Saturday, January 26, 2013

Now is the Time: Sebelius, Hyde, and Insel Begin National Dialogue on Mental Illness

HHS Secretary Sebelius held a public phone call on Jan 16 regarding the expansion of mental health (MH) treatment, especially for kids. This was the day after President Obama's "Now is the Time" [pdf] plan was released. The recorded 30-minute phone call is available until Feb 15 and can be listened to by calling 888-568-0013 (no codes or anything).

Here are some of the points I noted while listening:
  • 60% of people with mental illness and 85% of people with substance use disorders do not receive help
  • failure to receive help is largely due to stigma and people not asking for help [umm, what about failure to access help due to insurance barriers and inadequate and inaccurate provider directories?]
  • Project AWARE to train 5000 MH professionals to help identify MH problems in school age kids
  • to help eliminate stigma, she will be initiating a year-long "national dialogue" about mental illness, focusing on young people
  • mentioned a Healthy Transitions program for young adults

Then SAMHSA Director Pam Hyde entertained questions from callers. My telegraphic notes are below:

  • peer specialists (Pam called them "peer professionals")
  • surrogate parents and their MH needs
  • workforce issues
  • correlation of violence w psych meds; toxic practices w/in MH; stigma of coercive treatment; fear guns removed w/o reason 
  • veterans' advocate in Michigan: how do we determine who is at risk and who is not; removing vets' guns; how to reach people in gangs
  • APRN public health nurse: expanding nurses' scope of practice to treat people with mental illness can improve access
  • hope for expansion of voluntary, and not involuntary, treatment; "open dialogue" concept from Finland
  • ACLU: training police to deal better w MH symptoms, esp in kids, so they don't enter the justice system
  • NFFMH: concerns about cuts to existing programs for families

NIMH Director Tom Insel was also present, and said additional questions and comments can be sent to this email:


CatLover said...

Don't see how stigma can be reduced when the whole purpose of any new funding is to identify and lock up those crazy potential killers.

George Dawson, MD, DFAPA said...

Sounds like a typical political approach to problem solving. In order to solve the problem of no access and no services, the government needs to acknowledge their role in rationing along with their agents in the managed care industry. It seems like they will do anything except actually address the problem and this call is strong evidence that the trend is continuing.

Anonymous said...

To be honest, when I saw the title of this blog entry, I initially agreed with Dr. Dawson. But after seeing that the Open Dialogue Program was mentioned, I am cautiously optimistic that maybe the powers to be realize that the same old, same old (meds and nothing else) is not working.

Dr Dawson and the Shrink Rappers might want to read this article about Dr. Sandy Steingard, who has been a practicing psychiatrist for many years on Vermont and how she is leading a team in doing this program.

Dr. Dawson, I partially disagree that this has been an issue of access. Many of the shooters were already in the mental health system as they were taking psych meds. That worked really well didn't it?

Sorry, I don't mean to be sarcastic but I get extremely frustrated that this issue is being overlooked even though I feel that while drugs may be an issue in some of the shootings, that isn't always the case.

Maybe the APA needs to start demanding more programs like this because as Dr. Steingard said in the article, while APs are effective for some of her clients, they aren't for everyone and have serious long term side effects.

Also, in Finland, where this program originated and is very successful, patients in it look forward the participating. They were actually shocked that Americans had a different attitude about psychiatry which is totally understandable since all the profession has to offer is meds.

Until psychiatry starts truly believing that people can recover without meds who chose that approach, there will be more shootings and the folks in the mental health system will shy away out of fear of being locked up.


Susan Inman said...

Thank you very much for letting us know about this.
Anonymous might like to know that the Early Psychosis Intervention (EPI) programs we have in Canada certainly don't just offer medications. They provide many services (free of charge) which include excellent science based education about psychotic illnesses for both the clients and their families. Included in this education in the Vancouver EPI program is information about the lack of insight (also known as anosognosia) that is very common in psychotic illnesses. Why should people consent to treatment for illnesses they don't realize they have?

A key problem in both the US and Canada is the lack of public education about the early warning signs of psychosis. It's good to have plans for 5000 new workers to assist in identification of problems, but this knowledge is a public health issue and should be widespread. I discuss some of the reasons it isn't widespread in a recent Huffington Post Canada article, "What I Wish I Knew Before My Daughter's Psychotic Break."

Anonymous said...


I think what AA is saying is that the same things don't work for everyone so what might work for you, might not work for me. I see a psychiatrist, and if I were psychotic and he started talking about the "science based education about psychotic illness" that you mentioned, I think it would make me gag, and I would probably run away. I would be much more open to a program like AA mentioned. Different stuff works for different people.

There's an interesting documentary called A Drop of Sunshine which can be viewed for free on Culture Unplugged. It's about a young woman in India with schizophrenia. What I like about it is that the psychiatrist recogized that he didn't have all of the answers, and he listened to his patient. He worked with her, even when she did not want medications. I like my psychiatrist, and I suspect he is a lot like the psychiatrist in the documentary. He is open to my views and doesn't write me off as a crazy woman, he may not always agree with my decisions but he respects my right to make them.

Susan Inman said...

I should have offered more information about the Early Psychosis Intervention programs; they certainly don't offer psychoeducation programs to people trapped in a psychosis. These programs are offered when the person has emerged from psychosis and is trying to make sense of what has happened and ready to learn about how to manage such a difficult brain disorder. These are very popular programs among the participants and their families. And although the benefits of early psychosis intervention programs are well researched, the US has been very slow to adopt their use. I assume this is because of the enormous power of groups that don't view psychosis as a treatable brain disorder.
The attention given instead to Finland's small and minimally researched Open Dialogue program is troubling. These programs do use medications when necessary and, like early psychosis intervention, don't use them when they aren't necessary. Perhaps some of Open Dialogue's success can be attributed to the ample services provided - similar to the many helpful services EPI programs offer. I certainly don't see why OD's psychoanalytically oriented approach to psychosis would be more successful, since psychiatry was very unsuccessful in treating schizophrenia when this was the dominant paradigm.
I'm very concerned about the assumption that all people living with psychotic illnesses oppose involuntary treatment. My daughter and her friends want to ensure that they are never left in untreated psychosis in the future because of mistaken approaches to protecting their human rights.
Erin Hawkes has written an interesting article about how forced medication saved her life:

elbee said...

I was involuntarily committed. I was brought in by the police at the behest of my psychiatrist. Not something I'd like to repeat. However, if I hadn't had him and also caring family members I probably would have self-destructed. It's hard for me to even imagine what would have become of me. I also owe my life to psychiatric medication. I would definitely have committed suicide without it. I know not everyone has the same experience, but that is mine...

Joel Hassman, MD said...

If people really think that state and federal governments will step in and make a difference, please see Einstein's quote once more and regain perspective. Doing the same thing over and over and expecting different results is insanity, it really is.

Case in point is Maryland as example A. The state has closed state inpatient beds these past 10 plus years, and now you really think they will add sizeable monies to the budget to either reopen them or put realistic funds to compensate for seriously chronically ill patients to access substitute services out in the communities? Get real?

And what can the federal government possible offer at that level to impact on individual communities across the country? I forget the Surgeon General's name during the late Clinton era or early Bush period, who provided a frank look at mental health needs in his commission review, around 2000-2003 or so, and where have those findings gone?

Let's have a moment of brutal candor and honesty here folks, we are dealing with people in Congress who are as characterologically impaired as the patients those of us as providers see day in and out, except most of them in DC are as pathologically narcissistic and antisocial as you will meet. And to raise real intention to help people who do not vote as a collective, well, you figure it out!

Rigid inflexible people are running our governments, irregardless of party affiliation, and people who vote incumbent year in and out won't be of help. You want to make real change on the Dialogue on Mental Illness, 2 things have to happen: first, you'll have to wait until 2014, for the second thing, elect people who you personally ask what are their positions on mental health needs in this country, and their positions mirror yours.

We are a culture of scapegoating, lack of accountability, and focus on easy, quick outs. Nothing that resembles what needs to be done in mental health care. Am I wrong?!

Anonymous said...

Susan, sorry for jumping on you. I think I'm a little on edge because of all that is going on in the U.S. right now and the push to take away more of our rights It's really depressing. When I read "anosognosia," my mind immediately thought of Treatment Advocacy Center because they are the ones in the U.S. usually talking about it. TAC scares the heck out of me as a patient, because they believe the answer to everything is force. So, as a patient, I see anything associated with them and I want nothing to do with it. But, I do recognize that that may not have the same meaning in Canada (and also maybe not with everyone in the U.s.). So, my apologies for assuming the worst.

I like what SAMHSA is saying. It gives me hope. I would like to see psychiatry move more in that direction and away from the Treatment Advocacy Center's direction which focuses on force. Fortunately, my psychiatrist seems like he falls more on the SAMHSA side rather than the Treatment Advocacy Center side, which is a good thing.

I really encourage people to watch the documentary A Drop of Sunshine, because it shows psychiatry at its best I believe. I think the best fit for me is a psychiatrist who falls under that model. Like the psychiatrist in the documentary, my psychiatrist offers the medical model (i.e. medication) but doesn't force it. He respect's my voice, even when we may not agree. He is willing to admit there is much he does not know, works with me (and all of my opinions), and he honors me as an individual person. I would completely give up under a program that uses force, like AOT. It would crush my spirit.

So, yea for SAMHSA.

Heather said...


I have a quick question about your blog, do you think you could e-mail me?


leonard said...

Dear Heather: the blog email is shrinkrapblog at g m a i l dot c o m


Nathan said...

I would hope from a public health standpoint that increased access to and participation in treatment would be helpful for people, but there are also lots of folks who have had their lives made much worse from their voluntary or involuntary participation in the mental health system. Especially in light of proposed increased infringement on privacy, false reporting on the dangerousness of distressed people, inter-agency sharing, and rights violations, I don't see more people lining up for treatment.

I agree with Anonymous in that I bristle at psychoeducation about anosognosia as an example of a somehow safe, science-based, treatment for early psychoses. I think a lot of people have had the experience of that term thrust on them as an excuse to use forced treatment, mislead friends and family, and decrease coherency of their own thoughts and self-hood.

So, while it's nice to see lip service about supporting people who are distressed and a public health concern, I doubt these efforts will lead to better access to helpful care nor decrease stigma. If anything, I see increased possibility of entrenching a good patients vs. bad crazies system of care where if folks don't benefit from, disagree with, or don't want offered treatment, they are severely disciplined and demonized by forces of law, medicine, and media.

Roy said...

I hope this National Dialogue is not just about psychosis but about the range of mental illness and or mental health problems. There are many people with challenges around anxiety and depression, drug and alcohol abuse, domestic violence and self-hatred, who at some level want to get off the merry-go-round and have a healthier life. Making them feel like outcasts by forcing treatment and reporting them for thought crimes does not sound like actions conducive to seeking out help. Let's hope we can find better paths together, paths of optimism not cynicism.

Sarebear said...

I hope that they focus on all types and ages of people, not just young males who they can more easily picture shooting places and people up, and thus they may devote so much more time, attention, and funding towards, that there's less for the ill who fall outside of that demographic.

I'm skeptical that they have much concern, say, for a 40 yo mom who has been disabled by the various co-morbid disorders, illnesses, anxieties, etc. Esp. since they may assume said person gets disability. I am so tired of having to depend on charity for my mental health care.

I hope that they consider a wide variety of people and needs; I am quite skeptical about this.