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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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March 7, 2017 by Bob Nikkel, MSW

Victims of Success: an Update from Mad in America Continuing Education

In mid 2016, we asked Dr. Chris Gordon to consider teaching one of the Mad in America Continuing Education online courses. Dr. Gordon is the inspiring psychiatrist in Framingham, Massachusetts who, eight years ago, responded to a request from a person in his program to look into Open Dialogue, an approach to working with early psychosis in Finland. At that time, and unfortunately even now, very few if any mental health professionals in the United States had ever heard of this innovative and highly successful program.

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February 10, 2017 by Bob Nikkel, MSW

March 8 live webinar: Open Dialogue: A Recovery-Oriented Approach to Early Episode Psychosis

Six years ago, Dr. Chris Gordon set out to train in Open Dialogue practices which had produced such good long-term outcomes for first-episode psychotic patients in Northern Finland. Dr. Gordon is medical director of the large community mental health organization Advocates Inc. in Massachusetts.  Advocates developed the first pilot project in the country, which they call the Collaborative Pathway, to adapt these methods in the United States. Advocates’ outcomes have been promising, with very high satisfaction from young people and their families, and good clinical outcomes.

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January 27, 2017 by Bob Nikkel, MSW

SAMHSA’s Rose-Colored Lens

The US Substance Abuse and Mental Health Services Administration (SAMHSA) should be commended for its attempt to provide a basic understanding of recovery-oriented care, and its attempt to bring recovery-oriented practice into the mainstream of professional practice.  To that end, it has produced a series of on-line training modules for peers, social workers, nurses, psychologists and psychiatrists. It has done this in collaboration with related national professional and peer organizations.

I have taken advantage of their availability recently to review them for content and to make some comparisons to what we are offering at the Mad in America Continuing Education project.  In this blog, I will share my observations and focus on the medication module developed by SAMHSA in partnership with the American Psychiatric Association and the American Association of Community Psychiatrists.

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January 9, 2017 by Bob Nikkel, MSW

Holding the Hope for New Vision at the NIMH?

It’s the beginning of a new year — and with Dr. Joshua Gordon’s ascension to the position of director at the National Institute of Mental Health, a new approach to research on mental health care.


Or not?


A quick history of the NIMH leadership over the past couple of years:  From 2002 to 2015 Dr. Tom Insel headed up this federal agency, and led the charge for finding the “real” cause of “mental illness.”  He has now moved on to Google Life Sciences (GLS) to help in their mission to develop “new technologies to transform healthcare, such as a contact lens with an embedded glucose monitor. The GLS mission is about creating technology that can help with earlier detection, better prevention, and more effective management of serious health conditions.”  Insel’s stated intention in joining Google is “to explore how this mission can be applied to mental illness.”  Giving credit where it’s due, he did acknowledge that the chemical imbalance hypothesis wasn’t going anywhere. He was also critical of the process used in developing the latest edition of the Diagnostic and Statistical Manual DSM-5.


The official announcement of the new director’s appointment last July proudly proclaimed that Dr. Gordon and his colleagues at Columbia had been studying things such as “the role of the hippocampus, a brain structure known to be important for memory and emotional processes associated with anxiety and depression.”  Dr. Gordon’s research has also analyzed neural activity in mice who supposedly carry mutations “of relevance to psychiatric disease.”  How these objects of study are analogous to mental disorders is not described, but the lab studied genetic models of “these diseases from an integrative neuroscience perspective, focused on understanding how a given disease mutation leads to a behavioral phenotype across multiple levels of analysis.” The press release lists several methods used — in vivo imaging, anesthetized and awake behavioral recordings, and optogenetics; using light to control neural activity. A gigantic leap is then made: that his research “has direct relevance to schizophrenia, anxiety disorders, and depression.”
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