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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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August 25, 2019 by Andrea Zwicknagl

Open Dialogue and Research from the point of view of someone with lived experience

Talk by Andrea Zwicknagl for the HOPEnDialogue Kickoff Workshop 2nd July 2019, Rome

I am standing here today because – like perhaps many of you – there is a question about Open Dialogue that has been with me for a long time:

WHAT IF?  – What if we had had Open Dialogue?

I would like to share a little of my WHAT IF with you.

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August 15, 2019 by Sheila Hamilton & Cindy Marty Hadge | Beyond Well: Science

A life worth living

We are all on a spectrum of mental health and everyone will struggle at some point in their life. Let’s build a toolbox for living better.

Beyond Well: Science With Sheila Hamilton is here to explore our understanding of mental health challenges and what we’re learning about ways to help ourselves and others navigate and grow through them.

In this episode, Sheila talks with Cindy Marty Hadge about how a Hearing Voices support group in her neighborhood helped her move from a place of despair to a life of purpose and connection.

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August 5, 2019 by Andrea Zwicknagl

What if…

What if...

Andrea Zwicknagl’s presentation at the kickoff meeting of HOPEnDialogue, a new Open Dialogue international research collaborative, in Rome, Italy, July 2, 2019. Read by Guiseppe Salamina in her absence.

To learn more and to support this project, please visit https://mental-health-excellence.networkforgood.com/projects/72234-open-dialogue-research-development

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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 21, 2019 by Christopher Gordon, MD

Reflections on Rome

Kickoff of the New Open Dialogue International Research Collaborative: Hopes for HOPEnDialogue

On July 2 and 3, 2019, I was privileged to attend the first meeting of the HOPEnDialogue International Research Collaborative in Rome.  I attended as a representative of the Board of the Foundation for Excellence in Mental Health Care, along with the Foundation’s President and CEO, Gina Nikkel, and the Foundation’s new Chief Philanthropy Officer, Kevin Aspegren.

The meeting was hosted by the leaders of the project, Raffaella Pocobello and Giuseppe Salamina, and brought together forty representatives from 12 countries, first in an open forum to discuss the goals and overarching strategy of the project, and a second day for the 20 international members of the Advisory Council to address more focused challenges, such as site selection requirements; inclusion/exclusion criteria; training; fidelity; and outcomes.

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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 28, 2019 by Sandra Steingard, MD

A Guide to Long-Acting Neuroleptics: Education or Promotion?

Several weeks ago, I received a number of emails notifying me of a new pamphlet released by the National Council for Behavioral Health titled “Guide to Long-Acting Medications for Providers and Organizations.”

The pamphlet begins:

“This Guide to Long-acting Medications (LAMs) is a Call to Action for psychiatrists, other clinicians and behavioral health organizations to increase the use of LAMs.” It goes on to suggest that psychiatrists and their organizations (which comprise the membership of the National Council) rally resources to make these drugs more readily available as “first-line treatment.”

The authors opine upon “What Science Tells Us,” namely, that “there is enough science to demonstrate the degradational effects on brain tissue of each psychotic episode.” Moreover, we are informed that — when started early — the neuroleptic drugs will “avert progressive neurodegeneration and subsequent disability.”

The pamphlet is designed as a public health promotion with this message: If we can stop the progression of schizophrenia, we will improve long-term outcomes. This is purported to be based on science.

I would argue that if one follows the science, one might support instances in which long-acting drugs are useful but not necessarily to the extent suggested in this pamphlet. In addition, one would not promote the newer drugs as first-line treatments.

By downplaying some aspects of the available science, the pamphlet implicitly is acting as a promotional tool for the pharmaceutical industry. Furthermore, this pamphlet serves as an example of why simple disclosures of conflict do not adequately address deeper issues of bias and influence in our field.

While the authors correctly state that this was not funded by pharmaceutical companies, it is nevertheless influenced by their interests via the incursion of commercial interests into academia over the past few decades.

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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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