Standard treatment guidelines in psychiatry recommend that neuroleptic drugs are continued indefinitely after a person has experienced more than one psychotic episode. These recommendations are based on studies which have found a higher rate of recurrence of psychosis among those who stop as compared to those who remain on drug.
Anatomy of an Epidemic raised concerns about the long-term outcomes for those who remain on these drugs. Most psychiatrists, including me, assumed that by reducing risk of relapse one would be improving long-term outcome. However, there seems to be reasonable evidence that this assumption is not correct.
Not only does long-term use of drugs expose people to the risks of weight gain and tardive dyskinesia, the drugs may also impair functional outcome. My own view is that this is a discussion psychiatrists need to have with their patients. A person may choose to accept a higher (and not inevitable) risk of recurrence of psychosis as a way to minimize the long-term risks of negative outcomes associated with staying on drug.Read More
The following is a report from the National Action Alliance for Suicide Prevention Crisis Services Task Force from 2016, which focuses on transforming crisis response services to include recognition and response to trauma, a robust role for peer support, and a reorientation to recovery. This report, which we currently are finding very valuable in our on-going system transformation efforts in Connecticut, is a testament to the fact that even acute services, and even those services addressing persons in extreme distress, can be made strength-based, person-centered, culturally responsive (in including natural and community supports), and recovery-oriented.
After 40 years of working in the mental health field, I reflect on the beginning of my career in a National Institute of Mental Health–funded research project called “Soteria House.” I moved on to work in the public sector from crisis worker, to supervisor, to program manager, to Chief of Adult Outpatient services for the public mental health system in Santa Cruz County, California. I have come full circle, back to the lessons learned at Soteria House in the mid-1970s.
It is from this work experience that I learned about “extreme states”, aka persons labeled with psychosis and schizophrenia. As a 23-year-old undergraduate student working on my own major, art therapy, at University of California Santa Cruz, I was offered a field placement assignment at Soteria House.
My background was primarily art, but I was being encouraged to explore a new field called “art therapy.” This brought me to Soteria in San Jose, California. I arrived at Soteria, my first day on the job to find a Victorian-style large home in the heart of San Jose.Read More
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.)Read More
Psychiatry likes to portray itself as a scientific discipline, and indeed there is a lot of useful science to draw on when evaluating the evidence base connected to mental health problems, its causes and treatments. Sadly, most of the mainstream psychiatric literature of recent decades has shown a marked preference for rhetoric over scientific accuracy. Research and discourse in psychiatry are now dominated and infected by scientism — the promotion of a belief, sometimes intentionally, sometimes not, that because what you do and talk about sounds and looks like ‘science,’ it is ‘scientific’ — rather than a rational engagement with the nature and consequences of the actual scientific findings.
This scientism has sometimes scared critics from engagement with the actual science in preference of critiquing the suitability of using scientific reasoning to understand what we today define as ‘mental health.’ Opening the lid on both issues (the lack of engagement with the actual scientific findings and the suitability of using particular scientific methods for all knowledge generation) is important. We must endeavour to make transparent the grand deception that organisations such as the one I belong to (the British Royal College of Psychiatrists) are selling to the public about the nature of what we have come to call ‘mental illness,’ its causes, its treatments, and the way we should organise services to help those who become mentally unwell.Read More
Wishing you many blessings in 2018, the happiness you deserve, and challenges removed from your path! May we all approach 2018 with gratitude for what we have and the tenacity to improve the world we live in.
Here at The Foundation for Excellence in Mental Health Care we are most grateful for all the projects and research being funded by you, our donors. It is these very projects that are helping to improve the world we live in by affecting access to recovery-based programs and research knowledge to help people make more informed choices for their own mental health.Read More
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.Read More
Acting like a “nice, compliant” individual has seriously harmed me for most of my 67 years. Due to my economic privilege, I received the best medical and psychiatric treatment available and, for most of those years, I accepted the “official” narrative, the dominant explanation for my ongoing suffering. That narrative is a limiting belief that harmed me and continues to damage all of us—not just we who have been diagnosed, but entire societies.
Many people identify the proliferation of psychiatric drugs as the root of our harm. I see neuroleptic drug use not as the root but as the fruit of the destructive narrative upon which most of our industrialized, “developed,” societies depend. And without deep transformative change, the damage from that dependence may be irreparable.
The people I depended on as an infant and young child did and said things that both helped and harmed me. My early life felt confusing and terrifying, and it was my connection with animals that sustained me. I lacked basic trust and hid my vulnerability.Read More
Earlier this year, the American Journal of Psychiatry published a paper, “The Long-Term Effects of Antipsychotic Medications on Clinical Course in Schizophrenia.” This was a response to the concerns that have been raised that these drugs negatively impact long-term outcomes. The authors conclude, albeit in a somewhat lukewarm way, that overall, the “evidence for a negative long-term effect of initial or maintenance antipsychotic treatment is not compelling.” Robert Whitaker and Joanna Moncrieff, whose work was cited by the authors, have written critiques of this paper.
Even if one accepts the paper’s conclusions at face value, there is little argument regarding some serious long-term risks such as movement disorders and weight gain. One of the most compelling reasons why these authors support long-term care is related to the relapse data: when one is started on these drugs, the relapse rate is higher when they are stopped than when they are continued (at least over the first two years). However, there is general consensus that there are some individuals who will recover and not need medications long-term. In fact, there is even consensus that some can recover without drugs; the dispute is over numbers.Read More