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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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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.

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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.)

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December 11, 2017 by Bob Nikkel, MSW

How Would We Know If We Really Reformed the Mental Health System?

This post updated 12/28/2017

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.

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October 7, 2017 by Bob Nikkel, MSW

The Continuing Education Course on Withdrawal from Psychiatric Drugs is Here!

At the beginning of September, I wrote about the next stage of the Mad in America Continuing Education project—the development of webinar formats and I announced the planning for a “course” on withdrawal from psychiatric medications.  At that time, I was able to provide only introductory information but now I can provide a full picture of the 7 webinars that comprise the course and update a few other developments.

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September 27, 2017 by Bob Nikkel, MSW

New Continuing Ed Course On Psychiatric Drug Withdrawal

Overview

This series of seven 90-minute webinars will feature presentations by people with “expertise by lived experience,” psychiatrists, and other professionals on a topic of critical importance: What do we know about withdrawal from psychiatric medications? The educational purpose of the series is to present information and insights that arise:

  • from users’ experiences and their efforts to support others who want to taper from their psychiatric medications; research on drug withdrawal,
  • the clinical experience of psychiatrists and other professionals who have supported patients tapering from psychiatric medications, and
  • research on drug tapering programs and efforts

Education.MadInAmerica.com/p/psychiatric-drug-withdrawal

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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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