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February 6, 2018 by Bob Nikkel, MSW

What Would a Truly Integrated System of Care Look Like?

Imagine that you were the director of a health insurance company and you had just agreed to provide health coverage to several hundred thousand people and you will have to fund health care including mental health and alcohol/drug care too.  This is called “integration.”

What it means financially is that you will lose a lot of money if you ignore the physical health needs of people with mental health problems.  In the parlance of insurance folks, you’re “at risk.”

Now, someone walks into your office and tells you that about a quarter to a third of the people you’ve just signed up to serve are being poisoned but no one really knows about it or recognizes it.  If it’s true, you stand to lose a lot of money unless you figure out what’s going on.  And what if they also tell you that the poisoning is not some form of environmental pollution like smoky air or unclean water but is actually being caused by the very providers of health and mental health that you’re about to be supporting?

Since you’ve been in the health insurance business for a while, you recognize that in western medicine, almost everything that’s provided is some form of mutilation, i.e. surgery, or poisoning, i.e. medications.  (Please note that if you’re a physician and reading this and taking some level of offense, the recognition I just pointed to was made by a physician, a well-respected one at that and he meant no offense, nor do I – just a simple way of thinking about things and the key question is whether the risks outweigh the benefits or vice versa.)

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December 11, 2017 by Bob Nikkel, MSW

How Would We Know If We Really Reformed the Mental Health System?

This post updated 12/28/2017

I have been wondering for some time how we would know if the mental health systems in the United States were really reformed.  It is true that there are “a thousand points of light,” many great new and older programs and initiatives out there with tremendous advocacy and efforts at radical change.  But when a system leaves so many without recovery-oriented supports, it is like swimming upstream against a powerful current.  Here are 25 indicators that if fully implemented would represent a complete system reform.

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October 7, 2017 by Bob Nikkel, MSW

The Continuing Education Course on Withdrawal from Psychiatric Drugs is Here!

At the beginning of September, I wrote about the next stage of the Mad in America Continuing Education project—the development of webinar formats and I announced the planning for a “course” on withdrawal from psychiatric medications.  At that time, I was able to provide only introductory information but now I can provide a full picture of the 7 webinars that comprise the course and update a few other developments.

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September 27, 2017 by Bob Nikkel, MSW

New Continuing Ed Course On Psychiatric Drug Withdrawal

Overview

This series of seven 90-minute webinars will feature presentations by people with “expertise by lived experience,” psychiatrists, and other professionals on a topic of critical importance: What do we know about withdrawal from psychiatric medications? The educational purpose of the series is to present information and insights that arise:

  • from users’ experiences and their efforts to support others who want to taper from their psychiatric medications; research on drug withdrawal,
  • the clinical experience of psychiatrists and other professionals who have supported patients tapering from psychiatric medications, and
  • research on drug tapering programs and efforts

Education.MadInAmerica.com/p/psychiatric-drug-withdrawal

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September 1, 2017 by Bob Nikkel, MSW

The Continuing Evolution of Mad in America Continuing Education

The Mad in America Continuing Education Project is continuing to evolve.  Earlier in this year, we initiated a new way of providing our courses—a webinar format which has been going over quite well.  Over 200 people took Dr. Chris Gordon and Keegan Arcure’s live course on Open Dialogue —and the numbers have continued to grow as people watch the webinar after the fact.  So we have decided to ramp up our webinar offerings.  We have produced two more so far; one on Oregon’s early psychosis intervention program, EASA (Early Assessment and Support Alliance), and another with Denmark’s Olga Runciman speaking on withdrawing from antipsychotic drugs.

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June 23, 2017 by Bob Nikkel, MSW

You Say You Want a Revolution, Part 2

Two years ago, I wrote a blog entitled “So You Say You Want a Revolution?” in which I laid out in general terms what I saw at that time as the key ingredients in making revolutionary changes in public mental health systems–they were 5 C’s:  Commitment, Courage, Creativity, Capability, and Care.

I’ve had 2 more years to think about these things and have a few more thoughts on the topic.  If working from the 5 Cs seemed daunting before, my ideas for system revolution are now more specific and even more challenging.

A formative experience for me was beginning to work several years ago with a large state agency that served many young people with mental health problems.  A colleague from my days as the state mental health and addictions commissioner began to talk with me about my new perspectives on the treatment of people with mental health challenges.

He told me that he was interested in looking at how psychiatric medications were being used in his agency.  His words were encouraging:  “Whatever we’re doing, I want to make sure it is in the best interests of the youth in our care.”  I jumped at the chance.  I toured facilities, discussed the issues and the risks in overusing medications with another former colleague who was in charge of treatment services.

The bottom line ended up being a financial equation:  “If it costs a dollar to keep a young person out of trouble using medications and it costs a lot more to keep the young person under control with staffing, what do you think we’re going to do?”

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June 1, 2017 by Bob Nikkel, MSW

Trauma in Common?

Recently, I had a chance to look at a review of DJ Jaffey’s new book, Insane Consequences:  How the Mental Health Industry Fails the Mentally Ill.   As can be expected, the book will meet with considerable blowback–a starting example:  The title of the book using the long outdated term “insane” will set some bells and whistles going.

But I found myself asking whether that is such a good thing considering, among many other dynamics, the deep polarization that is spreading almost like an illness through all of America these days and even contaminating views of us abroad as well.

The dispute that will be ignited further is the one between the proponents of DJ Jaffey’s world and that of the “other side”–those who are equally dissatisfied with how the mental health system works because it does not respect the individuality of persons with major mental health challenges and does not support the idea that people can recover–even those with the most damaging diagnoses of “schizophrenia.”  The latter group is one that is actually quite diverse and includes everyone from progressive members of the American Psychiatric Association (admittedly still a minority though growing group) to the antipsychiatry advocates.  There are numerous other advocates in between including some long-time NAMI leaders who are speaking to the harm of conventional mental health treatment and pushing for many kinds of alternatives.

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April 12, 2017 by Bob Nikkel, MSW

Mad in America to Host Webinar On Oregon’s Innovative Early Psychosis Programs

On Friday, April 28th, from 1-2:30 pm Eastern time (10-11:30 am Pacific), Mad in America Continuing Education will be host a webinar on the Early Assessment and Support Alliance, a one-of-a-kind early intervention project in Oregon for youth experiencing psychosis. The EASA projects are unique in that they build on nearly 2 decades of outcome research and represent a pragmatic blend of models from Australia, Open Dialogue, and others.

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April 5, 2017 by Bob Nikkel, MSW

Opening a Dialogue about Early Psychosis Programming in the United States

As a state mental health commissioner and after, I’ve had a long interest in the development of early psychosis intervention services. During my tenure in the state executive position, I worked with a number of community partners to secure $4.3 million from the Oregon Legislature in 2007 to expand the regional Early Assessment and Support Alliance program to about 75% of the state and today, Oregon has 29 programs – more than the most populous states of California and New York.

So when the Schizophrenia Research Foundation announced a webinar to “discuss the paths and barriers to widespread effective care” for young adults and their families experiencing an early psychosis, I jumped at the opportunity to sign up.

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March 23, 2017 by Bob Nikkel, MSW

April 28 Webinar: Oregon’s signature early psychosis program & outcomes

MIACE-logoOn April 28, 1:00-3:00 pm (Eastern)/10 am-Noon (Pacific) Mad in America Continuing Education will host a webinar on a one-of-a-kind early psychosis intervention project, the Early Assessment Support Alliance (EASA). EASA provides training, research and support for Oregon’s statewide early intervention programs.

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