Subscribe X
Back to Top

Learn

Archives

August 29, 2019 by Bob Nikkel, MSW

System Change Webinars: Promoting Radical Change

During the past year, we have been working toward a series of Mad in America Continuing Education webinars on something we haven’t focused on enough.  That is the vital topic of how to make changes in real world programs that reflect the progressive reform agendas that reflect a “green” revolution in mental health care.

We have a series of monthly webinars starting on September 17 that we believe do this.  There are 10 topic areas with nationally and internationally recognized experts in promoting this kind of system change.  We will be discussing what’s worked and what we need to learn from what hasn’t worked. We believe that for anyone interested in radically improving mental health care, this is an essential course.

Read More

July 24, 2019 by Bob Nikkel, MSW

Responding to “The Case Against AOT”

Next Steps for Change

Robert Whitaker and Michael Simonson produced an essential review and critique of forced outpatient interventions in their July 14 article, “Twenty Years After Kendra’s Law:  The Case Against AOT.”

Bob has sometimes been criticized for not advocating more on the issues he raises.  The way I see it, that is not his job as an investigative medical journalist.  That is the job of his readers.

Read More

July 12, 2019 by Bob Nikkel, MSW

System Change Toward a Green Movement in Mental Health

One morning a few weeks ago, I woke up thinking maybe we should begin to think of reforms in mental health systems as a kind of “green movement” with some striking similarities to the other greens: the green environment, a green economy, green energy, and so on.

The upcoming Mad in America Continuing Education series intends to use that as a framework for the ten webinars we will launch soon. More on that in a bit, but first, some quick background is in order.

An early leader of the Modern Green Movement was Rachel Carson, whose book Silent Spring (1962) laid out the dangers of detrimental effects to the environment caused by the indiscriminate use of pesticides.

She made accusations against the chemical industry of spreading disinformation and public officials of accepting these claims. These accusations could just as easily be applied to the cozy relationships between the pharmaceutical industry and the major psychiatric organizations as documented in Robert Whitaker and Lisa Cosgrove’s Psychiatry Under the Influence (2015).

Read More

June 1, 2019 by Bob Nikkel, MSW

Public purse a cash cow for pharma

Could billions in taxpayer dollars for psych drugs be better spent?

A few years ago when I was directing a Medicaid mental health managed care organization, the irascible senator from Iowa, Chuck Grassley, got a burr under his saddle, as they say in the Midwest, about what the federal government was paying out for psychiatric medications in Medicaid expenditures.  And he was able to connect the cost information to individual prescribers.

The two highest prescribing billers were in my area in Oregon.  I was shocked for several reasons.

The first was that I had no idea what these figures were because they weren’t in my Medicaid budget.  The second was that the highest prescriber was in my area.  In one year alone, he had billed $457,000 of psychiatric medications, mostly Abilify.  The third—and this was an extremely dismaying shocker—was that he was a child psychiatrist, and so he had been prescribing Abilify and these other drugs to children and adolescents.

Read More

May 3, 2019 by Bob Nikkel, MSW

Ten Lessons for Mental Health System Change

For the past several years, my blogs have centered on a topic that is admittedly not the most exciting – how policy can affect practice, especially in public mental health systems.  Distilling my 50 years of experience with a combination of direct work with people, management positions within local and state organizations and nearly 6 years as a state mental health and addictions commissioner, I think I learned a number of lessons about system changes.  But I haven’t taken a deeper dive into strategies, especially focused for advocates who seek significant and even radical changes – until now.
Read More

March 14, 2019 by Bob Nikkel, MSW

Two Upcoming Webinars in Our Informed Consent Series

We have two outstanding webinars of great clinical relevance and interest coming up on the Mad in America Continuing Education Project.

Registrations are open at: education.madinamerica.com/p/what-would-real-informed-consent-on-drugs-look-like

On March 19, Dr. Sandy Steingard will talk about what informed consent can and should look like in a real life community mental health program. Dr. Steingard has been a leader in this country and is getting increasing attention elsewhere for her courageous and research-based approach to psychiatry. She is particularly well-prepared to discuss issues related to the use of psychiatric medications. You can see notice of her webinar here along with the learning objectives she will be addressing.

We are asking for a registration fee of $75 but it covers all 6 of the webinars in this series. You can contact me if you want to discuss an organizational rate or discuss a scholarship option.

Read More

March 12, 2019 by Bob Nikkel, MSW

National Basketball and Peer Supports

I see eye-to-eye with most players in the National Basketball Association.  Recently I proved this by a random meeting with two guys in the Portland airport who were just a shade taller than I am–one was a former NBA player and the other a current member of the Portland Trailblazers.  6-10 and 6-11, respectively.

So you are asking, what does this NBA stuff have to do with peer support?
Adam Silver, the commissioner of the NBA was interviewed recently and talked about the number of NBA players, who in spite of their athletic success–and I might add, their million dollar plus contracts–deal with a lot of unhappiness in their personal lives.
Read More

November 20, 2018 by Bob Nikkel, MSW

What Would Real Informed Consent on Psychiatric Drugs Look Like? New Webinar Series Begins January 22

I’m excited to announce a new series of Mad in America Continuing Education webinars for 2019. They focus on what I believe is a central issue—what does a true informed consent process look like for the prescription of psychiatric drugs? This is a leverage point for changing the paradigm of care by starting with how people are informed about what psychiatric drugs do.

I believe that righting this ship is largely going to be up to non-medical mental health professionals and persons with experience in having been through a system that fails miserably to provide real informed consent. Since we are a continuing education program, our courses are designed primarily for the first group: psychologists, social workers, nurses, licensed professional counselors, and marriage/family therapists. We will continue to apply for continuing education credits (CEs) and at some point recruit more interest from physicians so it would be worthwhile to apply for the more expensive continuing medical education credits (CMEs).

Read More

June 6, 2018 by Bob Nikkel, MSW

So What’s This About Another Webinar Series on Psychiatric Drug Withdrawal?

Some people are asking me, “Why another series of webinars on withdrawing from psychiatric drugs?” That’s a reasonable question given that our first series, Withdrawal from Psychiatric Drugs, covered a lot of territory. We presented general information as well as more specific subjects like wellness, personal experiences, research findings, and the evidence base for drug withdrawal.

But this subject is a complex one, and our first course was just our start in exploring this topic. With this second course we are focusing on the challenges that drug withdrawal presents to prescribers.

As many have noted, prescribers may have extensive experience getting patients on psychiatric medications and then managing their drug use, but little or no experience helping patients taper off the drugs. As some have quipped, prescribers have learned to fly the plane but not land it.

Read More

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.)

Read More


Related Blogs

  • Dr. David Healy

    Dr. David Healy

    Dr. Healy is a professor of psychiatry at Cardiff University in Wales and an author on the history of pharmaceuticals and government regulation.
    READ BLOG
  • Mad In America: Robert Whitaker

    Mad In America: Robert Whitaker

    Journalist and author Bob Whitaker distills the latest in pharmaceutical and mental health research.
    READ BLOG
  • Selling Sickness

    Selling Sickness

    Creating a new partnership movement to challenge the selling of sickness.
    READ BLOG
  • Kathy Brous

    Kathy Brous

    A serial of Kathy's recovery journey as an adult with attachment disorder.
    READ BLOG
  • Nev Jones

    Nev Jones

    Exploring the intersections of psychiatry, philosophy, neuroscience, cultural theory, critical community psychology and the mad/user/survivor movement.
    READ BLOG
  • 1boringoldman

    1boringoldman

    Retired psychiatrist and raconteur offers insightful analysis of the day's events from the woods of Georgia.
    READ BLOG