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Rally, the Excellence blog, gives voice to issues, ideas and news in mental health recovery

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January 30, 2015 by Bob Nikkel, MSW

Why Mental Health Systems Should Be Organized Under Alcohol and Drug Systems

bnikkel_miaceWhile I was in charge of the public systems for both mental health and addictions in Oregon, I found it a challenge to maintain an equal focus on alcohol/drug problems compared to mental health. One big reason for the emphasis on mental health was that the mental health budget was big, about 6 times greater than that for addictions. And that doesn’t even count the hidden funding for psychiatric drugs which probably added another 30 or 40% to mental health—atypical antipsychotics are a lot more expensive than Antabuse.

Although there was a huge difference in state financial support for the two areas, it always seemed to me that the social consequences were just as large and challenging in addictions as in mental health. Partly for that reason, when asked to recommend a new name for an integrated office blending the two previously separated program areas, I chose to put addictions first–the Addictions and Mental Health Division. The state legislature agreed and it became the agency’s name and, at least for the time being, still is. It may have been only symbolic but it was an attempt to stop seeing alcohol and drug services as the “little brother.”

Having stepped back and out of the line of fire now for several years, I’ve become more aware of the ways in which addictions may be a better conceptual umbrella than I’d considered in the naming process. Consider that the dynamics of “denial” and “enabling” are powerful themes in addictions treatment. Denial is the marked tendency for people struggling with addictions to believe that their drinking or drug use is really under control and that everyone around them is over-reacting. Enabling is the flip side of that coin in which those around them unwittingly play into the denial and without consciously trying actually make it easier for the addicted person to keep using.

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January 29, 2015 by Larry Davidson, PhD

Yale Symposium April 24, 2015

Larry-Davidson-PhDOn April 24th, the Foundation for Excellence in Mental Health Care is sponsoring an all-day symposium at Yale University entitled “New Data and New Hopes Call for New Practices in Clinical Psychiatry.” The symposium is co-sponsored by the Yale Program for Recovery and Community Health and the Department of Mental Health and Addiction Services for the State of Connecticut. Speakers include scientific advisors and board members of the Foundation, Yale Psychiatry faculty, and leading researchers and thought leaders from the U.S. Substance Abuse and Mental Health Services Administration, the University of Groningen in the Netherlands, and several other American universities.

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January 29, 2015 by Larry Davidson, PhD

Turning Lived Experience into Lived Expertise

Larry-Davidson-PhDThe International Leadership Academy Fund has been established at the Foundation for Excellence in Mental Health Care. It aims to prepare persons with lived experiences of mental ill health and recovery to take on leadership roles within their own local, regional, and national systems of care across the globe. The idea for this fund, and the program it seeks to develop, emerged from a meeting of prominent system leaders and advocates with lived experience who came together at Yale University in May of 2014. The meeting was sponsored by the International Institute for Mental Health Leadership (IIMHL), directed by Foundation Chair Fran Silvestri, and was held to invite input from leaders with lived experience as to how the work of the IIMHL could benefit from the wisdom they and others had accrued through their own personal experiences of recovery and mental health system transformation efforts. The meeting was co-chaired by Larry Davidson, a professor of psychology at Yale and member of the Foundation Board, and Anthony Stratford of MIND Australia, and included lived experience leaders from Scotland, England, the Netherlands, New Zealand, Canada, Australia, and the U.S.

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January 29, 2015 by Beatrice Birch

The Inner Fire Story

Beatrice Birch

Inner Fire Co-Founder Beatrice Birch

The catalyst for Inner Fire was a thirty-eight year old man named Zach, who while struggling with mental health challenges, tragically took his own life.  Zach did not know he had a choice to recover free from the harmful and stultifying side effects of psychotropic medications. Instead of connecting with his inner fire using holistic therapies, Zach chose to end his suffering amidst a fog of pain. Zach is but one of a multitude who gave up hope because he experienced no progress toward healing and no other choice for recovery was evident.

While working together at a treatment center in Vermont serving adults with serious psychiatric and addictive challenges, Beatrice Birch, a Hauschka Artistic Therapist and Jim Taggart, then Executive Director of the center, were distressed by the limited and often counter-productive treatment options for people like Zach. From Beatrice’s thirty years combined experience working in anthroposophical (complimentary) medical and therapeutic clinics in both the UK and Holland and her private practice in the USA, she knew  there were options for those who wanted to be proactive in their recovery process without using psychotropic medication.

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January 26, 2015 by Sandra Steingard, MD

Bring Back the Asylum?

This week, a commentary written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care Bring Back the Asylum,” was published in JAMA online. I share my perspective on this provocative suggestion which is influenced by recent dramatic changes in my home state.

Sandra-SteingardThis week a commentary, written by members of the University of Pennsylvania Department of Medical Ethics and Health Policy and titled “Improving Long-term Psychiatric Care: Bring Back the Asylum,” was published in JAMA Online. The senior author, Ezekiel Emanuel is former Special Advisor for Health Policy in the Obama administration and brother of Rahm, Mayor of Chicago and Obama’s former Chief of Staff. This commentary with its provocative title published in a high impact journal by a well connected physician is sure to garner considerable attention and influence.

As the title suggests, the authors recommend a return to asylum care, albeit not as a replacement for but as an addition to improved community services and only for those who have “severe and treatment-resistant psychotic disorders, who are too unstable or unsafe for community based treatment.”

The authors seem to accept the notion of transinstitutionalization (TI) which suggests that people who in another generation would have lived in state hospitals are now incarcerated in jails and prisons. This notion arose from two sets of statistics. The first is that, as rates of psychiatric hospitalization declined, rates of incarceration increased with the total in 2000 being about the same as it was in 1960. It gives the appearance that we just transferred people from one setting to another.

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January 17, 2015 by Bob Nikkel, MSW

2015 Edition of Early Psychosis Intervention Projects National Directory

bnikkel_miaceThe Foundation for Excellence in Mental Health Care is very pleased to announce the arrival of the second edition of the Program Directory of Early Psychosis Intervention Projects, a joint venture of Portland State University’s Regional Research Institute and the Foundation. This national listing has contact and some basic program information for about 70 projects in 18 states.

Most of the credit for creating the directory goes to Elinor Taylor at Portland State University. She has constructed and updated this work on top of a heavy academic and clinical workload and deserves recognition for this important document.

As described in the introductory section, the purpose of the directory is to create a database and list of early intervention programs for psychosis within the U.S. Additional goals include facilitating a communicative network among these programs, creating tools for referral, comparing outcome measurements, and determining potential future research studies. This information is up-to-date as of January 2015.

My hope is that in a few years, we will have hundreds of projects in all 50 states. When that day comes, we will realize the expectation that young people will recover their lives and never give credence to the all-too-common and destructive “diagnosis” of a “chronic mental illness.” It’s the system that’s been creating that tragic, unnecessary outcome.

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January 16, 2015 by Kathy Brous

Neurofeedback: Healing the Fear-Driven Brain

SebernFisherPsychotherapist Sebern Fisher gave a great webscast Oct. 14 in the National Institute for the Clinical Application of Behavioral Medicine series, about neurofeedback (biofeedback to the brain), which gives us access to our brain function frequencies. The brain gets organized from the womb in oscillatory patterns, and we with histories of early neglect and abuse, i.e. developmental trauma, suffer from disorganized and dysregulated brains.

Our fear circuits dominate. Neurofeedback can calm these erupting circuits, while encouraging neural connectivity, which helps us create a more coherent sense of self, so we feel safer and more centered.1

Folks with difficult parents often grow up with a “fear-driven brain” as I did — and it can be a huge relief to find out we’re not freaks; nope, we’re a chunk of the mainstream.  In fact, maybe 50% of Americans have some degree of this “attachment disorder” due to parents who were too scary to attach to. Of course it’s not their fault either, because odds are, our grandparents were too scary for our parents to attach to, and so on inter-generationally.

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January 16, 2015 by Bob Nikkel, MSW

New CEU/CME Course Available: Psychiatric Medications and Long-term Outcomes for Schizophrenia

bnikkel_miaceThe Mad in America Continuing Education Project is pleased to announce the posting of its second on-line course.

This course qualifies for 3.0 CMEs  approved by the American Academy of Family Physicians and 2.5 CEUs approved by Commonwealth Educational Seminars for psychologists, social workers, licensed marriage and family counselors, nurses and certified addiction counselors.

We are fortunate to have enlisted the expertise of one of the world’s premier researchers, Martin Harrow, PhD, of the University of Illinois Chicago Medical School as he presents his 26-year comprehensive outcome study of individuals diagnosed with schizophrenia and other psychotic disorders.

The course includes a one-hour discussion moderated by Bob Whitaker which includes Dr. Harrow’s chief collaborator, Dr. Thomas Jobe. The two lessons together focus on the improved outcomes for people who stopped taking antipsychotic medications compared to those on antipsychotics.


Martin-HarrowMartin Harrow, PhD

Martin Harrow is a psychologist and widely-cited expert on schizophrenia and bipolar disorders. He has published over 250 scientific papers and four books on these and related areas. As Director of the Chicago Followup Study, he has received several national awards for his research on thought disorder, psychosis, long-term adjustment, suicide, and recovery in schizophrenia. Recently his research has focused on longitudinal studies of the long-term effects of antipsychotic medications. He has been on the faculty at Yale University and the University of Chicago, and in 1990, moved to the Medical College of the University of Illinois as Professor and Director of Psychology in the Department of Psychiatry. He is now Distinguished Professor Emeritus there.

We look forward to sharing the work Dr. Harrow, Dr. Jobe and other colleagues in better understanding the relationship between long-term use or non-use of psychiatric medications and important outcomes like functional status, psychotic symptoms and rehospitalization.

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January 10, 2015 by Sandra Steingard, MD

Atul Gawande’s Being Mortal


Atul Gawande is a physician author whose work has been published in The New Yorker, among other places. Disclosure: I am a fan. What I love and respect most about his writing is that while he is unflinching in his critical view of medical practice, he writes with a deep humility and compassion. Medicine is, despite our aspirations towards technical mastery, practiced by humans. And all of us, even those privileged with years of schooling, are limited in various ways.

In his most recent book, Being Mortal, he explores the complexity of end of life care. He reviews the development of nursing homes in the US and describes some newer alternatives that are becoming available. He also writes about how people approach their final days. He describes with stunning clarity the extremely difficult choices people make as they loose their physical abilities and face their final days.

Why is this a topic I bring here?

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January 10, 2015 by Kathy Brous

California ACEs Summit

CA ACEs Summit Nov.2014At California’s first ACEs summit November 5-7, “Children Can Thrive,” over 200 health professionals, policy leaders and advocates gathered in San Francisco. They created a national model for a statewide dialogue on the biggest public health problem facing California today: Adverse Childhood Experiences (ACEs).  They focused on programs in health, education, juvenile justice and child welfare at the local and state levels, and how national policies can support those efforts. Also exciting, announced a $3 million grant November 3 to the Center for Youth Wellness (CYW), the clinic started by Dr. Nadine Burke Harris, organizer of the California ACEs Summit.  The grant is specifically aimed to get enough scientific documentation that childhood trauma causes adult onset diseases, to actually make toxic stress a diagnosis code billable for insurance.

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