telling
them why they
should protect funding for state mental health networks, the
Alternatives conference and the five mental health technical assistance
centers and how important they have been in your life, the life of
people you love and for citizens of your state. (See How to do it below and the attached
document on what to say).
Next, Sign our petition on
Change.org: Go to http://ncmhr.org and look for the
Action Alert with a link to the petition and more background.
Stay tuned for instructions on how counter
Tim Murphy’s bill that you will be receiving in a few days.
to do it:
FIND your U.S. Senators at http://www.opencongress.org/people/zipcodelookup.
Click the name of each Senator, scroll down to “ Contact Webform” to
send them an email. Before sending, copy and save your message. Request
a reply. You can also call their office and leave a message.
The attached document includes a list of Senators and Congressmen on
Appropriations Committees. If they represent you it’s doubly important
to educate them. If your Senators/Congressman is not on this
list, don’t worry--It’s still vital that contact them.
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
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
TELL your member of the House of
Representatives to fully
fund SAMHSA grants for statewide mental health consumer networks,
mental health technical assistance centers, the Alternatives
conference, and protection and advocacy programs. TELL
them state network grants, which total just $2.5 million now, teach
people with serious mental health conditions to stay well and recover.
TELL them how YOUR state network (and the local peer-run centers it
supports) have changed your life as a person with a serious mental
health condition and how you now help others. If your state doesn’t
have a mental health consumer network yet tell them you need one.
If your representative is listed on the attached document, it is doubly
important that they hear from you.
Email raymond.bridge@ncmhr to
get on our action list. Like us on Facebook (National Coalition for
Mental Health Recovery) Find us at http:ncmhr.org -
Note from Jean Arnold: I regret that the lists (referred to above) of
Congressional Committee members did not transfer to this
20, 2013 - News of the Week
BAD RAP... AGAIN
Tanya M. Luhrmann's opinion piece "The
Violence in Our Heads"
(NYTimes, 9/19/13) is a thought-provoking discussion of the effects of
culture on auditory hallucinations. Deserving wide attention
her description of intriguing and effective ways to relieve distressing
symptoms of psychosis. For example, the 'hearing
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
University, begins by speculating about recent mass murderers, Adam
Lanza and Aaron Alexis. (Neither, to my knowledge, has been
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
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
The public's perception depends largely on context. For
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)
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
ADVOCACY GROUPS PRESS FOR FAIR REPORTING
recent 60 MINUTES
segment hosted by Steve Croft focused on a national disgrace -- the
nation's undisputed neglect of Americans who are diagnosed with serious
psychiatric conditions. Ignoring an opportunity to discuss
scarcity of user-friendly treatments, the segment focused
psychotropic medications and forced treatment. The coercion
proponents' marketing strategy, "fear of violence," dominated
segment -- note its (shortened) title, "Imminent Danger".
is a letter from the Bazelon
Center for Mental Health Law to
60 MINUTES protesting "Imminent Danger's" harmful bias. The
letter is signed by 36 mental health organizations, and it joins many
other protests from individuals and organizations. (E-mail:
email@example.com and firstname.lastname@example.org)
Note: This week, the Bazelon
Center for Mental Health Law drafted a letter to the Executive Producer of CBS 60
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.
undersigned organizations, together representing tens of thousands of
individuals with psychiatric disabilities, family members, service
providers, and advocates, write to express our great disappointment
that CBS’ 60 Minutes chose to offer a dismal and inaccurate portrayal
of individuals with psychiatric disabilities in the September 29, 2013,
segment “Untreated Mental Illness an Imminent Danger?” We call on 60
Minutes to devote a future segment to presenting a different
perspective than that offered by E. Fuller Torrey, the psychiatrist
whose highly controversial views are featured in “Imminent Danger.”
Danger” portrays individuals diagnosed with schizophrenia as people
with hopeless futures whose primary life options are hospitalization,
homelessness, or incarceration.The segment provides no indication that
individuals with schizophrenia can and do live fulfilling lives, start
their own families, work, live independently, and participate fully in
their communities. Instead, such individuals are painted as consigned
to a life of misery and as ticking time bombs with the potential to
become violent at any time.
segment perpetuates false assumptions that there is a significant link
between mental health conditions and violence. Indeed, the point of the
segment seems to be that mass shootings would be preventable if it were
easier to hospitalize individuals with psychiatric disabilities.
Apparently relying on Dr. Torrey’s inaccurate statement that half of
mass killings are committed by individuals with serious mental illness,
the report states: “It's becoming harder and harder to ignore the fact
that the majority of the people pulling the triggers have turned out to
be severely mentally ill—not in control of their faculties—and not
receiving treatment.” Research shows that this is far from accurate.
One survey of mass shootings between 2009 and 2013 found that
perpetrators had a known mental health condition in only 11 percent of
these incidents.1 A recent study of the psychiatric characteristics of
homicide defendants found that psychiatric factors do not appear to
predict whether a homicide defendant used a firearm or killed multiple
Danger” also inaccurately suggests that the primary need in our mental
health system is for more involuntary hospitalization. In fact, we have
a long history of national and state reports—including the Surgeon
General’s Report on Mental Health in 1999 and the 2003 report of the
President’s New Freedom Commission on Mental Health—indicating that our
mental health system is broken because we are failing to invest in
effective community services (such as supported housing, supported
employment, mobile crisis services, peer supports, and mobile community
support teams).6Dr. Torrey’s focus on hospitalization and forced
treatment as the primary need in mental health systems is at odds with
a virtual national consensus that the focus should be community
the segment incorrectly suggests that the requirement that individuals
be dangerous before they can be involuntarily committed to a
psychiatric hospital is a significant barrier to treatment. Dr. Torrey
states in the segment that due to this requirement, in most states, it
is “almost impossible” to commit people. This is a gross misstatement
of fact. In fact, more than 52,000 individuals were involuntarily
committed to psychiatric hospitals last year. Moreover, the vast
majority of individuals who come before courts on involuntary
commitment petitions are committed.7
inaccuracies and omissions in “Imminent Danger” create a harmful
portrayal of Americans diagnosed with schizophrenia and other
psychiatric disabilities. This portrayal is likely to lead to further
discrimination and scapegoating of these individuals and to suggest
misguided policy solutions. Moreover, this segment misses the
opportunity to highlight the need for greater investment in effective
community services. We hope that 60 Minutes will devote a segment to
presenting a different perspective and we stand ready to work with you
on making that happen.
Association of People with Disabilities
Association on Health and Disability
Home Page/National Stigma Clearinghouse
Housing and Development
of Programs for Rural Independent Living
Self Advocacy Network
Street AEH Inc.
Center for Mental Health Law
Legal Rights Project
Consumer Recovery Coalition
Rights Education and Defense Fund
People of America
Health Association of Nebraska
Health Association Orange County, Inc.
Health Association Suffolk County
Association for Rights Protection and Advocacy
Coalition for Mental Health Recovery
Council for Community Behavioral Healthcare
Council on Independent Living
Disability Rights Network
Mental Health Consumers’ Self-Help Clearinghouse
York Association for Psychiatric Rehabilitation Services, Inc.
Family and Consumer Services
County United Veterans
Program for Recovery and Community Health
October 4, 2013 - News of the Week
STUDY SHATTERS POPULAR BELIEFS
Finds Psychiatric Factors Not Linked To Multiple Homicide Victims
Article: Clinical and Research news; Mark
Moran; September 17, 2013
Source: Thank you Briana
“Psychiatric Characteristics of Homicide
Defendants” is posted at http://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
“Psychiatric Factors Not Linked to Multiple
Victims” is posted at http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
more than a third of the defendants had prior psychiatric treatment,
few received treatment in the three months preceding the crime of which
they were accused.
factors do not appear to predict whether a homicide defendant used a
firearm, killed multiple victims, or is convicted of the crime, a
finding that would seem to counter the popular notion—prevalent in the
wake of recent mass killings that have made the news—that perpetrators
of mass gun violence are invariably mentally ill.
finding is from a study appearing in the SeptemberAmerican
Journal of Psychiatry that assessed the association between
homicide and a wide range of demographic and clinical variables.
found no relationship between the presence of psychiatric disorders and
the use of firearms. Also, the presence of a psychiatric disorder was
not related to offenses involving multiple victims.
37 percent of the sample had prior psychiatric treatment, only 8
percent of the defendants with diagnosed Axis I disorders had
outpatient treatment during the three months preceding the homicide.
with an Axis I disorder were overrepresented in homicide defendants,
but this was due to the high rate of substance use disorders found in
is notable that clinical variables, such as Axis I diagnoses, were not
associated with offense characteristics or case outcomes when
demographic and historical characteristics of the cases were included
in the models,” wrote lead author Edward Mulvey, Ph.D., of the
University of Pittsburgh Medical Center, and colleagues. “In
particular, while age and race were significantly related to the use of
a firearm, the addition of clinical variables to demographic and
historical variables did not improve model fit. Furthermore, a model
including demographic/historical and clinical variables did not
significantly predict a guilty verdict, suggesting that case-specific
factors were more salient in these determinations.”
the study, defendants charged with homicide in a U.S. urban county
between 2001 and 2005 received a psychiatric evaluation after arrest.
Demographic, historical, and psychiatric variables as well as offense
characteristics and legal outcomes were described. The researchers
examined differences by age group and by race; they also looked at
predictors of having multiple victims, firearm use, guilty plea, and
percent of the sample had at least one Axis I or II diagnosis usingDSM-IV
criteria, most often a substance use disorder (47 percent). Axis I or
II diagnoses were more common (78 percent) among defendants over age
40. Although 37 percent of the sample had prior psychiatric treatment,
only 8 percent of the defendants with diagnosed Axis I disorders had
outpatient treatment during the three months preceding the homicide.
suggests limited opportunities for prevention by mental health
providers, Mulvey and colleagues said. “The rate of previous treatment
observed in this sample raises issues relevant to mental health
policy,” they wrote. “Although 53 percent of the sample were diagnosed
with an Axis I diagnosis (including substance use disorders), less than
half of these individuals had ever been hospitalized. Also, among those
with an Axis I diagnosis, only 8 percent had received any treatment in
the three months preceding the homicide offense. Moreover, this low
frequency of recent psychiatric treatment differed markedly by
race….Widespread disparities in access to care and cultural differences
regarding help seeking are likely explanations for this difference. The
low rate of treatment in the months preceding the offense, however,
highlights the need for enhanced engagement of high-risk individuals
(especially during times of emotional crisis) if mental health care
providers expect to have an impact on serious violence.”
Hoge, M.D., says that study findings showing low rates of treatment in
the period prior to a crime suggest that crime-prevention strategies
relying on psychiatrists’ reports regarding treatment encounters will
not be effective.
Hoge, M.D., chair of APA’s Council on Psychiatry and Law, reviewed the
report. “Individuals with an Axis I disorder were overrepresented among
homicide defendants,” he told Psychiatric News,
“but this was
due to the high rate of substance use disorders found. The relationship
between substance use and serious criminal behavior is well
established. The study identified only 15 individuals—just 5 percent of
the sample—who had a mental disorder and no co-occurring substance use
disorder. Identification and treatment of substance use disorders are
important not only to alleviate individual suffering, but also to
improve public safety.
study findings address current concerns regarding gun use and mass
killings by those with mental illnesses,” he continued.“There is
widespread belief that mental illness is an important cause of firearm
violence and mass murder. In fact, the researchers found no
relationship between the presence of psychiatric disorders and the use
of firearms. Nor did the presence of a psychiatric disorder relate to
offenses involving multiple victims. These findings suggest that
policies designed to keep firearms out of the hands of individuals with
a history of mental illness will not prove to be effective as a
also said the study underscores the need for better access to
psychiatric treatment, particularly substance use treatment. However,
crime-prevention strategies that rely on psychiatrists’ reports are
likely to be ineffective because most of this population is not in
treatment or getting timely treatment.
“Psychiatric Characteristics of Homicide
Defendants” is posted athttp://ajp.psychiatryonline.org/data/Journals/AJP/927544/994.pdf.
“Psychiatric Factors Not Linked to Multiple
Victims” is posted athttp://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=1739096
October 1, 2013 - News of the Week
A PLEA TO
"Imminent Danger" is the now-shortened title of
recent "60 MINUTES" segment about violence and mental
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
imagery often used in CBS features during the 1990s. The
segment's original title, "Untreated mental illness an imminent
danger?", implied an open-minded, solution-seeking approach -- but no
balance was seen, and there was an appalling over-emphasis on
As many advocates point out, Dr. E. Fuller Torrey, a primary guest on
the show, is known for his disparagement of community programs favored
by many people with diagnoses of serious mental illnesses.
user-friendly programs that promote good outcomes deserve publicity as
much, if not more, than programs that have failed.
This is a plea for the mainstream media to give national exposure to
user-friendly, high-quality community programs and safe housing.
commentary by Linda Rosenberg
President and CEO, National Council for Community Behavioral
A Commentary and Source Materials
from Susan Rogers
Mental Health Consumers' Self-Help Clearinghouse
find it surprising that “60 Minutes,” which has a history of serious
investigative journalism, would do such a slipshod job on the segment
“starring” E. Fuller Torrey.
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.”
they include any information about the Hearing
Voices movement, which helps people learn to cope
effectively with the experience of hearing voices.
addition, in a small British pilot study,
16 individuals diagnosed with schizophrenia were able to control their
auditory hallucinations with an experimental treatment called “avatar
therapy.” The treatment involves creating a computer-based
representation – including a face and a voice – of the entity they
believe is talking to them. The individual’s therapist is then able to
speak through the avatar, encouraging the individual to counter the
voice and to take control of the hallucinations. Three of the 16 people
who participated in the study completely stopped hearing their voices
as a result of the therapy, and almost all of the participants reported
a reduction in frequency and in the severity of distress the voices
caused, according to a published report. Because of the pilot’s
success, The Wellcome Trust will fund a larger study, to be led by
researchers at King’s College London’s Institute of Psychiatry. Thomas
Craig, the psychiatrist who will lead the larger trial, said that if
the study is successful, the therapy could be widely available within a
Dr. Torrey believes that individuals diagnosed with mental health
conditions should be force-medicated if they refuse to take medication
voluntarily, award-winning journalist Robert Whitaker believes that
medication contributes to chronicity. In the era that followed the
introduction of Thorazine in 1955, there has been an exponential rise
in the numbers of individuals disabled by mental health disorders, he
reports in his book “Anatomy of an Epidemic.” Whitaker
told Behavioral Healthcare,
“. . . [U]nfortunately I’m afraid psychiatry no longer knows how to get
back on track with honest reporting of what it does and does not know,
and honest investigations of psychiatric medications. . . . Ultimately,
I think we need a new paradigm built on the framework of psychosocial
and recovery practices.”
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
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.
should do a follow-up piece in which it strives for accuracy, as
opposed to sensationalism.
National Mental Health Consumers’ Self-Help Clearinghouse
Director of Special Projects
Mental Health Association of Southeastern Pennsylvania
1211 Chestnut Street, 11th Floor
Philadelphia, PA 19107
800-553-4539, ext. 3812
800-688-4226, ext. 3812
National Mental Health Consumers’ Self-Help Clearinghouse
is a consumer-run national technical assistance center funded in part by
the Substance Abuse and Mental Health Services Administration.
views, opinions, and content on the Clearinghouse website and in
anything posted on the website or in these e-mails or attached to these
e-mails donot necessarily reflect the views, opinions, or policies of
the Center for Mental Health Services (CMHS), the Substance Abuse and
Mental Health Services Administration (SAMHSA), or the U.S. Department
of Health and Human Services (HHS).
September 23, 2013
- News of the Week
INTERVENTION TEAMS : Will New York City Act At Last?
Communities for Crisis Intervention Teams in NYC
Welcome to the online home of Communities for Crisis Intervention Teams
(CCIT-NYC). If you’d like to share this website with others,
the web address is: http://www.ccitnyc.org.
CCIT-NYC seeks to improve police responses to 911 calls involving
individuals with mental health concerns – often referred to as
“Emotionally Disturbed Person” (EDP) calls. (The NYPD gets
more than 100,000 EDP calls per year.)
By establishing a new community-police approach to EDP calls, we hope
to divert mental health recipients away from the criminal
justice system, and thereby avoid traumatic encounters and
injuries to police and mental health recipients.
Current State of Affairs:
At present, the NYPD are insufficiently prepared to deal effectively
with 911 calls involving individuals with mental health
concerns – often resulting in traumatizing and sometimes tragic
encounters between the police and individuals experiencing
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
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
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
deserve. Instead of being incarcerated, people in crisis need
treatment, housing, respite, and support in order to recover and live to
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.
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
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
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:
Community Organizer, Community Access
(212) 780-1400, ext. 7726
– News of the Week
PEERS AT WORK
A striking video (Huffington Post, 8-15-13) explains how Lisa Halpern,
a young woman diagnosed with schizophrenia, helps others
cope with this much-misrepresented diagnosis. Ms. Halpern is Director
of Recovery Services at a mental health services facility
where she oversees 18 peer recovery coordinators. By sharing her lived
experiences, she helps to reduce the isolation that nearly
everyone with a serious psychiatric vulnerability faces or
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
MALAJUSTMENT WEEK HAS ARRIVED !!!
Long ago, David Oaks and his staff at Mindfreedom
International chose the week of July 7, 2013 to celebrate the role
of 'creative malajustment' in ending social injustice through
non-violent revolution. Then, six months ago
David suffered a near-fatal fall followed by complications.
Yet this ambitious first-time-ever event moved forward (as
has David Oaks's recovery) as seen in a beautiful description
AR T QUOTATIONARY
5, 2013 - News of the Week
MALAJUSTMENT WEEK HAS ARRIVED !!!
Long ago, David Oaks and his staff at Mindfreedom International chose
the week of July 7, 2013 to celebrate the role of 'creative
malajustment' in ending social injustice through non-violent
revolution. Then, six months ago, David suffered a near-fatal
fall followed by complications.
Yet this ambitious first-time-ever event moved forward (as has David
Oaks's recovery) as seen in a beautiful description at http://www.cmweek. org
27, 2013 - News of the Week
REFORMS ARE HAVING AN "INCREDIBLY POSITIVE IMPACT" ON VERMONT'S MENTAL
to advocate Morgan Brown (http://beyond-vsh.blogspot.com/)
for forwarding a Times
Argus article by Peter Hirschfield, 6/22/13 "Good News is reported in mental
health care in Vermont")
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)
need for urgent action unleashed a strong, united push for more
community-based care. In 2012, the state passed a
mental health bill intended to increase options for early-stage
intervention, and to spare many patients from involuntary in-patient
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,
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
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
16, 2013 - News of the Week
(Changes made on
BAD RAP CONTINUES...
The most useful
diagnostic terms describe a condition; 'schizophrenia' does
Dr. Sally Satel, author and
continues to raise eyebrows. A recent After Words interview on C-Span
with Dan Vergano glued me to the screen for the entire hour.
was a perfect guest -- engaging, charismatic, thoughtful -- as
cautioned us to avoid premature and unrealistic
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
label alone can punish patients with a presumption of violence
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.
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
But Dr. Satel's premise is flawed. Schizophrenia is
unlike Alzheimer's and Parkinson's disease. The most obvious difference
is schizophrenia's lack of conclusive biological brain
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
Among prominent survivor leaders are Pat
Saks, and David
who were diagnosed and hospitalized for schizophrenia in their teens or
early 20s. They and their colleagues find innovative,
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
better sometimes confuse it with split personality. And a
20-year emphasis on violent behavior -- disproportionate to
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
with a historical recap, this article traces the current
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.
6, 2013 - News of the Week
CENTER ALERT: Stigma Wins, Privacy Loses in HHS Proposal
Judge David L. Bazelon Center for Mental Health Law
bazelon.org Washington DC
Proposal Would Diminish Privacy Protections
4, 2013 -- The Department of Health and Human Services (HHS) proposes
to change the Health Insurance Portability and Accountability Act
(HIPAA) in a way that singles out the records of people with mental
illnesses. The changes would apply different rules to certain mental
health records for the purpose of ensuring that more records are
reported to the FBI's gun database.
believe this is unnecessary, will not achieve the intended purpose of
reducing gun violence, and will only further stigmatize people with
mental illnesses and mental health treatment.
You Can Do
comments to HHS here on or before Friday, June 7.
can use our comments as a template.
2013 - News of the Week
PSYCHIATRIC LABELS SAID TO LACK VALIDITY
Countless millions of Americans suffer
their diagnostic label more than from symptoms that can often be dealt
with. Helped by self-awareness and supporting communities,
become experts at coping with their symptoms.
Unfortunately, the popular misuse of psychiatric labels over
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
decade will shift NIMH research funds to a search for biological
underpinnings of 'mental illnesses'. If successful, the
is likely to require new diagnostic terms.
Today's psychiatric labels lead to
and rejection. Will the discovery of biological markers end
prejudice that too often deters people from seeking help?
in Crisis..." (by JOHN HORGAN, SCIENTIFIC
AMERICAN, May 4, 2013)
York Times, May 7, 2013 (reprint protected by
Fair Use Standard)
Guide Is Out of Touch With Science, Experts Say
PAM BELLUCK and BENEDICT CAREY
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,
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
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
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
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
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
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
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
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
’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
Dr. Hyman, Dr. Insel and other experts
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
About two years ago, to spur a move in
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
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
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
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
said, patients will continue to be diagnosed with D.S.M. categories as
a guide, and insurance companies will reimburse with such diagnoses in
Dr. Jeffrey Lieberman, the chairman of
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
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
A CALL FOR
INFORMATION CONCERNING KENDRA'S LAW (AOT)
The New York
Safe Act Mental Health Section Should Be Suspended and Reconsidered
Kendra's Law (Assisted
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
(AOT) program's original recipients now, ten years later? Is
longitudinal study underway so that concrete lessons can be
learned? What evidence supported moving the law's expiration
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
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
Clarification is urgently needed
concerning the New York SAFE Act's
new statute that assigns an informant role to the entire New York
mental health system and related agencies. The
new rules have already spawned a wrongful accusation and a buck-passing
response. In Erie County this week a man was
targeted under the SAFE Act provision by police but responsibility for
the error is unclear. See news reports below.
Claims State Officials Intentionallhy Violated HIPPA to Enforce SAFE
Police Mistakenly Enforce SAFE Act Provision" more...
SAFE Act notification under fire" more...
29, 2013 - News of the Week
KENDRA'S LAW REKINDLE DISCUSSION
Have independent evaluations of Kendra's Law been ignored?
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
supervised treatment setting.
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."
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
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."
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
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
us hope that with constructive input from open minds, progress is
Law Updates: 2006-2013
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
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
Kendra's Law is premature, considering the cautionary findings of
independent evaluations in 2009 and 2010. A
evaluation is needed to update the in-house report of 2003 which
the Legislature found insufficient. Ten-year-old
from 2003 and repeated in "Final Report 2005, quoted often as
though current, is misleading.
11, 2013 - News of the Week
STUDENT PROPOSES IMPROVEMENTS IN MENTAL HEALTH SERVICES
The Harvard Crimson
recently ran a student's account
of his failed search for mental health services. For months
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.
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)
forwarded by Bill Lichtenstein, LCMedia.com)
2013 - News of the Week
IS FOR EVERYONE! (Conference Announcement)
April 4, 2013
Marriott, Albany, NY
Recovery is about doing things
differently. It’s about having hope and making changes.
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.
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.
conference is offered free of charge. Continuing education
credits will be available.
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.
please visit www.ccbh.com
and/or view the descriptive brochure linked below.
18, 2013 - News of the Week
SCHIZOPHRENIA'S BAD RAP
shootings have led to a welcome national focus on violence
prevention. It is troubling, though, to see the diagnostic
'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
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
How did schizophrenia acquire its inflated
to violence? Experts point to decades of media
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
politicians, headlined, "The Schizophrenics Are Loose -- Public
Nuisances," (The New York Post, 1991).
The media's persistent misrepresentation
'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")
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
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,
a terrible mismatch.
'Antisocial personality disorder' and 'schizophrenia' are not the same,
and the terms are not interchangeable.
With few exceptions, a 'schizophrenia'
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,
even laws. Surely we can head off further distortion of
'schizophrenia' by protesting its use as a blanket term in violent
"Facts About Schizophrenia". A booklet
issued by NYS Office of Mental Health, Gov. Mario Cuomo's
National Institute of Mental
12-month prevalence," website (2013)
Stuart, Heather, "Violence and mental
an overview," policy paper, pages 122-123, Queens University, Ontario
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,
Walsh et al. "Violence and schizophrenia:
examining the evidence," British Journal of Psychiatry, 180: page 494
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
COURAGEOUS YOUNG MAN SPEAKS OUT
Article Source: The Seattle Times (http://seattletimes.com)
Changing how we talk about mental illness
(originally published January 25,
(reprinted with protection of Fair Use
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
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
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
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
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
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.
15, 2013 - News of the Week
Let's Stop Blaming The Mentally Ill
By Lollie Butler Arizona Daily Star
January 15, 2013
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
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
"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
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,
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
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.
9, 2012 - News of the Week
GOT BETTER' CAMPAIGN GAINING MOMENTUM
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!
August 26, 2012
- News of the Week
STORY IN A VIDEO COULD MAKE ALL THE DIFFERENCE
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.
IT'S EASY TO
SHARE YOUR VIDEO STORY
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
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:
your support in making I GOT BETTER a success!
Please email us
feedback, or anything else about I GOT BETTER at email@example.com
Sophie and John
EXPLORES LANGUAGE OPTIONS
Years ago, David Oaks,
the founder and director of MindFreedom International, urged the mental
health community to stop using the term mental
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
is about opposing domination by any model in this complex
field. My call is about opposing bullying in mental health
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:
SEE THE ESSAY:
August 20, 2012 - News of the Week
FINDS FAULT WITH MEDIA DEPICTION OF PSYCHIATRIC VULNERABILITIES
"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
approach to mental illness doesn't help us understand it"
(8/18/2012), drew the following response from a concerned reader.
Aug 18, 2012 12:38 PM
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
SURVIVOR MAKES PLEA FOR OPEN
Reprinted using Fair Use Protection
The News Tribune
can tear down walls of misunderstanding about mental illness
by ALAN TAYLOR
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.
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
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?
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
June 14, 2012 - News of the Week
PRESS RELEASE 6/14/2012:
Campaign Defies Hopelessness In Mental Health Care
Immediate Release: contact firstname.lastname@example.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
"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
The Story Behind "I Got
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 email@example.com,
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
version of above news alert with links here:
20, 2012 - News of the Week
in Acute Care
"Before Healing Can Occur, People Must Feel
by Maggie Bennington–Davis, M.D., MMM
Recovery to Practice Highlights April 26, 2012
HEALING CAN OCCUR, PEOPLE MUST FEEL SAFE
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
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
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.
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.
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
Then the fun really
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.
realized that staff interactions completely set the tone for everyone
else, so we became mindful about communicating and working with one
Dr. Sandra Bloom, creator
of the Sanctuary
Model, taught us how to hold daily community meetings to
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
Every now and then, we
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.
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.
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
All of these changes
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
the Chief Medical and Operating Officer at Cascadia BHC in Portland,
May 7, 2012 -
News of the Week
DARK SIDE OF KENDRA'S LAW HISTORY
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
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.
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,
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"
an investigative report of Goldstein's downward spiral,
on the Streets" New York Times, by Michael Winerip, May 23,
1999 (This Times Magazine cover story appeared 5
after Kendra Webdale's death. New York's Kendra's Law passed
months later, despite then-known circumstances)
RAILROADING OF ANDREW GOLDSTEIN
Source: (with publisher's
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.
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.
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.
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.
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
End of article
26, 2011 - News of the Week
VOICES USA' JOINS WORLDWIDE MOVEMENT
14, 2011, was International Hearing Voices Day!
celebrate, the USA network of
voice-hearers launched their new website,
) 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.
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
is World Hearing Voices Day?
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.
Don’t Forget to Join the Hearing Voices Network USA on Facebook,
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.
2, 2011 - News of the Week
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
'something which becomes accepted as fact, although it may not be
is from Wikipedia, the free encyclopedia
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.
most recent example of Dr.Torrey's self-serving work appears in an
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.
the SB article, Dr. Torrey contends that actual
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.
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
Some examples of errors
in the connect-the-dots article:
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
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?"
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
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
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.
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."
Dr. Torrey implies
that his views are confirmed by a study by Jason C. Matejkowski et al
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
of Persons With Severe Mental Illness Who Have Been Incarcerated for
Journal of the American Academy of Psychiatry and the Law,
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
December 30, 2007 News
of the Week (National Stigma Clearinghouse)
TAC'S "TOP 10 STORIES OF 2007" CONTINUE A
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
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
of excerpt from NSC Archive (Dec 30, 2007)
9, 2011 - News of the Week
CLOSER LOOK AT HEARING VOICES
continues his remarkable New York Times series on mental illnesses
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
detail a therapist's successful battle against against suicidal
Clearly, Mr. Carey is
to a growing willingness among psychiatric survivors to explain their
experiences of living with disabling psychiatric conditions.
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.
You Live With the Voices in Your Head?, by Daniel B. Smith March 25,
of the Heart Facilitator Training
of Mental Illness Provides Good Cheer , by Robert David Jaffee,
August 9, 2011
to Cope With the Mind's Taunting Voices, by Benedict Carey, August 7,
on Mental Illness Reveals Her Own Fight. by Benedict Carey, June 23,
Hearing Voices Movement
18, 2011 - News of the Week
Source: NYAPRS Enews
Metabolic Conditions In People Diagnosed With SMI
Mental Health Weekly From the Field July 18, 2011
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).
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.
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
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
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.
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 firstname.lastname@example.org
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
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.
July 6, 2011 -
News of the Week
PLAN TO REDUCE STIGMA DISTORTS DATA
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
For those who are
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
accurately reflect reality – as any advertiser knows.
Torrey suggests six 'dots' as follows: (quote - bold type added)
individuals with mental illnesses has
increased over the
past half century.
(2) Violent acts committed by mentally ill
have increased over
the past half
(3) The perceptions of violent behavior by mentally ill persons is
an important cause of stigma.
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
individuals with mental illnesses will
(Note: 'Treat' and
'Treatment' are code words for
antipsychotic medication. ja)
Dr. Torrey misinterprets the findings of researchers to promote his
(1) Dr. Torrey misstates
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?"
Dr. Torrey misrepresents
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."
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
Journal of the American
Academy of Psychiatry and the Law, 36:74-86,
2011 - News of the Week
RESEARCHERS EXPOSE MYTHS ABOUT
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.
has been published on the website of The
ARTICLE by Jim Patterson
ESSAY by Jonathan M. Metzl
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
RUSH TO JUDGMENT SENSATIONALIZES MENTAL ILLNESSES (AGAIN)! (first
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
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
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
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 Viewer comment: email@example.com
Mail: Don Hewitt, 60 Minutes, CBS News, 524 West 57th Street, New York,
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
WORDS MATTER: A
BRITISH WEBSITE AIMS FOR CHANGE
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
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
STATISTICS CAN TWIST THE SIGNIFICANCE OF MEDICAL TREATMENTS
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
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
LANGUAGE, ATTITUDES, AND DISCRIMINATION
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
Psychiatric slurs are so common that they
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
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.
language is bias having a good time (paraphrasing
Michael Wood, 1995)
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.
language is more than bias; it's bias having a good time.
reason we can't get rid of it is that people like to be offensive.
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.
8, 2011 - News of the Week
HOUSING CRUCIAL TO TREAT MENTAL
By M. J. Bright, The Daily News,
Nanaimo (British Columbia, Canada)
Canada.com via Google Alerts
'Councillors waffle on housing plan' (Daily News, March 31)
I am a senior who volunteers three times a
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
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
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
2011 - News of the Week
VIDEO: SEVEN INSIGHTFUL PATIENTS DESCRIBE BOUTS WITH PSYCHOSIS
In brief videotaped portraits,
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.
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
OUTPATIENT COMMITMENT (IOC) IS NOT THE SOLUTION
It is now clear that forcibly
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
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.
excellent selected links:
Ignore Key Perspective About Arizona Tragedy A statement by
David Oaks, Director, MindFreedom International
Warn Against Stigmatizing Mental Illnesses A video interview
with Harvey Rosenthal, Director, New York State Association of
Psychosocial Rehabilitation Services (NYAPRS)
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)
COALITION SUGGESTS WAYS TO AVERT FUTURE TRAGEDIES
Coalition of Individuals with Mental Health Conditions Calls for
Reasonable Response to Arizona Tragedy
(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.
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
et al., Schizophrenia Bulletin, 2009).”
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.
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
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.”
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."
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
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.
B. Fisher, M.D., Ph.D., cell: 617-504-0832, firstname.lastname@example.org
Spiro, email@example.com, 877-246-9058
Rosenthal, executive director, New York Assoc. of Psychiatric
Rehabilitation Services, firstname.lastname@example.org, 518-527-0564
Coalition for Mental Health Recovery, 877-246-9058, email@example.com
January 10, 2011 - News of the
Excellent Article from Slate.com
ILLNESS' NOT AN EXPLANATION FOR VIOLENCE
shooter's psychiatric condition reveals little about propensity or
motive for criminal behavior
by Vaughn Bell, Slate.com
Shortly after Jared Lee Loughner had
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
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
A 2009 analysis of nearly 20,000
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
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
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
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.
Reprinted using Fair Use
January 7, 2011 - News
of the Week
FROM FEARMONGERING DEFEATS GOALS OF ADVOCATES
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
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
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
See the crude and deeply stigmatizing
cover, and read the excellent article by Judy Lightfoot concerning the
advocates' vehement protest, Can
scare tactics sell the state on mental health funding
18, 2010 - News of the Week
THOUGHTS ON A HUFFINGTON POST
From a marketing perspective, it
may be necessary
to capitalize on violence to
get the law passed
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
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
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
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
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
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
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.
Final Report on the Status of
Assisted Outpatient Treatment
March 2005 by the New York State Office of Mental Health. The findings
of this internal report did not justify making the law permanent.
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
3rd evaluation by Jo C. Phelan
et. al, published in Psychiatric Services:
Effectiveness and Outcomes of Assisted Outpatient Treatment in New York
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).