June 4, 2016 - News of the Week
ARTICLE from HUFFPOST BLACK VOICES,
March 29, 2016
by Octavio N. Martinez and Grgory Vincent
In 2009, a team of Duke University researchers set out to answer one of the thorniest questions at the intersection of mental health policy and race: Is the practice of involuntary outpatient commitment used more often with African-Americans than whites? And if so, what does that mean?
It was an important question to answer seven years ago. It’s even more important now, on two fronts.
We’re at a moment in the nation’s political consciousness when issues of race and state coercion are at the forefront. We also, somewhat coincidentally, may soon see the largest structural change to the nation’s federal mental health care system in decades, with reform bills currently under debate in both houses of Congress.
Both bills include increased funding for state programs that support involuntary outpatient commitment, or assisted outpatient treatment as it’s sometimes known. The practice allows judges to order people with serious and persistent mental illness to involuntary outpatient treatment plans even if they haven’t broken any laws or reached the threshold for inpatient commitment.
It’s an issue that has divided the mental health community to a rare extent. For its advocates, it’s a humane alternative to leaving people to deteriorate to the point where they’ll end up in jail, on the streets, or in acute crisis. For its critics, it’s an unnecessary and potentially traumatic act that violates people’s civil liberties and serves politically as a deflection from the real problems facing the mental health care system.
From either direction, questions over racial disparities need to be recognized and addressed sooner rather than later. We have to pay close attention, in other words, to the answers from that 2009 paper, and perhaps even closer attention to the much larger structural questions the researchers candidly admitted they couldn’t answer.
The researchers found that in New York, where the study was conducted, African-Americans were over-represented by a factor of five, compared to whites, among those mandated to outpatient commitment.
Upon closer inspection, the data showed that the reasons for this difference aren’t likely to be any bias or prejudice at the moment a clinician recommends outpatient commitment, or a judge orders it. Instead, it’s pre-existing disparities in factors like poverty, severe mental illness, and public hospitalizations.
In this realm, as in so many others, our nation’s history of racism and discrimination has rendered African-Americans more vulnerable and exposed. And these fundamental disparities have to inform the questions we ask about public policy.
Loss of autonomy over one’s own life and choices matters to all of us, of all races, but it may matter more when state coercion is applied to people from groups that have historically been subject to horribly unjust and destructive state coercion. It may mean that the protection of autonomy and liberty, for a person of color, should weigh heavier in the balance against the potential good of the forced treatment.
These aren’t easy concerns to balance. But the federal mental health care system, and any new laws that change it, can and should address them. There is more research to be done on potential disparities at all levels of the mental health care system. There is more work to be done integrating cultural and linguistic competency into the mental health care system. There is more research needed on the outcomes of outpatient commitment programs.
Above all, we all have a responsibility to make sure that we are not perpetuating a broader system of racial injustice and disparity. We have to be vigilant, particularly when it comes to programs that are coercive. The existing research on the outcomes of such programs is mixed, but even if they are beneficial, it is no guarantee that if the practice is expanded at the state level, each program in each state will be beneficial. If history is any guide, what may work well in New York for example, without bias or prejudice, could become something discriminatory and destructive in another state.
If lawmakers do end up moving forward on increased funding for involuntary outpatient commitment, let’s put measures in place to study the outcomes, identify racial differences and potential disparities, and revoke funding if state programs prove ineffective or discriminatory.
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January 28, 2016 - News of the Week
LANGUAGE MATTERS !
Why You Should Never Use the Term "The Mentally Ill"
Article By Jeff Grabmeier MedicalXpress.com January 26, 2016
Even subtle differences in how you refer to people with mental illness can affect levels of tolerance, a new study has found.
For example, participants were more likely to agree with the statement "the mentally ill should be isolated from the community" than the almost identical statement "people with mental illnesses should be isolated from the community."
These results were found among college students and non-student adults - and even professional counselors who took part in the study.
The findings suggest that language choice should not be viewed just as an issue of "political correctness," said Darcy Haag Granello, co-author of the study and professor of educational studies at The Ohio State University.
The push to change how society refers to people with mental illness began in the 1990s when several professional publications proposed the use of what they called "person-first" language when talking about people with disabilities or chronic conditions.
"Person-first language is a way to honor the personhood of an individual by separating their identity from any disability or diagnosis he or she might have," Gibbs said. "When you say 'people with a mental illness,' you are emphasizing that they aren't defined solely by their disability. But when you talk about 'the mentally ill' the disability is the entire definition of the person," he said.
Although the use of person-first language was first proposed more than 20 years ago, this is the first study examining how the use of such language could affect tolerance toward people with mental illness, Granello said. "It is shocking to me that there hasn't been research on this before. It is such a simple study. But the results show that our intuition about the importance of person-first language was valid."
The research involved three groups of people: 221 undergraduate students, 211 non-student adults and 269 professional counselors and counselors-in-training who were attending a meeting of the American Counseling Association. The design of the study was very simple. All participants completed a standard, often-used survey instrument created in 1979 called the Community Attitudes Toward the Mentally Ill.
The CAMI is a 40-item survey designed to measure people's attitudes toward people with diagnosable mental illness. Participants indicated the degree to which they agreed with the statements on a five-point scale from 1(strongly disagree) to 5 (strongly agree).
The questionnaires were identical in all ways except one: Half the people received a survey where all references were to "the mentally ill" and half received a survey where all references were to "people with mental illnesses."
The questionnaires had four subscales looking at different aspects of how people view those with mental illnesses. The four subscales (and sample questions) are:
Results showed that each of the three groups studied (college students, other adults, counselors) showed less tolerance when their surveys referred to "the mentally ill," but in slightly different ways.
College students showed less tolerance on the authoritarianism and social restrictiveness scales; other adults showed less tolerance on benevolence and community mental health ideology subscales; and counselors and counselors-in-training showed less tolerance on the authoritarianism and social restrictiveness subscales.
However, because this was an exploratory study, Granello said it is too early to draw conclusions about the differences in how each group responded on the four subscales.
"The important point to take away is that no one, at least in our study, was immune," Granello said. "All showed some evidence of being affected by the language used to describe people with mental illness."
One surprising finding was that the counselors - although they showed more tolerance overall than the other two groups - showed the largest difference in tolerance levels depending on the language they read. "Even counselors who work every day with people who have mental illness can be affected by language. They need to be aware of how language might influence their decision-making when they work with clients," she said.
Granello said the overall message of the study is that everyone - including the media, policymakers and the general public - needs to change how they refer to people with mental illness. "I understand why people use the term 'the mentally ill.' It is shorter and less cumbersome than saying 'people with mental illness," she said.
"But I think people with mental illness deserve to have us change our language. Even if it is more awkward for us, it helps change our perception, which ultimately may lead us to treat all people with the respect and understanding they deserve."
January 4, 2016 - News of the Week
A DUBIOUS DIAGNOSIS, ANOSOGNOSIA, AND A FEAR-FOCUSED CAMPAIGN
Has "anosognosia" tripled in ten years?
The diagnostic term "anosognosia," was created in 1914 by Joseph Babinski, a French-Polish neurologist. The diagnosis is primarily given to stroke patients who have lost awareness of a body part, a condition attributed to brain lesions.
In 2000, intense lobbying by Dr. E. Fuller Torrey and Dr. Xavier Amador convinced psychiatrists to add anosogosia to the psychiatrists' diagnostic bible, the DSM-IV. Anosognosia can be used to justify coercive treatment; this and the uncertainty of its relevance to mental illnesses raises moral and ethical concerns among its critics.
Before "anosognosia" became a psychiatric diagnosis, psychiatrists had relied on a "lack of insight" concept that allowed patients at least some voice concerning their treatment and medications. Now, the Treatment Advocacy Center in Arlington, Va (TAC) has reportedly conflated "lack of insight" with anosognosia.
It's worth noting that in 2004, Anthony S. David and Dr. Amador estimated that 15% of people with schizophrenia were affected by anosognosia (source: Wikipedia) That estimate has increased alarmingly. According to TAC, the 15% has grown to 50% for people diagnosed with schizophrenia, 40% of those with bipolar disorder. TAC and other coercion supporters also consider potential violence to be a hallmark of anosognosia.
An even further escalation of anosogosia has come from promoters of Congressional bill #HR 2646. When asked by a radio host if mentally ill people are more likely to be violent, Rep.Tim Murphy prefaced his circuitous answer by noting that "we're dealing with 60 million folks..." (10 million is the typical estimate of people diagosed with schizophrenia and bipolar disorder.) The Murphy statement suggests a flexible approach to diagnosing anosognosia. http://whyy.org/cms/radiotimes/2015/12/01/mental-illness-and-the-law/
How times have changed since 2000. In Dr. Amador's book. "I Am Not Sick, I Don't Need Help," he considered coercive treatment to be counter-productive. The book makes a convincing case that a treatment partnership is more effective than coercion and its results are more lasting.
"Anosognosia: How Conjecture Becomes Medical Fact" by Sandra Steingard, MD, concerning the rise of the term "anosognosia" in psychiatry
"Psychiatrists Raise Doubts on Brain Scan Studies"
Read more about insightul awareness in "The Issue of Insight" by Larry Davidson, Yale University Medical School,
Here's a brief description of the source of the word "anosognosia"
June 11, 1914. In a brief communication presented to the Neurological Society of Paris, Joseph Babinski (1857-1932), a prominent French-Polish neurologist, former student of Charcot and contemporary of Freud, described two patients with “left severe hemiplegia” – a complete paralysis of the left side of the body – left side of the face, left side of the trunk, left leg, left foot. Plus, an extraordinary detail. These patients didn’t know they were paralyzed. To describe their condition, Babinski coined the term anosognosia – taken from the Greek agnosia, lack of knowledge, and nosos, disease. 
Check out a new blog titled "IS AN OMINOUS NEW ERA OF DIAGNOSING PSYCHOSIS BY BIOTYPE ON THE HORIZON?"
December 1, 2015 - News of the Week
SHOULD KENDRA'S LAW GO NATIONWIDE ?
Three questions need answers. Has Kendra's Law reduced violence? Does the law alienate people who need help? Does the fear-focused marketing strategy used to pass New York's Kendra'a Law distort public understanding of the nation's violence?
It took 6 years of "imminent-danger" marketing by determined activists to launch Kendra's Law (KL), a compulsory treatment law intended for people with serious mental illnesses. Marketed as a public safety necessity, Kendra's Law was approved with unheard-of speed by New York's legislature and Governor George Pataki, and began operation in November 1999. The framers' ultimate goal -- a nationwide expansion of compulsory treatment -- has become a mainstay of HR 2646 now under discussion in the House. HR 2646 is one of several healthcare laws under consideration.
A tabloid editorial, "All right, let's turn back the clock" (NY Post (10/15/93), was an early sign that fear tactics would dominate the campaign for involuntary outpatient commitment (now called "assisted outpatient treatment" or AOT). Dr. E. Fuller Torrey launched the campaign at an APA conference in Baltimore with an unsubstantiated assertion: "The public stereotype that llinks mental illness to violence is based on reality, and not merely a stigma."
Next came opinion pieces, interviews, television features, and books by Kendra's Law's creators : Help the Ill Before They Kill - Armed and Dangerous - Imminent Danger - Why Deinstitutionalization Turned Deadly, - Mental Illness, Public Safety - Deadly Madmen - The Insanity Offense: How America's Failure to Treat The Seriously Mentally Ill Endangers Its Citizens - to name a few.
Critics say KL's marketing strategy has reduced community willingness to accept supportive services. They contend that fear of coercion turns away people in need. HR 2646's remedies -- coercion and institutions -- are unacceptable to ex-inpatient activists who want to expand existing programs that engage people who need help in non-threatening, non-stigmatizing community settings.
Supporters of HR 2646 proclaim KL's success by quoting numbers. Oddly, the outcome figures most quoted are based on data gathered not by outsiders but by the program's staff in 2005. At the time, 85 percent of Kendra's Law participants had no history of violence to others during the 3 years prior to entering the program. A later "first-ten-year report" simply repeats the 2005 outcome figures.
The public needs to know the 10-year outcomes for KL participants who had committed violent acts toward others before enterng the program. The law's expansion seems unjustified without an independent evaluation of the target population's long-term outcomes.
It is disappointing that the media madness leading up to the passage of Kendra's Law missed a timely opportunity to protest Gov. Pataki's drastic cutbacks to New York's struggling mental-health system. Instead, the fear-focused publicity transformed patients into imminent threats to every New Yorker.
It's been twenty-two years since the New York Post's "Let's Turn Back the Clock" editorial, and HR 2646 would make it happen.
Links to the largest studies of Kendra's Law's effectiveness are posted below.
Kendra's Law: Final Report on the Status, March 2005, by the New York State Office of Mental Health.
1st independent evaluation of Assisted Outpatient Treatment (AOT)
2nd independent evaluation by Jo C. Phelan et. al, published in Psychiatric Services 2010
3rd independent evaluation by Pamela Clark Robbins, et.al, published in Psychiatric Services 2010
August 14, 2015 - News of the Week
PEOPLe, Inc.ANNOUNCESA CRISIS AND STABILIZATION CENTER
A highly respected and successful 100% peer-run program in Poughkeepsie NY, PEOPLe, Inc., helps people whose lives have been derailed by mental health diagnoses. Opening soon, a crisis and stabilization center will expand PEOPLe Inc's recovery-oriented treatment options.
Under the leadership of executive director Steve Miccio, PEOPLe, Inc.brings hope and renewal to New Yorkers diagnosed with mental illnesses and to those whose conditions are complicated by mind-altering substance use. The program has been acclaimed and copied by activists here and abroad, despite derision of its user-friendly approach from advocates of forced treatment.
READ MORE ABOUT PEOPLE, INC.
July 1, 2015 - News of the Week
WILL THE MURPHY-JOHNSON BILL, HR2646, HELP STRUGGLING FAMILIES
Or will it arrest progress and turn back the clock on mental healthcare
Congressman Tim Murphy (R-PA) has vowed to conquer a thorny national disgrace: the public's neglect -- many would say abandonment -- of psychiatrically-labeled Americans and their families.
Rep. Murphy and Rep. Eddie Bernice Johnson (D-TX) have proposed a bill, HR 2646, titled "Helping Families in Mental Health Crisis Act of 2015," to rescue suffering families with psychiatrically-labeled members who are unable to find appropriate treatment and housing.
(Link to text of HR 2646 introduced June 4, 2015)
But the 173-page bill goes far beyond helping families in crisis. It proposes a massive restructuring of a system that distributes billions of federal mental health dollars to states and federal agencies. The question is whether HR 2646 would replace an unmanageable system with a worse one.
1) The bill does not address the negative public attitudes that have derailed attempts to establish community housing and supports. For forty years, essential housing and supportive programs have been rejected by communities, leaving only a small percentage of families able to find crucial community support. This serious impedimentt to community inclusion has caused untold pain and jeopardized the well-being of all concerned.
MORE about the bill....
The Murphy-Johnson bill overlooks a main reason millions of people with psychiatric labels are destitute. Advocates have for 40 years sought the effective community treatments, safe housing, programs and services that were promised when psychiatric institutions were emptied into unprepared communities. Yet the public has consistently and effectively blocked community housing and support. Why? There is an unreasonable amount of fear and rejection of people with psychiatric labels. This fact was stated most strongly by former Surgeon General David Satcher in his groundbreaking mental health report of 1999: "Because most people should have little reason to fear violence from those with mental illness, even in its most severe forms, why is fear of violence so entrenched?" At least some of that unwarranted fear was deliberately spawned by supporters of forced outpatient medication to promote their controversial agenda.
Using a twisted but effective strategy, suppporters of compulsory medication chose to "capitalize on the fear of violence" (their words) for 20 years to win public support for involuntary outpatient treatment and re-institutionalization. How will Rep. Murphy and Rep. Johnson convince the public that psychiatrically-labeled people are not to be feared as neighbors and co-workers? Will they even try, since they need a fearful public's support for HR 2646's restrictive provisions.
At worst, the exhaustively complex Murphy-Johnson bill may be raising false hope among families, proposing programs that alienate the people most in need of help, and reinforcing the public's misguided view that the nation's excessive violence is linked to mental illness. At least 0 billion federal dollars are spread among eight federal departments and agencies (SAMHSA gets a mere -4 billion). The devil is in the details of HR 2646. And in the priorties of its authors.
!! NEWS ALERT !!
A U.S. Senate bill will be introduced later this summer by Senator Chris Murphy (D-CT)
AN ACTIVIST STATES GOALS
Why We Need a Paradigm Shift in Mental Health Care: The Case for Recovery Now!
Another "May is Mental Health Month" has come and gone, and it is time to build on years of awareness campaigns and move into action to promote whole health and recovery. People with serious mental health conditions are dying on average 25 years earlier than the general population, largely due to preventable physical health conditions, so why do we still focus on mental health separately from physical health? And when we know that people with serious mental health conditions face an 80 percent unemployment rate, why do we largely ignore the role of poverty, economic and social inequality, and other environmental factors in mainstream discussions about mental health?
The vast majority of people living with mental health conditions, even people diagnosed with serious mental illness, can enjoy a high quality of life in the community with access to the right kinds of services and supports. Dr. Richard Warner, clinical professor of psychiatry at the University of Colorado, noted: "It emerges that one of the most robust findings about schizophrenia is that a substantial proportion of those who present with the illness will recover completely or with good functional capacity." A slew of other studies have found similar results.
Yet Mayor Emanuel is not unique in his choices. Community-based services have been slashed in many state and local budgets. Any short-term "savings" accomplished by such cuts will always be offset by the devastating long-term human and economic costs that result when we deny quality services and supports to the people who are most vulnerable.
http://www.huffingtonpost.com/ leah-harris/why-we-need-a- paradigm-sh_b_7560446.html
Ron Manderscheid on Defeating Stigma: The Five “P’s” of Inclusion and Social Justice
Adapted by Briana Gilmore, March 2015
That is how Ron Manderscheid, PhD, opened his address last month at the Together Against Stigma: Each Mind Matters conference in San Francisco. Manderscheid joined other mental health experts in a symposium to discuss how stigma can be reduced or eradicated through policies that support mental health promotion, prevention, and early intervention strategies.
Manderscheid’s opening remarks aren’t hyperbolic. People with mental health and substance abuse conditions die an average of 25 years before other citizens. Less than half of those with needs receive any care at all, and it takes an average of a decade before people access the treatment they need. Suicide rates are also at the historic high of 40,000 people a year, exacerbated by the economic insecurity and reduction in services brought on by the great recession. And as Manderscheid and this USA Today article elucidate, people often only receive care when their experiences have become severe enough that they have turned into complex, illness- and symptom-based disabilities. Advocates liken this to only admitting a cancer patient into treatment when they reach stage four of their illness.
So how can policy reduce stigmatization that prevents people from accessing care, living successfully in the community, and sustaining recovery? Ron Manderscheid advocates for a five-point reform plan that includes:
1. Parity: Leveling the insurance playing field through parity laws is a first step to affording equitable treatment for mental health and substance abuse. Many states and insurance companies are just at the beginning of implementing successful parity reforms, because they necessitate sweeping financial, regulatory, and programmatic changes that take time to adopt. They are also not fully applicable to Medicaid and Medicare recipients in most states, thus further exacerbating stigma for people and families experiencing poverty. Parity is now also only available when a person receives specific treatments. Dr. Manderscheid indicates that if we want true reform through parity, we need to extend it to equal housing, equal jobs, equal supports, and equal pay.
News report (7/7/15) Mad in America (http://www.madinamerica.com )
Yet another study -- this one published in Psychiatric Services (in Advance) -- has found that risk of gun violence is not linked to mental illnesses. Instead, once again, substance use and history of violence were found to be better predictors of violence.
The researchers from multiple institutions examined data from The MacArthur Violence Risk Assessment Study of 1,136 patients who had been discharged from acute civil inpatient facilities at three U.S. sites between 1992 and 1995.
Psychiatric News reported that, "Of the 951 persons available for at least one follow-up, 23 (2%) committed acts of violence with a gun. These 23 people tended to have admission diagnoses of major depression (61%), alcohol abuse (74%), or drug abuse (52%)."
"(T)he prior arrest rate of discharged patients who later committed gun violence was almost twice as high as the prior arrest rate of the overall sample (89% and 49%, respectively)," added Psychiatric News.
"When public perceptions and policies regarding mental illness are shaped by highly publicized but infrequent instances of gun violence toward strangers, they are unlikely to help people with mental illnesses or to improve public safety," concluded the researchers.
Data Show Mental Illness Alone is Not a Risk for Gun Violence (Psychiatric News Alert, June 23, 2015)
Steadman, Henry J., John Monahan, Debra A. Pinals, Roumen Vesselinov, and Pamela Clark Robbins. “Gun Violence and Victimization of Strangers by Persons With a Mental Illness: Data From the MacArthur Violence Risk Assessment Study.” Psychiatric Services, June 15, 2015, appi.ps.201400512. doi:10.1176/appi.ps.201400512. (Full text)
--Rob Wipond, News Editor, Mad in America
April 20, 2015 - News of the Week
THERAPY CAN HELP WITH HALLUCINATIONS
Article forwarded by NYAPRS E-News
NYAPRS Note: Thank you to RECOVER-e Works and their April, 2015 newsletter authors for the two excellent articles below on CBT for people experiencing extreme states and with serious diagnoses. Link: http://www.coalitionny.org/ the_center/recovere-works/ RECOVERe-works114-1April2015. html#Jack
CBT for schizophrenia? You don't know Jack.
by Abigail Strubel, MA, LCSW, CASAC
I met Jack in a dual diagnosis/re-entry program for parolees. All had fascinating stories about survival in prison (Got a little tinfoil? You can make a decent grilled cheese sandwich in a holding cell with a radiator). Most were symptomatic, because the policy was to take people off their medication as they neared release and were transferred to special barracks.
Jack told our admission coordinator his voices had advised him to skip intake. However, wary of returning upstate, he endured the appointment and met me. "I think I'll be able to work with you," he said. "You have intelligent eyes."
So did he, along with a glorious James Brown-esque pompadour. Jack was meticulous about his appearance. “Even when I was shooting ten bags of heroin a day, I made sure to shave, bathe, and wear clean clothes.”
"Ten bags a day?" I asked.
"Heroin makes the voices stop," he told me. "Better than any medication I ever tried."
Jack entered my office one day in a funk.
"I went to public assistance, and I know that lady's going to mess up my case," he said. "I could tell by how she looked at me. She made this face"—he pursed his lips and narrowed his eyes—"and the voices started saying, 'She hates you, she's not going to help you—she's going to get you all twisted.'"
"I wasn't there," I responded. "I don't know how she looked at you or what she thought. But there may be another way to interpret her expression—it could have been about something that happened before you even came into her office, or maybe she thought about something going on in her personal life.
"So the way she acted wasn't because of me?" he asked.
"Look," I said. "If you're right and she tries to mess with your case, you know I'll go to bat for you, make sure you get what you need. But it's possible something else was going on."
Jack nodded, then cocked his head to the side, listening. "The voices don't believe you," he said.
"Let me tell you about 'automatic thoughts,'" I said, and explained how almost everyone experiences a barely conscious stream of thoughts throughout the day. Some thoughts are positive, but many are negative. We can train people to become aware of their negative thoughts, and then dispute them.
"Your voices," I said, "are just a louder version of automatic thoughts. They're not real people; they're your own fears and doubts. When a voice says something negative, you can disagree. Ask, 'How likely is it that the welfare lady hated me on sight and wanted to make my life miserable? Could she have been having a bad day, and taking it out on me? If she did try to mess up my case, can my counselor help me straighten it out?'"
Jack thought that over. "You know," he said, "that makes a lot of sense. Because sometimes I can tell the voices are wrong right off the bat."
"And sometimes you might need to think about it a little more," I said, "or discuss it with me."
As treatment progressed, Jack's P/A case was resolved favorably, and he began contesting the negative voices on his own. Ultimately, he became a drug and alcohol counselor. His medications may never eradicate his voices, but now he knows how to dispute them.
Ms. Strubel is a clinical supervisor at Services for the Underserved/Palladia Comprehensive Treatment Institute-Bronx.
Cognitive Behavior Therapy (CBT) for Recovery: The Cutting Edge
by Elizabeth Saenger, PhD
But that discovery was three years ago. What have CBT researchers done for us lately?
Here are some advances from the last six months.
CBT as an Alternative to Drugs: A Proof-of-concept Study
When it comes to schizophrenia, the British seem to make a habit of upsetting the medical model. First they rejected auditory hallucinations as psychopathology, set up a hearing voices movement, and imported the concept to the US. Now researchers across the pond suggest in The Lancet: Psychiatry, the British journal of record, that CBT might get rid of persecutory delusions.
A small study focused on people with schizophrenia spectrum disorders. All had persecutory delusions, and had not taken antipsychotic drugs for at least six months. Researchers randomly assigned subjects to treatment as usual, or to a package of brief therapy including four CBT sessions focused on the subject’s specific delusions.
The goal of this package was to change people’s reasoning about their delusions. Investigators taught subjects to become more aware of their thinking processes, and to identify and inhibit jumping to conclusions. Researchers also encouraged subjects to be more analytical. These interventions increased subjects’ sense that they might be mistaken about their persecutory beliefs.
The results indicate that people were comfortable with therapy, and the intervention worked. Follow up data collected two months afterwards suggested the model was definitely useful.
Clinicians frequently use CBT as an adjunct to psychopharmacology for delusions, but they rarely use CBT alone. If further research confirms the results of this proof-of-concept study, perhaps people with schizophrenia will have more choices in the future. Given the common, generally unpleasant, side effects of antipsychotic drugs—such as weight gain, metabolic problems, movement disorders, and an increased risk of cardiac death—having a meaningful treatment choice in the journey toward recovery would be most welcome.
Merging CBT with Other Evidence-based Treatments
A recent tendency to mix and match evidence-based therapy has led to instances where CBT has been successfully merged with other psychosocial treatments. Here are three examples.
Social skills training. CBT material, such as that described above, can be presented using social skills training techniques, for example, waving a big flag in group to identify ("flag") beliefs that do not have evidence to support them. This treatment merger helps clients with cognitive and social deficits improve their negative (but not positive) symptoms, and is helpful for clients regardless of the severity of their cognitive impairments. Further, because the treatment is repetitive, new clients can join the group at any point.
Family psychoeducation. Data strongly show that CBT with family psychoeducation reduces stress, increases medication adherence, and decreases re-hospitalization. Modules are available that teach parents how to use CBT techniques with clients in recovery, and in other areas of their own lives.
Supported employment. CBT can help clients improve coping skills and challenge distorted beliefs about their vocational abilities. CBT is now being melded with supported employment to test the effectiveness of the combination. Preliminary results suggest people who received CBT in addition to supported employment might be more likely to work more hours per week.
Link:http://www.coalitionny.org/ the_center/recovere-works/ RECOVERe-works114-1April2015. html#Jack
March 29, 2015 - News of the Week
FIVE TIMELY "TALKING POINTS" WORTH REMEMBERING
Kudos to the Huffington Post's Healthy Living Staff for giving us a concise, doable and user-friendly list of "do's" for talking about a Germanwings airline crash that killed all who were aboard a flight to Dusseldorf on March 24.
"When tragedy strikes, it's a natural human inclination to want an explanation to help get closure for our feelings of anger and loss. When such information is unavailable to us, our grief remains in this limbo of sorts -- or worse, we search for our own answer to help us move forward."
ARTICLE: "The Way We Talk About Mental Illness After Tragedies Like Germanwings Needs To Change"
The Huffington Post / By Healthy Living Staff
Media reports erupted today with news that Germanwings co-pilot Andreas Lubitz may have been suffering from depression or another mental illness when he crashed the aircraft in the French Alps, most likely killing 150 people, including himself.
While headlines like U.K. tabloid The Sun's "Madman In Cockpit" are hardly surprising, such sensational links between mental illness and horrific tragedies can have an undesired outcome when it comes to stigma.
Here are five ways to have a more productive conversation about the complex interplay between mental health, violence and tragedies such as this one.
1. Depression doesn't cause violence.
The public's perception of mental illness -- which is largely fueled by movies featuring mentally-ill individuals turned violent and news headlines that thread mental illness into every story about mass killings -- needs a readjustment.
People who are depressed are not likely to be violent. If they were, we'd all be in trouble: One in five of us will experience a serious mental health issue at some point in our lives, but only 3-5 percent of violent acts in the United States are committed by an individual with serious mental illness -- a tiny fraction of the country's violent crimes.
"If we were able to magically cure schizophrenia, bipolar disorder, and major depression, that would be wonderful, but overall violence would go down by only about 4 percent," said Dr. Jeffrey Swanson, an expert on mental health and violence and a professor in psychiatry and behavioral sciences at the Duke University School of Medicine, in a recent interview with Pacific Standard.
What makes this misrepresentation even worse is that individuals who suffer from mental illness are 10 times more likely than the general population to be the victim of violent crime, an under-reported issue that is overlooked in favor of misleading depictions of depression as a violent condition.
2. Suggesting mental illness as the root cause of violence stigmatizes those who live healthy, full lives with conditions like depression.
Approximately one in four U.S. adults in a given year suffer from a diagnosable mental illness, making it highly likely that you know someone who has been affected. However, only 25 percent of people who have mental health symptoms feel that others are understanding toward people with mental illness, according to the CDC. And it's no secret why.
Public diagnoses, such as the discussion surrounding the Germanwings tragedy, plague every single mental illness sufferer. The truth is, the majority of those who have a mental health problem live healthy and complete lives. They are reliable at work and beloved by their families. Yet many people categorize them as "abnormal" because of unsubstantiated scapegoating during these types of tragedies, which can have a real impact: Studies have shown that knowledge, culture and social networks can influence the relationship between stigma and access to care. When people feel stigma, they are less likely to seek the help they need.
The vast majority of people with mental illnesses are law-abiding, responsible and productive citizens.
3. Mental illness disclosure policies can push people further into the closet.
Lubitz was seeking treatment for an undisclosed medical condition that he kept from his employers, alleged the public prosecutor’s office in Dusseldorf, Germany. They didn’t say whether it was a mental or physical condition, but investigators did note that they found a torn-up doctor’s note declaring him unfit for work, reported CNN. Employees in Germany are expected to tell their employers immediately if they can’t work due to an illness, according to Reuters, and that doctor's note would have kept Lubitz grounded and out of the cockpit.
Lubitz had passed special health screenings, including psychological ones, before he was hired on as a co-pilot in 2013, reported ABC News, but unlike in the U.S. airline industry, annual mental health screenings for pilots aren’t a requirement in Germany. Additionally, per Federal Aviation Administration rules, U.S. pilots must disclose all “existing physical and psychological conditions and medications” or face fines of up to 0,000 if they’re found to have delivered false information. That means if he were an American pilot, Lubitz would have been obligated to disclose any and all conditions, as well as the medicines he was taking, in order to remain in good standing at his job. Because of these and other policies, U.S. airline standards are regarded as the strictest and safest around the world (though not without their flaws).
But just because the FAA requires full health disclosure to an FAA-designated Aviation Medical Examiner doesn’t mean that pilots may feel completely safe disclosing their conditions, according to Ron Honberg, director of policy and legal affairs at National Alliance On Mental Illness.
“If a person feels that it’s safe to disclose, and that they’ll have an opportunity to get help -- that there won’t automatically be adverse consequences like being prohibited from ever flying again -- then they’re going to be more likely to disclose [a mental illness],” said Honberg. “But I think historically pilots have known that if they admitted it, they’d never be able to fly again.”
Generally speaking, barring industries where a person may be responsible for public safety (like a pilot or a police officer), one is not obligated to disclose any of this information to his or her employers in the U.S. Just as people don’t have to tell their bosses about diabetes, cardiac disease or HIV diagnoses, employees can’t be forced to discuss their mental health history beyond anything that may interfere with a person’s function at the job, explained Honberg. And employers can’t ask job candidates about their medical records or medical history except to ask about whether something might impact a person’s functional limitation in a job.
“It has to be focused on if they’re capable of doing the job,” said Honberg. “Are there physical or mental health factors that may preclude them from being able to do that?”
The FAA does not track rates of dismissal for pilots who disclose mental illnesses versus other conditions, or the number of pilots who continue to fly after disclosing a mental illness. But until we have all the facts about Lubitz’s situation, it’s important to hold off on any policy changes that might attempt to close up perceived loopholes, he said.
“It’s really important to have all the facts, particularly before we decide on any policies to prevent anything like this from happening again,” said Honberg. “We want to somehow create a proper balance that on the one hand protects public safety and on the other hand encourages people to seek help if needed."
4. The conversation surrounding mental illness and mass violence reveals our ingrained ethnic and racial biases.
Lubitz allegedly committed mass murder and, as many people have pointed out, it is troubling that his acts are ascribed to mental illness when, if he were Muslim or a racial minority, he would likely be assigned a two-dimensional ideological motivation.
Yes, this is a disturbing expression of the dominant culture's racial pathologies, but rather than trying to correct the balance by referring to white mass murderers in an un-nuanced fashion, as some have suggested, perhaps the more productive action would be to view the underlying mental health problems among everyone who carries out mass violence -- regardless of race, religion or country of origin.
Again, most people with mental illness will never be violent, but those who are violent often do have an underlying trauma or condition. "More and more evidence from around the world is suggesting that many of the terrorists wreaking havoc both in America and abroad are racked with emotional and mental trauma themselves," wrote Cord Jefferson in The Nation in 2012:
To be clear, nobody’s saying that all -- or even most -- terrorists aren’t cold, bloodthirsty killers who know exactly what they’re doing every time they commit another heinous act. But there is reason to believe that a significant number of foreign and domestic terrorists are suffering from the exact same mental distresses by which we quickly assume men like James Holmes and boys like Eric Harris and Dylan Klebold, the Columbine killers, to be afflicted.
Indeed, Jefferson went on to note a study of Palestinian men who had signed up to be suicide bombers that found 40 percent showed suicidal tendencies by traditional mental health measures, and recruiters admitted looking for "sad guys" to carry out mass violence.
More generally, the way we view mental health and race has a lasting public health impact: Minority and immigrant communities in the U.S. are dramatically underserved, according to a government report (and corroborated by the American Psychological Association). One major problem, according to the Surgeon General's report, is misdiagnosis or lack of diagnosis due to cultural biases on the part of mental health practitioners.
5. We may never have a diagnosis, and we have to be okay with that.
When tragedy strikes, it's a natural human inclination to want an explanation to help get closure for our feelings of anger and loss. When such information is unavailable to us, our grief remains in this limbo of sorts -- or worse, we search for our own answer to help us move forward.
In a recent article for The New Yorker, Philip Gourevitch aptly explained this phenomenon:
To be told that a scene of mass death is the result of an accident of terrorism is to be given not only an explanation of the cause but also an idea of how to reckon with the consequence -- through justice, or revenge, or measures meant to prevent a recurrence.
According to CNN, a physician did declare Lubitz unfit to work the day of the flight, and instead of sharing that information with Germanwings, Lubitz disposed of the note and boarded the plane. But even in light of such information, it's highly unlikely that we will ever know exactly what was going on in the mind of this pilot, and it is far from our place to speak as though we have a definitive answer.
In the words of Gourevitch, we are left with a sense of "cosmic meaninglessness and bewilderment" when horrific events such as this one occur, and while that is one of the toughest collections of emotions to grapple with, there is no credible alternative in cases like this.
MORE ARTICLES (The Atlantic and The Boston Globe)
http://www.theatlantic.com/ health/archive/2015/03/ depressed-doesnt-mean- dangerous/388922/
http://www.bostonglobe.com/ metro/2015/03/28/will-crash- plane-reportedly-hand-pilot- spark-stigma-anew-over-mental- illness/ KJLtkKIbgVoDVZU5e2lh1N/story. html?s_campaign=8315
February 19, 2015 - News of the Week
http://www.madinamerica.com/ 2015/02/return-asylums-lets- not
October 18, 2014 - News of the Week
Vivid accounts tell us how Winston Churchill and Abraham Lincoln battled disabling depression even as they made history. But before we can truly understand and empathize with people who have psychiatric vulnerabilities, we need people of our own time and environment to tell us what they experience.
Today's easy access to videos and social media allows the general public unprecedented views of how mental illnesses affect a life. Every story is unique. A recent example comes from Carmen Lee, a Californian whose suicide attempts in her early 20s prefaced 20 years of hospitalizations. In a remarkable 6-minute video on Facebook. "No Longer Pretending..." (https://vimeo.com/105064330) Lee explains the essence of her survival. Put most simply, Lee used her positive energy to refute the stereotypes that misrepresent the mental health community, thereby aiding progress toward social justice.
In 1985 Carmen Lee began the Peninsula Network of Mental Health Clients, and in 1990 she developed the Stamp Out Stigma program (SOS) (www.stampoutstigma.net). Traveling throughout the bay area and beyond, SOS teams have delivered over 2,600 presentations to organizations and agencies of every description, having directly reached well over 500,000 people and many more by ripple effect. Lee's advocacy includes participation in statewide planning forums.
Carmen Lee's video premiered on September 25th for a large crowd in San Francisco's new Levi Stadium, home of the 49ers. It was a gala event honoring mental health activism and educational outreach in Northern California and beyond. The event was sponsored by Caminar, a San Francisco Bay Area mental health agency that helped Carmen Lee recognize her strengths and encouraged her work.
August 11, 2014 - News of the Week
HOW TO REDUCE GUN VIOLENCE AND SUICIDE
The massacre of schoolchildren in Newtown, Connecticut, in late 2012 stirred a wrenching national conversation at the intersection of guns, mental illness, safety, and civil rights. In the glare of sustained media attention and heightened public concern over mass shootings, it seemed that policymakers had a rare window of opportunity to enact meaningful reforms to reduce gun violence in America. And yet, the precise course of action was far from clear; competing ideas about the nature and causes of the problem -- and thus, what to do about it -- collided in the public square.
Article source: ANNALS OF EPIDEMIOLOGY
July 15, 2014 - News of the Week
A BRITISH SURVIVOR CHALLENGES SCHIZOPHRENIA'S BAD RAP
Article Source: The Independent, July 15, 2014 http://www.independent.co.uk
For article and a video, click title:
SCHIZOPHRENIA: the most misunderstood mental illness?
By Rachel Hobbs
"While mental health stigma is decreasing overall ... people
Earlier this year Jonny Benjamin set up a nationwide search to #findmike, the stranger who
talked him out of taking his own life on Waterloo bridge. People told him he ‘didn’t look like a
schizophrenic’ - so what do people imagine?
Let’s face it, when most people think about schizophrenia, those thoughts don’t tend to be
overly positive. That’s not just a hunch. When my charity, Rethink Mental Illness, googled
the phrase ‘schizophrenics should...’ when researching a potential campaign, we were so
distressed by the results, we decided to drop the idea completely. I won’t go into details,
but what we found confirmed our worst suspicions.
Schizophrenia affects over 220,000 people in England and is possibly the most stigmatised
and misunderstood of all mental illnesses. While mental health stigma is decreasing overall,
thanks in large part to the Time to Change anti-stigma campaign which we run with Mind,
people with schizophrenia are still feared and demonised.
Over 60 per cent of people with mental health problems say the stigma and discrimination
they face is so bad, that it’s worse than the symptoms of the illness itself. Stigma ruins lives.
It means people end up suffering alone, afraid to tell friends, family and colleagues about
what they’re going through. This silence encourages feelings of shame and can ultimately
deter people from getting help.
Someone who knows first hand how damaging this stigma can be is 33 year-old Erica
Camus, who was sacked from her job as a university lecturer, after her bosses found out
about her schizophrenia diagnosis, which she’d kept hidden from them.
Erica was completely stunned. “It was an awful feeling. The dean said that if I’d been open
about my illness at the start, I’d have still got the job. But I don’t believe him. To me, it was
She says that since then, she’s become even more cautious about being open. “I’ve
discussed it with lots of people who’re in a similar position, but I still don’t know what the
best way is. My strategy now is to avoid telling people unless it’s comes up, although it can
be very hard to keep under wraps.”
Dr Joseph Hayes, Clinical fellow in Psychiatry at UCL says negative perceptions of
schizophrenia can have a direct impact on patients. “Some people definitely do internalise
the shame associated with it. For someone already suffering from paranoia, to feel that
people around you perceive you as strange or dangerous can compound things.
“I think part of the problem is that most people who have never experienced psychosis, find
it hard to imagine what it’s like. Most of us can relate to depression and anxiety, but a lot of
us struggle to empathise with people affected by schizophrenia.”
Another problem is that when schizophrenia is mentioned in the media or portrayed on
screen, it’s almost always linked to violence. We see press headlines about ‘schizo’ murderers
and fictional characters in film or on TV are often no better. Too often, characters with
mental illness are the sinister baddies waiting in the shadows, they’re the ones you’re
supposed to be frightened of, not empathise with. This is particularly worrying in light of
research by Time to Change, which found that people develop their understanding of mental
illness from films, more than any other type of media.
These skewed representations of mental illness have created a false association between
schizophrenia and violence in the public imagination. In reality, violence is not a symptom of
the illness and those affected are much more likely to be the victim of a crime than the
We never hear from the silent majority, who are quietly getting on with their lives and pose
no threat to anyone. We also never hear about people who are able to manage their
symptoms and live normal and happy lives.
That’s why working on the Finding Mike campaign, in which mental health campaigner Jonny
Benjamin set up a nationwide search to find the stranger who talked him out of taking his
own life on Waterloo bridge, was such an incredible experience. Jonny, who has
schizophrenia, wanted to thank the man who had saved him and tell him how much his life
had changed for the better since that day.
The search captured the public imagination in a way we never could have predicted. Soon
#Findmike was trending all over the world and Jonny was making headlines. For me, the best
thing about it was seeing a media story about someone with schizophrenia that wasn’t linked
to violence and contained a message of hope and recovery. Jonny is living proof that things
can get better, no matter how bleak they may seem. This is all too rare.
June 15, 2014 - News of the Week
A "60 MINUTES" BIAS HARMS MILLIONS
In September of last year, 60 Minutes infuriated many viewers by portraying people with schizophrenia and similar conditions as individuals at high risk of committing violence. Viewers deluged CBS with angry protests.
On Sunday, June 8, the feature, "Imminent Danger" was aired for the second time. Clearly, 60 Minutes showed bias by repeating a one-sided feature that was full of inaccuracies.
Following the September broadcast, the Bazelon Center for Mental Health Law outlined the viewers' objections and pointed out the segment's inaccuracies in a letter to CBS (for the full letter skip down to More Information)
Excerpt: "Imminent Danger" portrays individuals diagnosed with schizophrenia as people with hopeless futures whose primary life options are hospitalization, homelessness, or incarceration. The segment provides no indication that individuals with schizophrenia can and do live fulfilling lives, start their own families, work, live independently, and participate fully in their communities. Instead, such individuals are painted as consigned to a life of misery and as ticking time bombs with the potential to become violent at any time."
"Imminent Danger" was hosted by Steve Croft and featured Dr. E. Fuller Torrey, the nation's leading proponent of compulsory antipsychotic medication and preventive hospital commitment. Both men showed a strong commitment to coercive treatment, and both were willing to distort facts to win public support for regressive practices. As one angry viewer wrote,
"It's time to get another 'reporter' to do some real investigation and offer a balanced story rather than what seems like a personal mission by Mr. Croft to further disenfranchise people who have received psychiatric diagnoses. Ten years ago in October 2002 and June 2003, Mr. Croft did a story called "Armed and Dangerous" that, like this segment, relied mostly on the singular opinion of Dr. Torrey ... he's obviously not done any more real research in the past decade as this piece is as uninformed, biased and journalistically irresponsible as the last one... "
Steve Croft's flowery introduction made clear that Dr. Torrey had determined the program's direction. Dr. Torrey and Dr. Jeffrey Lieberman, leading proponents of compulsory antipsychotic medication, used the time to convince viewers that meds, forced if necessary, will end "preventable tragedies."
Oddly, Dr. Torrey's collection of well over 3,000 "Preventable Tragedies" holds some surprises. After downloading the collection's homicide summaries years ago, the National Stigma Clearinghouse found that medication failed to deter homicide in many cases. Further, a New York Times series analyzing 50 years of mass murders (April 2000) reported that among the 24 slayers who had been prescribed medication, nearly half (10) were taking medication at the time of their rampage.
And regarding violence, Dr. Torrey's guesstimates have media appeal, but more to the point are figures from authoritative sources. Schizophrenia affects just over 1% of the adult population (National Institute of Mental Health-NIMH) and of these people, 99.97% of them will not be convicted of serious violence in a given year (Walsh et.al. 2002. "Violence and Schizphrenia: Examining the Evidence," British Journal of Psychiatry, 180: page 494)
"Imminent Danger's" lack of balance is easily confirmed in its online transcript. The over-emphasis on schizophrenia was particularly misleading.
An insightful observation was made by Tom Dart, the Cook County Sheriff, after he described the petty offenses of most incarcerated mentally ill inmates:
"This is a population that people don't care about and so as a result of that there are not the resources out there for them."
What effect has Dr. Torrey's 20-year over-emphasis on violence had on public opinion?
For more information, read a New York Times 4-part series on "Rampage Killers" (link is below)
May 2, 2014 - News of the Week
A CLOSER LOOK AT "LACK OF INSIGHT"
Recent articles and briefing papers by supporters of forced treatment assume that patients who refuse psychiatric treatment do so because of structural brain abnormalities that block awareness. They say nearly 50 percent of people with schizophrenia and bipolar disorder require forced anti-psychotic medication to combat the assumed cause of treatment refusal. Although the faulty brain lesions have not been found and their response to anti-psychotic medication is unknown, supporters expect these hurdles to be cleared by advanced brain imaging techniques within a few years.
A thought-provoking article below addresses the "lack of insight" concept and approaches to treatment. This analysis is a valuable resource for understanding the variety of ways to view "lack of insight.". With pressure building for a major expansion of forced meds, an informed public is crucial..
THE ISSUE OF INSIGHT
by Larry Davidson, Ph.D.
Yale University School of Medicine
February 6, 2012
But what about people who won't accept having a mental illness?
These questions—and others like them—are frequently posed by frustrated practitioners and distressed family members trying to assist people who appear not to want help. One concern, or assumption, about these questions is that they point to a key limitation of the recovery paradigm, implying recovery and recovery-oriented practices are only for people who readily acknowledge having a mental illness. After all, how can a person be "in recovery" if he or she has nothing to recover from? One of the major differences between mental illnesses and other medical conditions is the issue of insight. People with diabetes know they have diabetes; people with asthma know they have asthma, etc., but some will argue that most people with serious mental illnesses (or at least those with schizophrenia) lack insight into having the illness. Therefore, they will not participate in the treatments needed to manage their conditions. Such perceptions lead some people to argue that coercion and involuntary treatments are necessary, at least for those who refuse any or all treatments. The lack of insight also poses a major challenge to person-centered care planning and recovery-oriented practice, if both presume the person will take responsibility for driving his or her own care and overall recovery process. Is not insight, therefore, required for recovery?
While it may sound contradictory at this point, I intend to show in the following two sections not only that recovery-oriented practice is possible for people who appear to lack insight, but that it may also be precisely these people who most need recovery-oriented care. (Click for full article)
February 24, 2014 - News of the Week
January 18, 2014 - News of the Week
DR. TORREY'S FIXATION ON VIOLENCE FUELS FEAR AND DISCRIMINATION
Dr. E. Fuller Torrey's latest book. "American Psychosis," begins by describing the events, shortsighted decisions, and inertia that led to the present quagmire we call the nation's mental health system. The book's main message, however, promotes Dr. Torrey's solution: more psychiatric hospitals and court-ordered medication. This is Torrey's mantra. What's galling is his continuing reliance on lurid stories to win public support for his controversial - many say regressive - agenda. A book revue by Michael A. Friedman, M.D. notes that Dr. Torrey "does not shy away from recounting one horror story after another."
National Stigma Clearinghouse files show that for at least twenty years, Dr. Torrey has relied on the fear of violence to win new laws forcing psychiatric treatment. In 1994, D.J. Jaffe, an advertising executive and Torrey supporter, wrote: "From a marketing perspective, it may be necessary to capitalize on the fear of violence to get the law passed." This was not a passing comment. Five years later, Mr. Jaffe advised a national NAMI audience, "Laws change for a single reason, in reaction to highly publicized incidents of violence." And later that year, 1999, the passage of NY's Kendra's Law proved Jaffe right. (It didn't matter that Kendra Webdale's assailant was the opposite of a 'treatment refuser', a label he carries to this day as he serves his prison term).
Just as disturbing is the Torrey/Jaffe team's "ends justify the means" approach. After advising his NAMI audience to use violence to attain their goals, Jaffe added, "I am not saying it is right, I am saying this is the reality." The media welcomed the Torrey/Jaffe team's sensational approach, and from the 1990s onward, Dr.Torrey enjoyed a lion's share of media coverage concerning mental illnesses. The consequences?
Blame for the nation's horrific amount of gun violence now falls on a minority with little means of defense. Injustice against innocent people is condoned. And many who need help are afraid to ask for it.
A tragic example: "Dad! Dad! Learning from the Kelly Thomas Tragedy"
Source: NYAPRS (New York Association for Psychiatric Rehabilitation Services)
An Orange County California jury’s acquittal last week of Fullerton police officers charged with causing the brutal death of Kelly Thomas, a homeless man with a mental health history, has set off a national uproar amongst human rights and mental health advocates. In the wake of the court’s action, the County DA’s courage to prosecute the case has been cited and the FBI has opened an investigation to see if Thomas’ civil rights were violated.
Kelly Thomas had struggled for years with mental health issues and homelessness. His pointless, tragic death has devastated his family, community, and the national and international mental health community. His death also brings attention to the misconception that people with a psychiatric diagnosis are violent, whereas evidence shows that they are far more likely to be the victims of violence than the perpetrators of it.
Sunday’s 7 pm Albany vigil has been getting a lot of national attention and support as advocates from around the country call for justice and accountability of our law enforcement to the rights and protection of each and every citizen. (Vigil Announcement: Mental health and human rights advocates gather to grieve and decry police killing, First Unitarian Church, Albany, NY, 7:00 pm, Sunday, January 18, 2014)
January 11, 2014 - News of the Week
DAVID BROOKS TAKES HEAT FOR HIS VIEWS ON MARIJUANA
THE PUBLIC NEEDS FACTS ABOUT POTENTIAL HARM
NYTimes columnist David Brooks recently expressed misgivings concerning recreational marijuana use, based on his own experiences. A displeased pro-marijuana advocate, Joe Dolce, was quick to counter Mr. Brooks online. For his takedown, Mr. Dolce interviewed Dr. Lester Grinspoon, a well-known longtime promoter of smoking cannabis. The interview gives an enticing glimpse of Dr. Grinspoon's idyllic view of marijuana, while dissing David Brooks as uninformed.
May I suggest a bit of balance.
While there is little conclusive research on pot's hazards, many studies done over the past decade, mostly in the UK and Europe, have found brain changes among young users. Findings from British researchers ten years ago are now being confirmed by studies in the US. CBS News "Marijuana use linked to schizoprenia risk in teens"
A quote in 2008 from the UK's Guardian indicated pot's harmful potential. "Last year, a review of all the studies to date, published in The Lancet, was able to assert that even having tried cannabis once can be shown to increase the risk of developing schizophrenia. And it is estimated by Murray [Robin Murray, a British researcher] that at least 10 percent of all people with schizophrenia in the UK would not have developed the illness had they not smoked cannabis." "My brother's first joint and his descent into a mental war zone"
Many families with a 'seriously mentally ill' family member will attest that pot-smoking has led to family tragedies. Last week, a NYTimes editorial stated that "Roughly 36 percent of 12th graders reported having used marijuana in 2013." "The Marijuana Experiment," NYTimes 1/3/2014
"Smoking Pot Doubles Mental Illness Risk" (Christchrch New Zealand)
"Marijuana linked to brain-related memory woes, schizophrenia risk in teens" (CBS News)
"The Marijuana Experiment" (New York Times editorial)
"Continued Cannabis Use and Risk of Incidence...10 Year Follow-Up Cohort Study" (Medscape signup needed)
December 15, 2013 - News of the Week
MENTAL HEALTH CONSUMER NETWORKS ARE IN JEOPARDY
A proposed Congressional Bill is described as helping families in mental health crisis. Unfortunately, the bill includes onerous provisions that would halt effective wellness programs designed by patients and ex-patients. This alarming Bill would "slash funding for recovery oriented services--including peer-run services and family supports--in exchange for regressive and involuntary treatment" (NYAPRS). Further, it would "restructure federal funding to heavily encourage the use of force and coercion..." (NDRN).
(NYAPRS, New York Association for Psychiatric Rehabilitation Services; NDRN, National Disability Rights Network)
The "Helping Families in Mental Health Crisis Act" was introduced on December 12 by Rep.Tim Murphy of Pennsylvania.
Read the following links and learn more about this threat to progress.
"Mental Health America Faults Rep. Tim Murphy's Legislation..."
Statement of David Shern, Ph.D., president and CEO, Mental Health America
Mental Health Advocates Blast Murphy Bill as Regressive
GOP Rep. Murphy rolls out mental health legislation
By David Sherfinski, The Washington Times, 12/12/13
Alert: Urge Congress to Protect SAMHSA and Consumer Programs!
NYAPRS News: This comes from the National Coalition for Mental Health Recovery, an organization that NYAPRS supports. We urge you to contact your representatives to demand that budget cuts do not impact mental health recovery services that keep people engaged and working toward their well-being. Along with the Congressional deal to tighten the budget and restrict mental health spending, an act submitted by Representative Tim Murphy would favor involuntary services and reduce funding for rehabilitation services, including peers and family support. Contact your representative today, sign the petition at change.org, and get on the NCMHR action list!
SAMHSA Grants for State Networks, The Alternatives Conference and the 5 Mental Health Technical Assistance Centers Are At Risk!
YOU can help.
Educate your Senators and your Representative about these vital programs.
They need to hear from YOU now.
Budget negotiators in Congress just reached a deal that squeezes dollars for all health funding including mental health. Most members of Congress don’t know about the life-saving work and value of state mental health consumer networks and national TA centers. It is up to you to educate them.
Yesterday, Representative Tim Murphy of Pennsylvania released a mental health bill that—among many other disturbing changes-- would reorganize SAMHSA and end funding for state networks, the Alternatives conference and technical assistance centers.
What to do now:
Right now, send emails and make phone calls to you members of the House and Senate appropriations committees telling them why they should protect funding for state mental health networks, the Alternatives conference and the five mental health technical assistance centers and how important they have been in your life, the life of people you love and for citizens of your state. (See How to do it below and the attached document on what to say).
Next, Sign our petition on Change.org: Go to http://ncmhr.org and look for the Action Alert with a link to the petition and more background.
Stay tuned for instructions on how counter Tim Murphy’s bill that you will be receiving in a few days.
How to do it:
1. FIND your U.S. Senators at http://www.opencongress.org/people/zipcodelookup. Click the name of each Senator, scroll down to “ Contact Webform” to send them an email. Before sending, copy and save your message. Request a reply. You can also call their office and leave a message.
Note from Jean Arnold: I regret that the lists (referred to above) of Congressional Committee members did not transfer to this posting.
November 20, 2013 - News of the Week
THIRTY-SIX ADVOCACY GROUPS PRESS FOR FAIR REPORTING
A recent 60 MINUTES segment hosted by Steve Croft focused on a national disgrace -- the nation's undisputed neglect of Americans who are diagnosed with serious psychiatric conditions. Ignoring an opportunity to discuss the scarcity of user-friendly treatments, the segment focused on psychotropic medications and forced treatment. The coercion proponents' marketing strategy, "fear of violence," dominated the segment -- note its (shortened) title, "Imminent Danger".
Below is a letter from the Bazelon Center for Mental Health Law to 60 MINUTES protesting "Imminent Danger's" harmful bias. The letter is signed by 36 mental health organizations, and it joins many other protests from individuals and organizations. (E-mail: and )
NYAPRS Note: This week, the Bazelon Center for Mental Health Law drafted a letter to the Executive Producer of CBS 60 Minutes, in regards to the September 29 segment “Imminent Danger”. The views expressed in that program were regressive; the segment falsely portrayed persons with mental health diagnoses as hopeless, futureless individuals at high risk for committing violence. NYAPRS—as well as numerous other organizations indicated below—have signed this letter in protest of the unacceptable and misguided views expressed in the show that not only go against our mission, but also the consensus priorities of our mental health services system. Please read the full letter below.
Dear Mr. Fager:
The undersigned organizations, together representing tens of thousands of individuals with psychiatric disabilities, family members, service providers, and advocates, write to express our great disappointment that CBS’ 60 Minutes chose to offer a dismal and inaccurate portrayal of individuals with psychiatric disabilities in the September 29, 2013, segment “Untreated Mental Illness an Imminent Danger?” We call on 60 Minutes to devote a future segment to presenting a different perspective than that offered by E. Fuller Torrey, the psychiatrist whose highly controversial views are featured in “Imminent Danger.”
“Imminent Danger” portrays individuals diagnosed with schizophrenia as people with hopeless futures whose primary life options are hospitalization, homelessness, or incarceration.The segment provides no indication that individuals with schizophrenia can and do live fulfilling lives, start their own families, work, live independently, and participate fully in their communities. Instead, such individuals are painted as consigned to a life of misery and as ticking time bombs with the potential to become violent at any time.
The segment perpetuates false assumptions that there is a significant link between mental health conditions and violence. Indeed, the point of the segment seems to be that mass shootings would be preventable if it were easier to hospitalize individuals with psychiatric disabilities. Apparently relying on Dr. Torrey’s inaccurate statement that half of mass killings are committed by individuals with serious mental illness, the report states: “It's becoming harder and harder to ignore the fact that the majority of the people pulling the triggers have turned out to be severely mentally ill—not in control of their faculties—and not receiving treatment.” Research shows that this is far from accurate. One survey of mass shootings between 2009 and 2013 found that perpetrators had a known mental health condition in only 11 percent of these incidents.1 A recent study of the psychiatric characteristics of homicide defendants found that psychiatric factors do not appear to predict whether a homicide defendant used a firearm or killed multiple victims.2
“Imminent Danger” also inaccurately suggests that the primary need in our mental health system is for more involuntary hospitalization. In fact, we have a long history of national and state reports—including the Surgeon General’s Report on Mental Health in 1999 and the 2003 report of the President’s New Freedom Commission on Mental Health—indicating that our mental health system is broken because we are failing to invest in effective community services (such as supported housing, supported employment, mobile crisis services, peer supports, and mobile community support teams).6Dr. Torrey’s focus on hospitalization and forced treatment as the primary need in mental health systems is at odds with a virtual national consensus that the focus should be community services.
Finally, the segment incorrectly suggests that the requirement that individuals be dangerous before they can be involuntarily committed to a psychiatric hospital is a significant barrier to treatment. Dr. Torrey states in the segment that due to this requirement, in most states, it is “almost impossible” to commit people. This is a gross misstatement of fact. In fact, more than 52,000 individuals were involuntarily committed to psychiatric hospitals last year. Moreover, the vast majority of individuals who come before courts on involuntary commitment petitions are committed.7
These inaccuracies and omissions in “Imminent Danger” create a harmful portrayal of Americans diagnosed with schizophrenia and other psychiatric disabilities. This portrayal is likely to lead to further discrimination and scapegoating of these individuals and to suggest misguided policy solutions. Moreover, this segment misses the opportunity to highlight the need for greater investment in effective community services. We hope that 60 Minutes will devote a segment to presenting a different perspective and we stand ready to work with you on making that happen.
American Association of People with Disabilities
American Association on Health and Disability
Anti-Bias Home Page/National Stigma Clearinghouse
Arbor Housing and Development
Association of Programs for Rural Independent Living
Autistic Self Advocacy Network
Baltic Street AEH Inc.
Bazelon Center for Mental Health Law
Clubhouse of Suffolk
Connecticut Legal Rights Project
Delaware Consumer Recovery Coalition
Disability Rights Education and Defense Fund
Disability Rights International
Equip for Equality
Little People of America
Maine Center, Inc.
Mental Health America
Mental Health Association of Nebraska
Mental Health Association Orange County, Inc.
Mental Health Association Suffolk County
National Association for Rights Protection and Advocacy
National Coalition for Mental Health Recovery
National Council for Community Behavioral Healthcare
National Council on Independent Living
National Disability Rights Network
National Mental Health Consumers’ Self-Help Clearinghouse
New York Association for Psychiatric Rehabilitation Services, Inc.
Parsons Family and Consumer Services
Suffolk County United Veterans
Yale Program for Recovery and Community Health
October 4, 2013 - News of the Week
NEW VIOLENCE STUDY SHATTERS POPULAR BELIEFS
A PLEA TO MAINSTREAM MEDIA
(See more information below)
A commentary by Linda Rosenberg
A Commentary and Source Materials from Susan Rogers
I find it surprising that “60 Minutes,” which has a history of serious investigative journalism, would do such a slipshod job on the segment “starring” E. Fuller Torrey.
The producers apparently saw no reason to include the fact that people diagnosed with schizophrenia can and do recover. Significantly, a decades-long study by the World Health Organization found that individuals diagnosed with schizophrenia usually do better in countries in the developing world – such as India, Nigeria and Colombia – than they do in such Western nations as Denmark, England and the United States. According to an analysis of results, “Patients in developing countries experienced significantly longer periods of unimpaired functioning in the community, although only 16% of them were on continuous antipsychotic medication (compared with 61% in the developed countries). . . . The sobering experience of high rates of chronic disability and dependency associated with schizophrenia in high-income countries, despite access to costly biomedical treatment, suggests that something essential to recovery is missing in the social fabric.”
Nor did they include any information about the Hearing Voices movement, which helps people learn to cope effectively with the experience of hearing voices.
In addition, in a small British pilot study, 16 individuals diagnosed with schizophrenia were able to control their auditory hallucinations with an experimental treatment called “avatar therapy.” The treatment involves creating a computer-based representation – including a face and a voice – of the entity they believe is talking to them. The individual’s therapist is then able to speak through the avatar, encouraging the individual to counter the voice and to take control of the hallucinations. Three of the 16 people who participated in the study completely stopped hearing their voices as a result of the therapy, and almost all of the participants reported a reduction in frequency and in the severity of distress the voices caused, according to a published report. Because of the pilot’s success, The Wellcome Trust will fund a larger study, to be led by researchers at King’s College London’s Institute of Psychiatry. Thomas Craig, the psychiatrist who will lead the larger trial, said that if the study is successful, the therapy could be widely available within a few years.
Although Dr. Torrey believes that individuals diagnosed with mental health conditions should be force-medicated if they refuse to take medication voluntarily, award-winning journalist Robert Whitaker believes that medication contributes to chronicity. In the era that followed the introduction of Thorazine in 1955, there has been an exponential rise in the numbers of individuals disabled by mental health disorders, he reports in his book “Anatomy of an Epidemic.” Whitaker told Behavioral Healthcare, “. . . [U]nfortunately I’m afraid psychiatry no longer knows how to get back on track with honest reporting of what it does and does not know, and honest investigations of psychiatric medications. . . . Ultimately, I think we need a new paradigm built on the framework of psychosocial and recovery practices.”
The “60 Minutes” producers made a serious error in relying upon Dr. E. Fuller Torrey as its main source. Torrey admits to fabricating “evidence” to further his goal of making it easier to lock up people who have psychiatric diagnoses. Toward this end, he has for years engaged in “an intensive public relations campaign linking mental illness with violence.”
To the contrary, according to a NY Times article, only about 4 percent of violence in the United States can be attributed to people with mental illness.” And the 4 percent statistic is about violence of any kind – which, according to the study cited, would include something as relatively innocuous as threatening threatening behavior – as opposed to just homicides. Also, since the fears of the general public largely focus on strangers with mental health conditions, it is significant to report another study, which estimated that there is only one stranger homicide per 14.3 million peopl year.
“60 Minutes” should do a follow-up piece in which it strives for accuracy, as opposed to sensationalism.
Susan Rogers, Director
The National Mental Health Consumers’ Self-Help Clearinghouse
The views, opinions, and content on the Clearinghouse website and in anything posted on the website or in these e-mails or attached to these e-mails donot necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).
July 5, 2013 - News of the Week
HOME PHILOSOPHY ART QUOTATIONARY
Recovery in Acute Care
"Before Healing Can Occur, People Must Feel Safe"
by Maggie Bennington–Davis, M.D., MMM
Source: Recovery to Practice Highlights April 26, 2012
BEFORE HEALING CAN OCCUR, PEOPLE MUST FEEL SAFE
There is an old medical school adage that says "first, do no harm." In acute hospital settings, people describe all-too-frequent experiences of fear and panic, loss of control, loss of self-determination, seclusion, restraint, and unwanted medications. Inpatient units can seem downright dangerous, not only to those hospitalized, but to staff as well. Before healing can occur, people must feel safe.
During my tenure as the medical director of psychiatry at Oregon's Salem Hospital, I was part of the miraculous transition to a trauma-informed environment. Seclusion and restraint were eliminated, and there was a substantial decline in the administration of involuntary medications (as well as a 30 percent decline in the use of routine medication). People became more involved in psychoeducational groups and therapeutic exchanges with staff. Injuries sustained by staff and those hospitalized dropped dramatically, lengths of stay decreased, and financial performance improved. It was a wonderful example of parallel process—recovery for those coming into the hospital and for the hospital itself.
Recently, I had a phone call from a psychiatrist who specialized in organizational consultation. He asked me, "After you quit doing restraint, what did you do when someone was really upset and out of control?"
I had to pause before I answered, because there wasn't a simple way to respond. Staff in the program were never told not to use seclusion, restraint, medication, or other means of control. Restraint went away because it was no longer necessary, not because it was "banned." If a situation required restraint or seclusion to prevent serious harm, appropriate measures would be taken. But the environment had drastically changed, and those situations didn't occur very often.
We included the people we served as we began our transformation and philosophical shift. We immersed ourselves in understanding the neurobiology of trauma, fear, fight-or-flight response, and the realization that traumatized people perceived our clumsy attempts at "safety" as predatory and controlling. We were astonished to learn virtually everyone who came (or was brought) to us had suffered through difficult childhood experiences. It humbled us to think about our past reactions to these folks and the pejorative language we had used to explain what suddenly seemed like perfectly rational behavior (manipulative, aggressive, help-seeking, belligerent, difficult, etc.). Suddenly, power struggles made a lot of sense, disengagement seemed self-preserving, and the minor events that precipitated catastrophic reactions didn't seem so minor after all. When we changed the lens to one that was trauma informed and started asking "What happened to you?" instead of "What is wrong with you?", everything else changed too. (highlighting added by ja)
In essence, when we changed ourselves and the hospital to be really, truly "safe," the people we were serving also felt safe. Independent of diagnosis, symptoms, age, sex, or history, we were by far the most significant variable.
Then the fun really began. We started using our environment to regulate certain physiological responses of people at the hospital. We used drumming techniques to normalize heart rates, music to soothe, colors to evoke calm, and artwork to inspire (instead of posted rules forbidding balloons and knives). We asked ourselves and those we were serving, "What helps us feel safe?" The answers were friendly greetings, calm voices, beauty in our surroundings, constant information, sharing meals, and talking openly about upsetting events. We changed our language, our assumptions about recovery, and our expectations, and made a point of including families and friends. We educated ourselves about customer service. Putting people's fears to rest as soon as possible became our business.
We also realized that staff interactions completely set the tone for everyone else, so we became mindful about communicating and working with one another.
Dr. Sandra Bloom, creator of the Sanctuary Model, taught us how to hold daily community meetings to discuss safety with those we were serving as well as staff (doctors, administrators, janitors, cooks, security, etc.). The twice-daily meetings became the anchors of our serenity. If something happened that shook our sanctuary, we spent the next community meeting determining how to return to safety. We knew when something frightening happened to one person in the community, everyone was affected.
Every now and then, we still experienced an upsetting event. I will never forget the woman who repeatedly banged her head against the hospital wall. She had been restrained many times before, always to keep her from harming herself. We mulled over how we could help her in our new environment. In a community meeting, another hospitalized woman told the newcomer, "Honey, when you bang your head like that, it hurts my head." The group suggested we move the bed to the center of the room, away from the walls that facilitated her head banging. Finally, the banging stopped and the woman began to heal.
There was the man who paced the unit's perimeter, talking frenetically to himself and occasionally banging his fist on the wall. During a community meeting, folks who had been in the hospital for a few days kindly told him they were frightened of him. He looked shocked and apologized, saying he would never hurt anyone. His pacing stopped, his fear and anger seemed to subside, and he began to pursue the opportunities we offered to support his healing process.
We learned to have a different threshold for upsetting behavior. Staff were constantly encouraged by managers to do what was necessary to keep things safe, but the word "safe" became much more inclusively defined. Our staff created an environment where everyone really did feel safe, and the outbursts, anger, and violence mostly melted away.
All of these changes created completely different roles for staff—jobs that focused less on maintaining order and policing the unit, and much more on healing and partnering with people to initiate and support their recovery journeys. The transformation exemplified recovery more than any treatment plan I have ever witnessed. It was truly a highlight of my career.
Dr. Bennington–Davis is the Chief Medical and Operating Officer at Cascadia BHC in Portland, Oregon.
THE DARK SIDE OF KENDRA'S LAW HISTORY
The trouble-prone, eight-year-long court case concerning Kendra Webdale's terrible death at the hands of Andrew Goldstein ended abruptly when both sides agreed to avert a third agonizing trial. It wasn't a perfect closure, but an understandable one. However, the two earlier failed trials spurred lawyer/advocate Patricia Warburg Cliff, then a board member of national NAMI, to express her dismay in a thought-provoking article, "The Railroading of Andrew Goldstein." This informative commentary (below) was published in the Journal of California AMI, vol.11, September 2000.
Questions remain. Key among them: Why does the press often call Andrew Goldstein a 'treatment refuser'? Doesn't this libel a man who knew his diagnosis was severe schizophrenia with uncontrolled violent outbursts, and for two years had requested a supervised treatment setting? Looking back, it is also clear that Kendra's Law proponents missed an opportunity to point out that rare disasters are more likely to occur when insufficient mental health services are the norm. Instead, they focused their call-to-action on a man trapped by and ultimately destroyed by draconian policy decisions.
And still the myth goes on. Just last week, Albany's Legislative Gazette reported a new push to make Kendra's Law permanent, wrongly describing Andrew Goldstein as "a man diagnosed with, but not seeking treatment for, schizophrenia."
When fading facts become harder to verify, the insights, observations, legal experience, and personal views of a witness can be a valuable resource. Thank you, Patricia Warburg Cliff, for "The Railroading of Andrew Goldstein"
For an investigative report of Goldstein's downward spiral, click: "Bedlam on the Streets" New York Times, by Michael Winerip, May 23, 1999 (This Times Magazine cover story appeared 5 months after Kendra Webdale's death. New York's Kendra's Law passed 3 months later, despite then-known circumstances)
ARTICLE: THE RAILROADING OF ANDREW GOLDSTEIN
by Patricia Warburg Cliff
End of article
September 26, 2011 - News of the Week
'HEARING VOICES USA' JOINS WORLDWIDE MOVEMENT
To celebrate, the USA network of voice-hearers launched their new website, ( http://www.hearingvoicesusa.org ) Already the site offers a wealth of information including resources and links to a network of websites across the globe -- in Australia, Greece, England, Wales, Denmark, the Netherlands and more.
In growing numbers, people who hear voices are breaking a silence imposed by negative social attitudes (stigma). This breakthrough movement, aided by the Internet, eases the pain of misunderstanding and isolation. Learn more with a visit to About Us: Hearing Voices USA http://www.hearingvoicesusa.org/about-us.html
Below is an excerpt from the National Empowerment Center press release: What is World Hearing Voices Day?
From the Intervoice Website (http://www.intervoiceonline.org): World Hearing Voices Day celebrates hearing voices as part of the diversity of human experience, increasing awareness of the fact that you can hear voices and be healthy. It challenges the negative attitudes towards people who hear voices and the incorrect assumption that hearing voices, in itself, is a sign of illness.
September 2, 2011 - News of the Week
HOW FICTION BECOMES FACTOID
Dr. E. Fuller Torrey is perhaps psychiatry's most visible spokesperson. He is also the nation's most active proponent of forced psychotropic medication for psychiatric outpatients. Unfortunately, Dr. Torrey has often stretched or misquoted outright the research findings of others to win support for his controversial agenda.
The most recent example of Dr.Torrey's self-serving work appears in an article, Stigma and Violence: Isn't It Time To Connect the Dots, which first appeared in July in the advance publication of Schizophrenia Bulletin (SB), and is now in the September 2011 issue.
In the SB article, Dr. Torrey contends that actual acts of violence are the basis of stigma against people who are labeled mentally ill. Torrey says this cause of prejudice and discrimination can be eliminated by accepting and acting upon his assumptions about violence (named 'dots'). In discussing these assumptions, Torrey cites studies to support his views.
Interestingly, some of the studies quoted in Torrey's SB article are on file at the National Stigma Clearinghouse. In every one, Torrey has either cherry-picked, or worse, altered the study findings to suit his purpose.
Some examples of errors in the connect-the-dots article:
(1) Dr. Torrey misstates former Surgeon General David Satcher's conclusions about stigma and violence described in Dr. Satcher's groundbreaking report on mental health in 1999 (page 8). Dr. Torrey mistakes "perception of violence" to mean "evidence of violence" and thus twists Dr.Satcher's conclusions to agree with his own opinion that violence causes stigma. In fact, Dr. Satcher concludes that the public's fear is disproportionate the the low risk of violence; his report states: "Because most people should have little reason to fear violence from people with mental illness, even in its most severe form, why is fear of violence so entrenched?"
(2) Dr. Torrey misrepresents research findings (article 1996) of Matthias C. Angermeyer and Herbert Matschinger, University of Leipzig to support his view that violence committed by mentally ill people is a major cause of stigma. In fact, the researchers concluded that media coverage of mental illnesses promotes stigma by focusing selectively on incidents of violence. They noted that such selective coverage has a detrimental effect on public opinion and “important implications for public policy issues," and to correct this they proposed that "Having demonstrated the detrimental effects of selective reporting, we must focus our attention on the inevitable question of how to counteract such reports."
In sharp contrast, the Torrey article's opening paragraphs deride advocates' attempts to balance the media's coverage of mental illnesses. For 20 years, Torrey's focus on "walking time bombs" has taken precedence over features that could show voluntary treatment programs that work for hard-to-treat individuals, and articles that reflect a growing recognition that despite serious psychiatric conditions, people can achieve fulfilling lives.
Could the public's unwarranted fear of people labeled with mental illnesses, described by Surgeon General David Satcher and others, be fallout from Dr. Torrey's 20-year public focus on violence to attain his medication goals?
December 30, 2007 News of the Week (National Stigma Clearinghouse)
TAC'S "TOP 10 STORIES OF 2007" CONTINUE A PATTERN OF FEARMONGERING
End of excerpt from NSC Archive (Dec 30, 2007)
August 9, 2011 - News of the Week
A CLOSER LOOK AT HEARING VOICES
Benedict Carey continues his remarkable New York Times series on mental illnesses with "Learning to Cope With the Mind's Taunting Voices" (Times Front Page, August 7, 2011). The series' first article ("Expert on Mental Illness Reveals Her Own Fight,” June 23) described in detail a therapist's successful battle against against suicidal impulses.
Can You Live With the Voices in Your Head?, by Daniel B. Smith March 25, 2007
Coverage of Mental Illness Provides Good Cheer , by Robert David Jaffee, August 9, 2011
Learning to Cope With the Mind's Taunting Voices, by Benedict Carey, August 7, 2011
July 18, 2011 - News of the Week
Metabolic conditions like weight gain, hypertension and diabetes, are common in populations with serious, persistent mental illnesses. People are dying 25 years younger than average, mostly from cardiovascular illnesses. This problem is made worse by the most common side effect of psychiatric medications: weight gain, diabetes, high blood pressure and high cholesterol. There are two related issues in prescribing: off-label use against FDA recommendations; and unnecessary use of multiple psychiatric medications (documented by Lloyd Sederer, M.D., medical director at the New York State Office of Mental Health, in journal articles and blogs).
- End of Article -
A 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 Dots?"
For those who are unfamiliar with Dr. Torrey's views concerning stigma, he believes that a primary cause of stigma is violence committed by mentally ill individuals. A basic flaw in Dr. Torrey's argument concerns his merging of perception and evidence. The public's perceptions may not accurately reflect reality – as any advertiser knows.
Dr. Torrey suggests six 'dots' as follows: (quote - bold type added)
(1) Stigma against individuals with mental illnesses has increased over the past half century.
(2) Violent acts committed by mentally ill persons have increased over the past half century.
(3) The perceptions of violent behavior by mentally ill persons is an important cause of stigma.
(4) Most episodes of violence committed by mentally ill persons are associated with a failure to treat them.
(5) Treating people with serious mental illnesses significantly decreases episodes of violence.
(6) Reducing violent behavior among individuals with mental illnesses will reduce stigma.
(Note: 'Treat' and 'Treatment' are code words for antipsychotic medication. ja)
Unfortunately, Dr. Torrey misinterprets the findings of researchers to promote his plan.
(1) Dr. Torrey misstates former Surgeon General David Satcher's conclusions about stigma and violence described in Dr. Satcher's groundbreaking report on mental health in 1999 (page 8). Dr. Torrey mistakes "perception of violence" to mean "evidence of violence" and thus twists Dr.Satcher's conclusions to agree with his own opinion that violence causes stigma. In fact, Dr. Satcher concludes that the public's fear is disproportionate the the low risk of violence; his report states: "Because most people should have little reason to fear violence from people with mental illness, even in its most severe form, why is fear of violence so entrenched?"
(2) Dr. Torrey misrepresents research findings (article 1996) of Matthias C. Angermeyer and Herbert Matschinger, University of Leipzig to support his view that violence committed by mentally ill people is a major cause of stigma. In fact, the researchers concluded that media coverage of mental illnesses promotes stigma by focusing selectively on incidents of violence. They noted that such selective coverage has a detrimental effect on public opinion and “important implications for public policy issues," and to correct this they proposed that "Having demonstrated the detrimental effects of selective reporting, we must focus our attention on the inevitable question of how to counteract such reports." In sharp contrast, the Torrey article's opening paragraphs deride advocates' attempts to balance the media's coverage of mental illnesses. For 20 years, Torrey's focus on "walking time bombs" has taken precedence over features that could show voluntary treatment programs that work for hard-to-treat individuals, and articles that reflect a growing recognition that despite serious psychiatric conditions, people can achieve fulfilling lives.
In a later paper (International Journal of Law and Psychiatry, 2001 Vol. 24, pp 469-486) Dr. Angermeyer and Beate Schulze state that "deviance is a prime component of 'newsworthiness'. The marked over-representation of forensic cases in press reporting about mental health is clearly the product of impact-maximizing and complexity-reducing selection routines in news production."
(3) Dr. Torrey implies that his views are confirmed by a study by Jason C. Matejkowski et al (2008). This study does not support and is not relevant to Dr. Torrey's opinion that violence is increasing among people who have a serious mental illness. In fact, the reseachers' findings discredit the familiar stereotype that Dr. Torrey has so often promoted. The article by Matejkowski et al is an analysis of violence committed by persons who have a mental illness, and is free online. “Characteristics of Persons With Severe Mental Illness Who Have Been Incarcerated for Murder”, The Journal of the American Academy of Psychiatry and the Law, 36:74-86, 2008.
RESEARCHERS EXPOSE MYTHS ABOUT VIOLENCE
For decades people with mental illnesses have been unjustly blamed for the nation's extraordinary amount of gun violence. The truth about violence, long distorted by violence-prone media and forced-medication advocates, is the topic of an article by Jonathan Metzl of Vanderbilt University, Focus on mental illness in gun debate is misleading.
The entire essay has been published on the website of The Lancet (www.thelancet.com)
PREVIEW ARTICLE by Jim Patterson
ENTIRE ESSAY by Jonathan M. Metzl
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
CBS RUSH TO JUDGMENT SENSATIONALIZES MENTAL ILLNESSES (AGAIN)! (first broadcast)
Assumes unknown "sniper on a killing spree" has a mental illness
Using bogus homicide numbers and a bumbling choice of archive materials, "Armed and Dangerous," (a 60 Minutes segment on October 13), tried to link a proposed federal gun law amendment, a series of sniper murders, and mental illness. Not enough time was spent on opposing facts and views, and people with mental illnesses were made to seem like one of society's most dangerous populations.
This is just the latest example of "walking time bomb" stories aired by CBS on 48 Hours, 60 Minutes, and 60 Minutes II. The earliest example in our CBS News file is a report in 1987 by Bernard Goldberg. Mr. Goldberg mentioned some form of "killing" 20 times in the 4-minute "news" piece, which concerned five violent incidents committed by "deranged" people over an unspecified number of years.
Last night, "Armed and Dangerous" tried to weave together stories about the present sniper killer in Maryland; a proposed gun law to add involutarily-committed psychiatric patients to federal criminal databases; and high-profile shootings by Colin Ferguson (1993), Russell Weston (1995) , Michael McDermott (2000), and Peter Troy (2002). Only Mr. Weston and Mr. Troy had any history of involuntary institutionalization, meaning that the gun law amendment would not have red-flagged the other two men for gun checks.
The important story missed is that Weston and Troy are prime examples of dismal mental health system failure. Mr. Weston was known both to the system and the FBI as someone who desperately needed help. Mr. Troy was also well-known as deeply disturbed and needing intensive care. Both cases show negligence at all levels of government to fund the required programs.
Most outrageous were the lead-in statements by Steve Croft: "Why is it so hard to stop deranged gunmen from terrorizing American communities, like the sniper who has terrorized Maryland?" And, "Every year across the United States, nearly 1,000 homicides are committed by people with severe mental illness."
The initial statement has two flaws. First, it assumes that the Maryland sniper is "deranged," at a time when there is absolutely no evidence to that effect. The killer could equally as plausibly be a sociopath, or an El Queda terrorist, or simply an angry boy of the Columbine type. Secondly, it implies that such activity is going on almost routinely across America, when anyone who reads the newspapers knows it is not.
The second statement includes the infamous "1,000 homicides" statistic that originated in the imagination of Dr. Fuller Torrey, and is unsupported by any scientific evidence.
In addition, the program failed to stress the existence of various sub-populations in this country that are far more violence-prone than people with mental illnesses.
One has to express dismay at such a sloppy, misshapen piece of journalism. It certainly falls far below the standards we have come to expect from 60 Minutes.
This segment must not be repeated. Contact 60 Minutes and executives at CBS.
E-mail Viewer comment:
Telephone comment: 212-975-3247
Mail: Don Hewitt, 60 Minutes, CBS News, 524 West 57th Street, New York, NY 10019
David F. Poltrack, Senior V.P., Research & Planning, CBS, Inc., 51 West 52nd St., New York, NY 10019
For a transcript ( + 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
Ten mental health organizations in the UK have joined in launching a beautifully-designed, well-organized new website, WordsMatter. Their aim is to establish a systematic process for encouraging people to praise good, and challenge poor, reporting on mental health issues.
June 2, 2011 - News of the Week
HOW STATISTICS CAN TWIST THE SIGNIFICANCE OF MEDICAL TREATMENTS
A New York Times column ("Translation Matters In Choices On Data" (5/31/2011) by Nicholas Bakalar reports a recent study of how treatment choices are typically made by health professionals, patients, students and the general public.
It may be necessary to right-click the link, then click "open in new window"
May 11, 2011 - News of the Week
THOUGHTS ABOUT LANGUAGE, ATTITUDES, AND DISCRIMINATION
Offensive language is bias having a good time (paraphrasing Michael Wood, 1995)
Psychiatric slurs are so common that they go unnoticed in our everyday speech. Even a standard-setter for language, the New York Times, lets columnists vent their frustration by calling opponents "crazies," and "certifiables."
It would be comforting to think that psychiatric slurs have taken on such broadened usage that they no longer denigrate mental illnesses. Sadly, that hasn't happened. Take for example Alfred Hitchcock's use of the prefix "psycho" (the original meaning is "mind") as a movie title. Hitchcock would surely be pained to know that his creation is a lucrative favorite of product merchandisers who twist the word to mean violence. A recent example is the 2011 calendar cover of Psycho Donuts in Silicon Valley.
To the detriment of the mental illness community, "psycho" has become so popular that dictionaries now list as its colloquial meanings "psychotic" and "psychopathic." This causes major confusion since clinically these are very different conditions.
Is there a solution? Suggestions are welcome. For starters, the following quote is from Michael Wood, historian and educator. Source: "We Are What We Write," New York Times, May 21, 1995.
Offensive language is more than bias; it's bias having a good time.
Just received, May 15: An astute and thought-provoking essay on language by David Oaks, Director, MindFreedom International, click "LET'S STOP SAYING "MENTAL ILLNESS" !
Announcing a new peer-reviewed open access Journal
STIGMA RESEARCH AND ACTION (SRA)
Stigma Research and Action is an open-access not-for-profit journal with no article-processing charge. It provides immediate open access to its papers on the principle that making research freely available to the public supports a greater global exchange of knowledge.
SRA's online journal is a multi-disciplinary forum for the dissemination of information advancing both research and practice as applied to any stigmatizsed condition or group.
To learn more and to read the first issue, visit http://www. stigmaj.org
April 8, 2011 - News of the Week
HOUSING CRUCIAL TO TREAT MENTAL HEALTH ISSUES
By M. J. Bright, The Daily News, Nanaimo (British Columbia, Canada)
Reprinted using Fair Use standard
Jauary 23, 2011 - News of the Week
A MUST-SEE VIDEO: SEVEN INSIGHTFUL PATIENTS DESCRIBE BOUTS WITH PSYCHOSIS
In brief videotaped portraits, seven courageous young people open their lives to the public, showing that self-understanding can be both rewarding and distressing.
This is a timely, must-see segment in a New York Times health series titled Patient Voices.
The Voices of Schizophrenia was created by Tara Parker-Pope (September 15, 2010).
Link to video: http://www.nytimes.com/interactive/2010/09/16/health/healthguide/te_schizophrenia.html
January 16, 2011
INVOLUNTARY OUTPATIENT COMMITMENT (IOC) IS NOT THE SOLUTION
It is now clear that forcibly medicating psychiatric outpatients will not prevent mass murders. When rare rampages have occurred, very few assailants had predictive histories that would have qualified them for involuntary outpatient commitment (IOC). IOC laws give the public a false sense of security rather than protection.
Kendra's Law, said to be the nation's model IOC statute, was quickly passed in August 1999 by the New York State Legislature and signed by Governor George Pataki following an intense campaign of scare tactics and false information. There was never doubt that Andrew Goldstein was guilty of Kendra Webdale's death on January 3, 1999, in a Manhattan subway. But for two previous years Goldstein had searched in vain for the help and supervision he knew he needed. Yet the forced-treatment proponents, ignoring Goldstein's 13 voluntary admissions to psychiatric facilities, proclaimed him a "treatment refuser." Anger overwhelmed facts and an outpatient forced-treatment statute (Kendra's Law) was enacted with record speed.
Thus was lost a singular opportunity to focus public attention on New York's dangerously broken system and scarcity of effective programs.
Has Kendra's Law met its promise to successfully treat patients who have histories of violent behavior (description not available) ? An internal report in 2005 showed that 85% of the program's participants had NO such history. A brutal murder in Manhattan (2008) was commited by a man who, according to his father, was in treatment under Kendra's Law. The Arizona version of Kendra's Law failed to deter the Tucson tragedy. And although the Treatment Advocacy Center claims spectacular success, a close look at the figures (elevated by basing outcome results on percentages-of-percentages) show a self-serving interpretation of the program's outcomes. Two recent independent evaluations found that the program's flaws are serious enough to postpone its expansion or permanence.
Oddly, forced treatment proponents say next to nothing about the well-known dangerous combination of alcohol, street drugs, and psychiatric diagnoses. One would expect the Treatment Advocacy Center to be in the forefront of developing and promoting integrated treatment programs aimed at treating a population whose rates of violent behavior far exceed those who have a mental illness alone. The Treatment Advocacy Center's narrow focus on medication for close to 20 years is inexplicable when safer, more acceptable treatment methods are available but lack the resources to expand.
Below are excellent selected links:
Media Ignore Key Perspective About Arizona Tragedy A statement by David Oaks, Director, MindFreedom International
Advocates Warn Against Stigmatizing Mental Illnesses A video interview with Harvey Rosenthal, Director, New York State Association of Psychosocial Rehabilitation Services (NYAPRS)
Link to Rosenthal video, in case of a problem...
Challenge the Stigma That Deters Mentally Ill From Seeking Services by Eduardo Vega, Executive Director, Mental Health Association of San Francisco. Source: San Francisco Chronicle (Jan 14, 2011)
January 12, 2011
ADVOCACY COALITION SUGGESTS WAYS TO AVERT FUTURE TRAGEDIES
For Immediate Release:
National Coalition of Individuals with Mental Health Conditions Calls for Reasonable Response to Arizona Tragedy
WASHINGTON (1/10/11) – The National Coalition for Mental Health Recovery (NCMHR), an organization of statewide networks of persons in recovery from mental health conditions as well as individual members, joins the nation in grieving the shooting of Rep. Gabrielle Giffords and other Arizonans. “We especially understand the impact of violence because, contrary to popular belief, research has shown we are no more violent than the general population and in fact are 11 times more likely to be victims of violence,” said NCMHR steering committee member Daniel B. Fisher, M.D., Ph.D.
“Let’s not scapegoat and stigmatize an entire group for the actions of a single individual,” Fisher said. “A literature review has shown that the homicide of a stranger by a person with severe mental health issues occurs to 1 in 14 million persons. This is so rare that the authors concluded it was impossible to predict violence by individuals with mental health issues (Nielssen et al., Schizophrenia Bulletin, 2009).”
The NCMHR urges decision makers to focus as much on Arizona’s and the nation’s climate of violent discourse and the need for gun control as on controlling persons labeled with mental illness. “We know from our personal experience that recovery from trauma is nurtured by respectful dialogue and blocked by vitriolic diatribe such as we see today,” Fisher continued. “We have developed the values and skills to heal the anger we believe causes much of our discord. We have learned that anger and hopelessness can be transformed to a passion for life when people are listened to and understood, especially by peers,” he said.
“As usual, there are calls for forced treatment,” he continued. “Yet Arizona already has involuntary outpatient commitment (IOC)” – which allows the compulsory treatment of individuals with mental health conditions who live in the community – “and that did not prevent this violence. In fact, IOC makes people afraid to seek treatment, fearing services that are stigmatizing and coercive.”
The NCMHR supports the provision of hopeful, compassionate services and support, and research into holistic, non-pharmaceutical approaches instead of the system’s over-reliance on psychotropic treatment. “We know from experience that peer support can reach isolated, frightened persons,” Fisher said. “So we call for a national initiative to provide peer support services at colleges and high schools to help troubled students through respectful, mutual assistance. We need to infuse recovery and support into our mental health care systems, our first responders and the criminal justice system through innovative programs such as emotional-CPR (a preventative public health program) and peer-run alternatives to hospitalization.”
NCMHR member Harvey Rosenthal, a leading spokesperson for the peer movement, was Rep. Giffords’ classmate in 2003 at Harvard's Kennedy School for Policy Leadership. “Gabby has a long record of fighting against discrimination on behalf of Americans diagnosed with mental health issues,” said Rosenthal. “We don’t believe she’d want stigma and discrimination to be fueled by this shooting."
In March 2008, Giffords praised passage of the parity legislation designed to end discrimination against persons seeking treatment for mental health issues. "Discrimination has no place in our society," said the Tucson lawmaker.
NCMHR supports the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which works to promote hope and recovery for individuals with even the most severe mental health conditions. “We appreciate the groundbreaking work SAMHSA is supporting to expand innovative outreach and engagement services, to improve service responsiveness and raise standards of care,” said NCMHR director Lauren Spiro.
Daniel B. Fisher, M.D., Ph.D., cell: 617-504-0832,
Lauren Spiro, , 877-246-9058
Harvey Rosenthal, executive director, New York Assoc. of Psychiatric Rehabilitation Services, , 518-527-0564
National Coalition for Mental Health Recovery, 877-246-9058,
January 10, 2011 - News of the Week
Excellent Article from Slate.com
'MENTAL ILLNESS' NOT AN EXPLANATION FOR VIOLENCE
Reprinted using Fair Use protection
January 7, 2011 - News of the Week
FALLOUT FROM FEARMONGERING DEFEATS GOALS OF ADVOCATES
Associating mental illness with violent behavior creates a huge barrier to funding services adequately ... a larger concern is about the long-term consequences of stigma aroused by the report [see below], especially when reinforced by prevailing media images of mental illness. Stigma sets up barriers to housing, jobs, forming relationships -- it really sets people back. And individuals who are ill won't seek help because they don't want to be considered one of 'those' people. Jennifer Stuber, Washington State Coalition to Improve Mental Health Reporting. From article by Judy Lightfoot, Crosscout.com, Jan 05, 2011
Bad news came this week from Washington state. Facing cuts to mental health services, a healthcare union hoped to win more funds from the state legislature by playing a violence card. Union spokespeople told protesting advocates that tight competition for scarce funds drove them to use a violent cover image and caption on a report they submitted to the legislature.
The downside is that fearmongering results in less public support, not more. (Study Finds Fear Tactics Win Public Support for Coercion, Segregation, and Avoidance -- But No Increase in Resources) Source: Patrick Corrigan et.al., Implication for Educating the Public on Mental Illness, Violence, and Stigma, Psychiatric Services 55-577-580 May 2004
See the crude and deeply stigmatizing report cover, and read the excellent article by Judy Lightfoot concerning the advocates' vehement protest, Can scare tactics sell the state on mental health funding
December 18, 2010 - News of the Week
THOUGHTS ON A HUFFINGTON POST BLOG AUTHOR
From a marketing perspective, it may be necessary
Memo from D.J. Jaffe to NAMI advocates, 1993
Despite a strong push by supporters of Kendra's Law to make it permanent, New York's lawmakers voted in June 2010 to extend the law for five years and further test its effectiveness. The most recent evaluations (see list below) of the controversial law found that the key issue of voluntary vs. involunary psychiatric medication was far from resolved due to insufficient data. Researchers also found troubling disparities in the law's implementation across the state.
1st evaluation of Kendra's Law:
2nd evaluation of Kendra's Law:
3rd evaluation by Jo C. Phelan et. al, published in Psychiatric Services: