From 2012 to 2018, Parachute NYC offered a “soft landing” for people experiencing psychiatric crisis in New York City. Along with a respite center, Parachute mobile teams consisted of teams of health care professionals, including peer specialists, psychiatrists, social workers, and family therapists, who were each trained in the principles of Open Dialogue and Intentional Peer Support. Open Dialogue, developed in Western Lapland in Finland, espouses a practice of healing through polyphonic (many voices) dialogue within a non-hierarchical network, tolerating uncertainty, and treating every utterance as meaningful and rational. Intentional Peer Support, developed by and for peer specialists, embraces crisis as opportunity, mutual accountability within partnerships, and trauma-informed care. Parachute represented the first instance in which peer specialists were integrated into the Open Dialogue model.Read More
The Hearing Voices movement began in Europe in the late 1980s when Marius Romme, a psychiatrist, realized that his training and therapeutic techniques were not helping one of his patients to manage the voices in her head. In listening to Patsy Hage, Romme began to wonder if maybe other voice-hearers might be in a better position to help her than he was. His hunch turned out to be correct, and the Hearing Voices Network (HVN) was co-founded by Romme and Hage in 1987.
The HVN is a peer-to-peer, nonclinical support group based on the radical idea that voice-hearing is not automatically a sign of pathology. Unlike traditional methods that encourage voice hearers not to engage with or listen to their voices, the HVN takes the opposite approach: voice-hearers are encouraged to explore and discover for themselves what their voices mean. The groups also provide social support and acceptance– something that is vitally important given the social distancing and isolation often reported by voice hearers. And the groups offer practical strategies for living with and managing voices.Read More
In the United States, media representations of voice-hearers are rare and mostly negative. When our stories *are* shared, we are often portrayed as one-dimensional, irrational, violent or unable to contribute to our communities. Research indicates that one in ten people hear voices at some point in their adult lives, however; negative media representation leads many to stay silent about these experiences. We now know that that silence and isolation can make an experience of hearing voices more distressing and harder to navigate.
With the Hearing Voices approach, we create space for voice-hearers to share their experiences in all their individual complexity. We see over and over the healing value of articulating what our voices say, how long they have been in our lives, and what life events they might relate to. We have seen the importance of making room for trauma-informed and culturally-competent understandings of both why voices/visions occur and what healing practices are available.Read More
Is diagnosing a person and labeling them as mentally ill truly helpful? Ironically, when I first entered therapy it was because I feared mental illness. I did my best going to therapy for over 16 years, but to no avail. I received not one diagnosis but four of them. I finally realized that the mental health system is designed primarily to diagnose and place labels on human beings. These diagnoses or labels not only deem people to be mentally ill or defective, they also often prevent people from reaching their true potential.Read More
In the largest newspaper in the world this week, one of the largest problems in the world was proposed as having a very simple solution.
There are few problems more heartbreaking and excruciating than the growing epidemic of youth (and adults) taking their own precious lives. And so, it’s understandable that great attention continues to go towards solutions that can make a difference.
In response to this urgent challenge, psychiatrist Richard A. Friedman asked in a New York Times op-ed: “How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness?”
Do we? That’s certainly a widely shared perception among many in the general public today. But is the answer really this clear?Read More
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.Read More
Open Dialogue is alive and well in Massachusetts. Since 2011, when Advocates was the first recipient of funding support from the Foundation for Excellence in Mental Health Care, Advocates has been providing Open Dialogue services in two programs based in Framingham, Massachusetts.
Advocates is a full-service, not for profit provider of services and supports to people with psychiatric conditions, developmental and other cognitive disabilities, substance use conditions, and other life challenges, offering residential supports, outpatient and emergency services, among other supports, all dedicated to the idea that everyone, regardless of diagnosis or disability, can live a full, challenging and rewarding life of their own design, given the right supports.
With the initial support from the Foundation for Excellence in Mental Health Care, and with additional support, particularly from the Department of Mental Health, Advocates was able to train 35 staff members at the preeminent training site for Open Dialogue in the US, the Institute for Dialogic Practice under the direction of Dr. Mary Olson, currently affiliated with Yale University.
We then launched two programs – one for young people experiencing early episode psychosis, called The Collaborative Pathway; the other for people receiving services from the Department of Mental Health, whose difficulties had become or were at risk for becoming more chronic, called Open Dialogue in Behavioral Health Services. With support from the Cummings Foundation, and ongoing support from the Department of Mental Health, both programs have been delivering Open Dialogue Services for nearly ten years.Read More
Anthropologists who study the psychiatric field recently had papers published in two highly influential journals. The New England Journal of Medicine featured a commentary by Gardner and Kleinman, “Medicine and the Mind — The Consequences of Psychiatry’s Identity Crisis” while “Merging Intensive Peer Support and Dialogic Practice: Implementation Lessons From Parachute NYC” by Hopper and colleagues was in Psychiatric Services.
Arthur Kleinman and Kim Hopper are leaders in their field. For this reason alone, these papers are worthy of review. While they both call for or describe reform initiatives, they point us in different directions with regard to the future role of psychiatrists.Read More
This Continues the Spotlight on the Suicides series. Astonished by the conclusion of Stephen O’Neill’s inquest, I wrote to Northern Ireland’s Deputy First Minister, copied to the Ministers of Health in Ireland, Simon Harris, in Wales Vaughan Gething, and in England Matt Hancock, along with the Danish MEP, Margrete Auken, the European Ombudsman, Emily O’Reilly and Martina Anderson, a Northern Irish MEP.
Michelle O’Neill MLA
Deputy First Minister
Coalisland Sinn Fein Office
Co Tyrone BT71 4LN
Dear Michelle O’Neill
Re: Stephen O’Neill
I testified recently at Stephen O’Neill’s inquest. Concerned about the conclusion, I have since liaised with several lawyers, one of them a coroner, to explore what might be done to prevent an unfortunate inquest compounding an unnecessary death.
The options available to anyone unhappy with an inquest, primarily review whether there has been a breach of legal process. It is clear to the O’Neill family, and to me, there hasn’t been a breach of legal process, and even a judicial review at this point would be unlikely to contribute to the public safety in the manner the family had hoped for from an inquest.
This leaves the family in a situation resembling that of the relatives of those who died on the recent Boeing 737 Max flights. Had these deaths not been so public, a coroner would likely have concluded they were an unavoidable accident and his/her brief was just to record a death by plane crash. This verdict would have been supported on judicial review.
I am writing to you because there have been thousands of deaths like Stephen O’Neill’s and almost certainly will be thousands more – hundreds of Boeings – and, if a decent coroner like Mr McGurgan cannot see a way to make a difference, no-one will do anything to forestall these further deaths. The situation calls for a political rather than a judicial response.Read More
One of the first things I do when returning home from a trip away is to stop by my local coffee shop and get my favorite iced tea. Do I go for the tea… well no, not really. No matter where I live, I have been doing this for years because it is not really about the beverage, it is about the people. The folks that work at my local coffee shop, whether it was when I lived in Pasadena, California, Rockville, Maryland or now in Hollywood, California, make the day just a bit brighter.
This story isn’t about the iconic and ubiquitous coffee shop, coffee or tea. It is about “Connection”. Away for a week in Trieste, Italy, I return to my local coffee shop to be greeted by London – there we are – Black Girl Magic! She knows my name, I know hers.Read More