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February 17, 2020 by Bob Nikkel, MSW

Turning the Corner: How Are We Educating Psychiatrists in Medical Schools?

A presentation on “psychiatric access” reveals it to be nothing more than a primary care doctor and a psychiatrist discussing medications over the phone.

Every few months I take in a “grand rounds” presentation in psychiatry to get a feel for what’s going on in the medical education of future psychiatric practitioners. (Grand rounds are a type of medical education lecture that often presents a “case study” of patients and their treatment.) Some say we’re turning a corner in the way psychiatry treats people, and I want to be hopeful that it’s true.

The topic this time was a relatively new “psychiatric access” project. I initially thought it might be about getting appointments for mental health services more efficiently. That might or might not be a good idea depending on the type of service to be accessed. But it turned out that it was actually a phone consultation (usually of about 15-20 minutes) between primary care physicians and psychiatrists.

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December 20, 2019 by Bob Nikkel, MSW

Informed Consent Standards – A House of Cards

I recently submitted a recommendation to Oregon’s mental health officials as they consider revising their clinical standards. My recommendation for these clinical practice standards has to do with providing true informed consent for prescribing psychotropic medications. If it were adopted, it would threaten to bring down a kind of “house of cards” that is the centerpiece of the mental health system.

The state is asking for feedback on what they call administrative rules for behavioral health. These rules provide the practice standards required of service providers.

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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.

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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.

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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).

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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.

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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.
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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.

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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.
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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).

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