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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).

A half century ago, commercial and guild interests began to influence leadership and eventually take over mainstream mental health systems. This view has saturated public opinion to the degree that if you ask the average person in the grocery store, they will tell you that mental health problems are mostly chemical imbalances.

If you ask many psychiatrists what people want when they come to see them, they will usually tell you people want the right medication.

As a counter narrative, I believe that understanding system change and reform in mental health with this “green” lens makes use of a powerful theme which is increasingly accepted and it lays out a road map to make innovative programs and initiatives the new norm for system-wide responses to mental health challenges.

Think of the following parallels between the perspectives of the green movements and what we are pointing to:

Addressing pollution. There is increasing evidence of psychiatric medications like antidepressants and benzodiazopines in water supplies. But the more significant problem is the presence of psychiatric drugs in the neurological systems of those who take them, especially over the mid to long term and in children and adolescents.

This form of toxicity underlies the excessive tobacco usage and is a major factor in the 20-25 year loss of life expectancy in those prescribed these drugs for the most challenging problems and who take them over long periods of time.

Protecting nature. In our movement to reform systems of care, this would mean promoting good mental health—from simple exposure to the natural world to participating in healthy activities in the outdoors like walking, jogging, and hiking.

It would encourage other natural ways of healing and reducing stress like yoga and meditation. It would make healthy (i.e. “green”) foods available rather than the artificial, high-calorie items that contribute to weight gain and other medical conditions.

Recognizing risks to financial sustainability. Green movements recognize that everything that harms the environment ultimately costs more in the long term. This is just as true of the increasing use and expenses of psychiatric drugs as well as the epidemic of disability caused in large part by the excessive and long-term use of these drugs.

Unsuccessful treatments also result in the most expensive levels of care, like short-term and long-term psychiatric hospitals and restrictive intensive residential facilities. Finally, adding more and more diagnoses every year just adds to the use of drugs in more and more people.

Respecting the complex and interactive dynamics involved in harming and restoring the environment. This is also true in the complex world of mental health challenges. As in the natural world, there is increasing recognition of the many influences that lead to mental health challenges. These include reactions to trauma, social determinants of health, family communications, stressful school and work environments, bullying, alcohol and drug use, overuse of psychiatric drugs, involuntary treatments, discrimination, isolation, lack of safe affordable housing, the involvement of law enforcement, corrections and child welfare systems. There are many more.

One prime example is the use of psychiatric diagnoses, especially those that are understood to be simply chemical imbalances and which therefore will last a lifetime. This supports the idea of “chronic mental illnesses” rather than recovery.

Recognizing the complex and dynamic nature of the many interacting influences that impact mental health would lead mental health systems to more success in outcomes and would emphasize paths to recovery like trauma-informed care, supported employment and peer supports.

The upcoming Mad in America Continuing Education series starts in September and runs for ten months. I will start this series by introducing the green concept as a way to do system change and then turn it over to nine nationally and internationally respected leaders who will talk about their experiences doing this kind of change in their program or clinical specialty.

These are not abstract theorists but people with real world seasoning. They will talk about what’s worked and what hasn’t worked with recommendations for advancing this green movement.

The presenters, dates and times for the “live” webinars are as follows:

Bob Nikkel, MSW: State Mental Health Commissioner (2003-2008) and Founding Board Member, Foundation for Excellence in Mental Health Care
September 17, 2019

What a Green Movement in Mental Health Means and how system changes can lead in that direction. The integration of Medicaid health care services in Oregon will be used as an illustration of what worked and what didn’t and why.

Robert Drake, MD, PhD, Andrew Thomson Professor of Psychiatry, Community and Family Medicine, and Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth
October 15, 2019

Supported employment as a key to recovery in mental health and how it can be become an essential part of every mental health program

Michael Cornwall, PhD, Marriage & Family Therapist, Benicia, California
November 19, 2019

How counseling, family therapy and parent training can be provided in the most difficult public school systems in a way that makes referral for psychiatric medications completely unnecessary

Leah Harris, MA, Trauma-Informed Care Specialist and Coordinator of Consumer Affairs, National Association of State Mental Health Program Directors
December 17, 2019

A description of trauma-informed programs and how to make them the standard of care in every program from outpatient to residential to inpatient levels of care

Gina Nikkel, PhD, President and CEO, Foundation for Excellence in Mental Health Care
January 21, 2020

What real world experience has taught about making system changes at local, regional and state levels. A description of how partnerships, program ideas, budget development, legislation and advocacy come together.

David Hughes, PhD, President, Human Services Research Institute, Cambridge, Massachusetts
February 19, 2020

How to use research and a data-driven approach to support and guide system change based on decades of the Human Services Research Institute’s experience conducting system change activities for behavioral health systems.

Malcolm Aquinas, MAT CPSS LPE, Professional Consultant, National Center for Trauma Informed Care
March 17, 2020

Lessons learned in making program and institutional culture changes needed to respect human rights and dignity in state hospitals

Jennifer McClaren, MD, Assistant Professor of Psychiatry, Geisel School of Medicine at Dartmouth
April 28, 2020

A description of “de-prescribing” psychotropic medications to children and adolescents. How to develop these approaches in a systematic way with outpatient, inpatient and child welfare settings.

Kim Scott, MPP, President and CEO, Trillium Family Services
May 19, 2020

How a community program’s wide range of services for children, adolescents and families successfully transferred state hospital units to community residential programs, and lessons learned in what system changes were needed to accomplish that.

Laysha Ostrow, PhD, Founder and CEO, Live & Learn and Adjunct Professor, School of Community and Global Health, Claremont Graduate University
June 16, 2020

Peer services and the challenges and opportunities in making them an integral part of every mental health program. A description of the cultural, financial, regulatory and training changes needed to make these sustainable.

So that we can reach a broader audience to include more mainstream leaders, we will be giving members of national and statewide mental health program leadership organizations half off the registration fee—so it would be $75 for all ten 90-minute webinars. I expect to get 1.0 CE for each webinar for psychologists, social workers, nurses, licensed professional counselors and marriage/family therapists. As usual, we will also offer an early bird special plus some limited scholarships for individuals and organizations that cannot afford to pay the full $150 fee.

Please stay tuned for the official announcement and registration links. This series will be unlike any others in the past four years in its blending of program and clinical themes with how to change systems.

bnikkel_miaceRobert Nikkel, MSW, is a Clinical Assistant Professor in the Public Psychiatry Training Program at Oregon Health and Science University. He was the State of Oregon’s commissioner for both mental health and addictions from 2003-2008. He is the director of the Mad in America Continuing Education project and a member of the Board of Directors of the Foundation for Excellence in Mental Health Care.

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