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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


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

As is well known, the pharmaceutical industry has long funded CEU and CME curriculums, and given that funding influence, such curriculums have paid little attention to psychiatric drug withdrawal. Mad in America Continuing Education does not receive any corporate funding for its online seminars, and thus this seven-seminar course will be one of the first online continuing education courses on psychiatric drug withdrawal that is free from such corporate funding.

This MIA course is not designed to provide advice to individuals who are seeking to taper from their medications. Instead, it is designed to explore the risks and rewards of doing so and methods for doing so successfully. It is also designed to identify the many shortcomings in our medical and societal knowledge about withdrawing from psychiatric drugs.

A unique aspect of this course is that it begins and ends with seminars featuring a panel of “experts by experience”—those who have personal experience withdrawing from psychiatric medications and who are now engaged in promoting knowledge about this subject in one manner or another.

The cost of the seven-seminar course is $100. However, there is an early-bird price of $50 for the first 75 students that register.  The early-bird coupon code is EARLYBIRD.

Non-professionals who cannot afford these fees can apply for a scholarship.

Each seminar will offer one CEU, and thus seven CEUs for the complete course. (Pending approval.)





October 24, 2017: Experts by experience

9:30 pm GMT,   5:30 pm Eastern,   4:30 pm Central,    3:30 pm Mountain,   2:30 pm Pacific

Emily Cutler will moderate a panel of three individuals, Dina Tyler, Oryx Cohen and Jocelyn Pedersen, who have successfully withdrawn from psychiatric medications.  They will tell of their experiences doing so and also describe their ongoing efforts to provide support to others seeking to taper from the drugs.


November 14, 2017: Antipsychotic withdrawal/reduction in a public mental health setting

7:30pm GMT,   2:30 pm Eastern,   1:30 pm Central,   12:30 pm Mountain,   11:30 am Pacific

Psychiatrist Sandra Steingard presents on research that provides an evidence-based rationale for supporting patients to taper from antipsychotics. She will discuss some of the challenges psychiatrists face when they are open to tapering and discuss her 5-years of experience of using a collaborative decision model that supports public mental health clients in deciding whether to reduce their dose of neuroleptic drugs.


December 12, 2017: Medication reduction and wellness

7:30pm GMT,   2:30 pm Eastern,    1:30 Central pm,   12:30 pm Mountain,   11:30 am Pacific

Psychiatrist Kelly Brogan presents on her clinical experience working with patients withdrawing from psychiatric drugs; the role of addressing the physical and emotional reasons that gave rise to psychiatric “symptoms” in the first place (with a particular focus on anxiety and depression); and the psychospiritual underpinnings of this withdrawal process. She will describe her approaches in her clinical practice and her online healing community.


January 16, 2018: An alternative, non-medical approach to drug withdrawal

6:30pm GMT,   2:30 pm Eastern,    1:30 pm Central,      12:30 pm Mountain,    11:30 am Pacific

Swedish Therapist Carina Håkansson will tell of her nearly three decades of experience, first as Founder of the Family Homes Foundation and now as founder of The Extended Therapy Room, helping people taper from psychiatric medications. She will speak of her need to “put on a white coat”, given the absence of a medical-based practice for drug withdrawal.  She will tell of how residential care can be organized around a person in crisis during drug withdrawal. She will also report on the activities of the International Institute on Psychiatric Drug Withdrawal, which she founded last year to bring together international experts on this subject to develop both drug-withdrawal training and research.


February 20, 2018: The evidence base for psychiatric drug withdrawal and risks of withdrawal syndromes

6 pm GMT,    1 pm Eastern,   12 Noon Central,   11 am Mountain,   10 am Pacific

Psychiatrist Peter Breggin will present on the hazards of long-term use of psychiatric drugs, which provides a compelling “evidence base” for psychiatric drug tapering protocols; drug-withdrawal syndromes that patients experience when tapering from psychiatric drugs; the biological explanations for such syndromes; and for patient-centered and controlled approaches to successful drug tapering and withdrawal.


March 20, 2018: A harm-reduction approach to psychiatric drug withdrawal

5 pm GMT,    1 pm Eastern,   12 Noon Central,   11 am Mountain,   10 am  Pacific

​T​herapist​ Will Hall, ​​​PhD candidate, and author of the Harm Reduction Guide to Coming Off Psychiatric Drugs (translated into 15 languages and used world-wide) discusses how he works with individuals, families, and clinicians using a person-centered and flexible approach to drug withdrawal as a life change ​and learning ​process​, including drug response diversity,​ ​crisis risk,​ ​and alternative responses to experiences seen as psychotic.


April 17, 2018: Developing a drug-withdrawal agenda for the future

5 pm GMT,    1 pm Eastern    12 Noon Central     11 am Mountain      10 am Pacific

A panel of people with lived experience will review this first MIA withdrawal course, its strengths and shortcomings, and discuss an agenda for developing drug-tapering knowledge and support programs. What do we, as a society, know about this subject, and what do we need to learn?


Presenter Bios

October 24

Moderator Emily Sheera Cutler is a Mad woman and psychiatric survivor who is passionate about fighting for cognitive liberty – the right to experience any and every thought, feeling, belief, state, and expression of such as long as it does not harm another person – and combating paternalism. She received her Bachelor’s in Communication from the University of Pennsylvania, where she completed an honors thesis on sizeism and ways to promote fat acceptance in schools. After her involuntary psychiatric hospitalization at age 20, Emily became particularly interested in fighting for the civil liberties of people labeled mentally ill and became involved with the psychiatric survivors movement.  Emily is currently the Assistant Editor and Community Moderator for Mad in America. In addition to her role at Mad in America, she is a consultant at the National Empowerment Center, where she has helped plan the consumer/survivor/ex-patient led Alternatives Conference and assisted with Emotional CPR, a non-coercive, non-pathologizing approach to emotional distress and crisis. Emily is also the founder of the grassroots group Southern California Against Forced Treatment, which works to educate the public about the issue of psychiatric confinement and forced treatment as well as provide a force-free, coercion-free space for people to express themselves authentically.

Oryx Cohen is Chief Operating Officer of the National Empowerment Center (NEC) and is working on mental health systems change on state by state basis. The most important part of what informs his work is his lived experience with altered states of consciousness: being diagnosed, hospitalized, and subsequently finding a path to healing.  Oryx is also the Co-Producer and a subject in the award-winning social action documentary, HEALING VOICES, which was released in 2016.  Oryx trains with fellow Freedom Center co-founder Will Hall across the world on harm reduction approaches to coming off psychiatric drugs.  He co-directed the Western Massachusetts Recovery Learning Community for several years and helped them develop a high successful system-funded peer-run alternative to the mainstream system (  He has served on several boards and committees internationally, nationally and regionally, including the International Network Toward Alternatives for Recovery (INTAR) and the National Association for Rights Protection and Advocacy (NARPA). He has volunteered with MindFreedom International, directing its Oral History Project which collected and documented consumer/survivor/ex-patient stories of abuse, empowerment, and healing in the mental health system. He is currently adjunct faculty in the Westfield State College Psychology Department.

Jocelyn Pedersen graduated Suma Cum Laude from Brigham Young University with a BS in education and a minor in music. She spent two years teaching before she decided to start a family and become a full time mother of two children and part time performer.  Prescribed Ambien for insomnia, Jocelyn developed a benzodiazepine associated illness, was misdiagnosed, and treated for 3 years with antidepressants and a benzodiazepine.

After becoming educated about this iatrogenic illness, Jocelyn worked to educate and assist others in safely tapering and recovering from benzodiazepines and their associated disability.  She has used her YouTube platform, Benzo Brains, to create educational/support content for benzo victims and their loved ones.   Jocelyn was invited to participate in a panel at the 2017 International Benzodiazepine Symposium in Bend, Oregon.  She is currently an author at Mad in America and The Mormon Women Project.

Dina Tyler is a psychiatric survivor, trainer, advocate and peer supporter. She holds the values of the consumer/survivor/ex-patient movement close to her heart that people should have a choice in their treatment, that social inclusion and empowerment of people with lived experience should be a primary focus of improving services, and that recovery-oriented, whole health and integrative approaches should be part of the public mental health system. Dina currently works with people and families seeking an alternative to conventional mental health treatment, supporting those who choose to discontinue taking psychiatric drugs, through offering peer support, sharing personal experience of withdrawal, and working directly with individuals, providers and support networks to create environments conducive to successful withdrawal in the community.

Dina is the Director of the Bay Area Mandala Project, a group bringing together alternative healing communities to support the transformational and spiritual aspects of extreme states of consciousness. She has seven years experience in community mental health working in early psychosis and bipolar intervention programs around the Bay Area, where she trained and supervised peers and family supporters, trained clinical staff on recovery-based language and approaches, and brought compassionate alternative approaches through direct peer support and mentorship.  She is a co-founder, facilitator and Board Member of the Bay Area Hearing Voices Network. Dina was awarded the prestigious Peer Specialist of the Year by the National Council for Behavioral Health in 2015 for her work with young adults recently diagnosed with Schizophrenia.


November 14

Sandra Steingard, MD is Associate Clinical Professor of Psychiatry at University of Vermont Larner College of Medicine and Chief Medical Officer at Howard Center, a community mental health center in Burlington, Vermont where she has worked for the past 22 years. For over 25 years her clinical practice has primarily included patients with schizophrenia and other psychotic illnesses. She was named to Best Doctors in America in 2003. She currently writes a blog called “Anatomy of a Psychiatrist” a She has served on the board of the Foundation for Excellence in Mental Health Care since 2012 and has served as chair since 2016.

In recent years, her main areas of interest have been in using antipsychotic drugs in a more selective ways and integrating Open Dialogue practices into her clinic. Along with colleagues, she has developed a Vermont-based need-adapted program called Collaborative Network Approach. Dr. Steingard has presented a previous course for Mad In America Continuing Education, “Antipsychotics: Short and Long-term Effects.”  She has lectured around the world on these topics.  She chaired a workshop and symposium at American Psychiatric Association meetings on the optimal use of antipsychotic drugs. She has tracked a series of individuals who have been tapering their doses of antipsychotic drugs and will present this data in this lecture.


December 12

Kelly Brogan, MD is a Manhattan-based holistic women’s health psychiatrist, author of the NY Times Bestselling book, A Mind of Your Own, and co-editor of the landmark textbook, Integrative Therapies for Depression. She completed her psychiatric training and fellowship at NYU Medical Center after graduating from Cornell University Medical College, and has a B.S. from MIT in Systems Neuroscience. She is board certified in psychiatry, psychosomatic medicine, and integrative holistic medicine, and is specialized in a root-cause resolution approach to psychiatric syndromes and symptoms.

She is on the board of GreenMedInfo, Price-Pottenger Nutrition Foundation, Functional Medicine University, Pathways to Family Wellness, NYS Perinatal Association, Mindd Foundation, the peer-reviewed, indexed journal Alternative Therapies in Health and Medicine, and the Nicholas Gonzalez Foundation. She is Medical Director for Fearless Parent and a founding member of Health Freedom Action. She is a certified KRI Kundalini Yoga teacher and a mother of two.


January 16

Carina Håkansson, is a Doctor in psychology and licensed psychotherapist at the Extended Therapy Room in Gothenburg, Sweden, where she as part of her work helps people taper off psychiatric medications.  In 1987 she created the Family Care Foundation which is built on close collaboration between family homes (a kind of foster home), those called “clients,” their families and professional helpers in order to provide a place which could create “new possibilities” while avoiding the use of psychiatric diagnoses.  In 2016 she founded the International Institute for Psychiatric Drug Withdrawal to bring together international experts on this subject to collect existing knowledge and to develop drug-withdrawal training and research.

Carina has written a number of articles about psychiatry and societal treatment of children in foster care and the ongoing challenges of helping people withdraw from psychiatric medication.  She has written three books. The latest, Ordinary Life Therapy: Experiences from a Systemic Collaborative Practice, was published in 2009. One of her articles, “Cut Out Wood Dolls,” was published in the journal Psychosis, and explores what it is like to “be with” a person who is experiencing terror.



February 20

Peter Breggin MD is a Harvard-trained psychiatrist and former Consultant at NIMH who has been called “The Conscience of Psychiatry” for his many decades of successful efforts to reform the mental health field. His work provides the foundation for modern criticism of psychiatric diagnoses and drugs, and leads the way in promoting more caring and effective therapies. His research and educational projects have brought about major changes in the FDA-approved Full Prescribing Information or labels for dozens of antipsychotic and antidepressant drugs. He continues to educate the public and professions about the tragic psychiatric drugging of America’s children.  Dr. Breggin has taught at many universities and has a private practice of psychiatry in Ithaca, New York.

Dr. Breggin has authored dozens of scientific articles and more than twenty books, including medical books and the bestsellers Toxic Psychiatry and Talking Back to Prozac. Two more recent books are Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide and Crime and Psychiatric Drug Withdrawal: A Guide for Prescribers, Therapists, Patients and their Families.  His most recent book is Guilt, Shame and Anxiety: Understanding and Overcoming Negative Emotions.  As a medical-legal expert, Dr. Breggin has unprecedented and unique knowledge about how the pharmaceutical industry too often commits fraud in researching and marketing psychiatric drugs. He has testified many times in malpractice, product liability and criminal cases, often in relation to adverse drug effects and more occasionally electroshock and psychosurgery.



March 20

Will Hall, MS is a counselor and facilitator working with individuals, couples, families and groups,   He has taught and consulted on mental health, trauma, psychosis, medications, domestic violence, conflict resolution, and organizational development.   He is a schizophrenia diagnosis survivor and has worked for more than 15 years in community development in the recovery and psychiatric survivor movement.  He is the author of The Harm Reduction Guide to Coming Off Psychiatric Medications and many other publications.

He has consulted and presented for more than 50 organizations in over 13 countries

He holds a Diploma and Masters Degree in Process Work from the Process Work Institute, and is a PhD candidate at Maastricht University Medical Center and has studied with Jaakko Seikkula in Open Dialogue at the Institute for Dialogic Practice.

bnikkel_miaceRobert Nikkel, MSW, is a Clinical Assistant Professor in the Public Psychiatry Training Program at Oregon Health and Science University. He was the State of Oregon’s commissioner for both mental health and addictions from 2003-2008. He is the director of the Mad in America Continuing Education project and a member of the Board of Directors of the Foundation for Excellence in Mental Health Care.

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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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