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What is the American Psychoanalytic Association?

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Introduction

The American Psychoanalytic Association (APsaA) is an association of psychoanalysts in the United States. APsaA serves as a scientific and professional organisation with a focus on education, research, and membership development.

Brief History

The American Psychoanalytic Association was founded in 1911 by Welsh neurologist and psychoanalyst Ernest Jones, with the support of Sigmund Freud. Other founders of the organisation are Adolf Meyer (psychiatrist), James Jackson Putnam, G. Lane Taneyhill, John T. MacCurdy, Trigant Burrow, and G. Alexander Young.

The APsaA is the second oldest American psychoanalytic organisation, after the New York Psychoanalytic Society which was founded a few months before by Abraham Arden Brill.

In 1991 the APsaA issued a statement allowing training of gay psychoanalysts. In 1992 the APsaA prohibited discrimination against gay people when selecting teaching faculty. In 2019 the APsaA apologised for having treated homosexuality as a mental illness.

Membership

APsaA has over 3,000 members, including 33 accredited training institutes and 38 affiliate societies. At the association’s biannual meetings held in February and June, members convene to exchange ideas, present research, and discuss training and membership issues.

What is the American Counselling Association?

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Introduction

The American Counselling Association (ACA) is a membership organisation representing licensed professional counsellors (LPCs), counselling students, and other counselling professionals in the United States. It is the world’s largest association exclusively representing professional counsellors.

The non-profit organisation serves more than 55,000 members from various practice settings, including mental health counselling, marriage and family counselling, addictions and substance use disorder counselling, school counselling, rehabilitation counselling, and career and employment counselling. Counselling professors and students are also represented.

Its stated mission is to “enhance the quality of life in society by promoting the development of professional counsellors, advancing the counselling profession, and using the profession and practice of counselling to promote respect for human dignity and diversity”.

The association headquarters is located in Alexandria, Virginia.

Brief History

The group was founded in 1952 as the American Personnel and Guidance Association (APGA), formed by the merger of the National Vocational Guidance Association (NVGA), the National Association of Guidance and Counselor Trainers (NAGCT), the Student Personnel Association for Teacher Education (SPATE), and the American College Personnel Association (ACPA).

The American Personnel and Guidance Association changed its name to the American Association of Counselling and Development (AACD) in 1983. On 01 July 1992, the association adopted its current name.

ACA presidents are elected by association membership for a one-year term.

Branches & Divisions

There are 20 chartered divisions within the American Counselling Association. These divisions provide leadership, resources and information unique to specialised areas and/or principles of counselling. Divisions are chartered by ACA elect division officers who govern their activities independently and carry a voice in national ACA governance. Members enhance their professional identity and practice by joining one or more divisions. ACA has 56 chartered branches in the US, Europe and Latin America.

Publications

ACA publishes books, journals and other educational materials on counselling topics. The organisation’s flagship magazine, Counselling Today, is published once a month and sent to all ACA members via US mail.

ACA Takes a Stand

In 2016, ACA moved its 2017 San Francisco Conference & Expo from Nashville, Tennessee to San Francisco, California after Tennessee’s legislature passed a discriminatory bill, HB 1840/SB 1556, targeting members of the LGBTQ community and others. The bill allowed counsellors in Tennessee to turn clients away based on “strongly held principles.'” “The legislation ‘denies services to those most in need, targets the counseling profession’ and violates the ACA’s code of ethics, the group said.”

“Tennessee’s governor, Republican Bill Haslam signed the bill into law on April 27, insisting it was not meant to be discriminatory. But opponents said the law permits therapists and counselors to deny treatment to gay, lesbian, transgender and other patients. After Haslam signed the bill, ACA members debated the issue and decided not to hold the meeting in Tennessee. Officials said the association received bids from 13 cities after deciding to nix Nashville, but chose San Francisco as ‘the best choice and … an inclusive and inviting city’ for its members.”

What is the American Academy of Psychoanalysis and Dynamic Psychiatry?

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Introduction

The American Academy of Psychodynamic Psychiatry and Psychoanalysis (AAPDPP)is a scholarly society including psychiatrists interested in all aspects of psychodynamic psychiatry.

Origins

The American Academy of Psychoanalysis was founded in 1956. At that time, the American Psychoanalytic Association, which was the dominant psychoanalytic organisation in North America, set standards for training psychoanalytic candidates at psychoanalytic institutes and certified individual psychoanalysts and institutes as well. The seventy-six Charter members who founded the Academy were concerned that focus on certification associated with a rigid Freudian framework inhibited free and open discourse about basic psychoanalytic concepts. They wanted to establish a forum for open discussion and debate but not an organisation that would certify psychoanalysts or psychoanalytic institutes. The guiding philosophy of this new organisation was expressed by its first President, Janet Rioch:

“The process of communication by forum is of value to encourage honest exchange of scientific opinion and observations; to build upon and expand those basic premises which survive critical scrutiny; to have the courage to discard that which cannot be regarded as scientifically valid in light of our present knowledge.”

Psychoanalysis and Psychiatry

Since the inception of the Academy, great changes have taken place in the practice of psychoanalysis and in the application of depth psychology (from the German term Tiefenpsychologie and commonly termed “psychoanalytic psychology”) to psychiatric symptoms, syndromes and disorders. The Academy changed its name to The American Academy of Psychoanalysis and Dynamic Psychiatry and became an Affiliate organisation of the American Psychiatric Association in 1998. From originally being an organisation of medical psychoanalysts, the Academy became an organisation of psychiatrists interested in all aspects of psychodynamic psychiatry. Psychoanalysis as a treatment technique remains one of its many interests. The membership of The Academy consists of psychiatrists, psychiatric residents, and medical students. Researchers and scholars who are not psychiatrists are welcomed as Scientific Associates.

Psychodynamic Psychiatry

Psychodynamic psychiatry is a new discipline that has emerged from a fusion of psychoanalytic and extra-psychoanalytic psychology, neuroscience and academic psychiatry.

Psychodynamic treatments are based on assessment that is carried out from a developmental perspective. Particular attention is paid to the person’s present and past psychiatric illnesses, experiences of trauma, and family history. The patient’s behaviour is reported both descriptively using established psychiatric diagnostic criteria from the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and from the International Classification of Diseases (ICD). The patient’s behaviour is in addition understood in terms of subjectively constructed narratives.

Psychodynamic psychiatry accepts concepts that are clinically useful and/or scientifically important but discards those that have not stood the test of time. Although it enthusiastically endorses research, it also recognises that much knowledge about normal and abnormal behaviour (however these terms are defined) is based on clinical experience. Thus, for example, the official journal of the American Academy of Psychoanalysis and Dynamic Psychiatry is entitled Psychodynamic Psychiatry and publishes clinical case discussions as well as scholarly reviews and research investigations. As time goes on, psychodynamic psychiatry as a body of knowledge will change as more is learned about the relationships between neuroscience, psychopathology, and individual feelings and behaviour.

All psychodynamic treatments are organised around a therapeutic alliance forged by both participants. They include psychoanalysis, briefer therapies and combinations of therapies including, for example, individual and group psychotherapy, family therapy and/or pharmacotherapy. Psychodynamically oriented treatments may be of any duration from a single meeting to weeks to years. They may take place anywhere the practitioner meets with a patient – not only in the outpatient setting but in inpatient psychiatric services, the emergency ward, and general hospital medical and surgical settings where consultation-liaison psychiatrists use developmental principles and alliance with the patient to render care. In other words, wherever the psychodynamically trained psychiatrist interacts with a patient, the practitioner uses a developmental approach to understand that person and help him or her get better.

Activities

All activities of the Academy foster communication and discussion of psychodynamic concepts as expressed in clinical treatment, research, psychological development and diverse other ways as well. A major priority of The Academy is to teach the principles of psychodynamic psychiatry to medical students, psychiatric residents and other mental health professionals and students. The specific activities include:

  • Annual Meeting Of The Academy The meetings take place immediately prior to the annual meeting of The American Psychiatric Association (APA) and are usually organised around a central theme for example, the meeting in 2013 was focused on the suicidal patient.
    • The meeting in 2016 was focused on play.
  • Symposia and workshops at the American Psychiatric Association and the Institute on Psychiatric Services (IPS)
  • Annual meeting in Italy co-sponsored with OPIFER (Organizzazione Psicoanalisti Italiania Federazione e Registro).
  • Past meetings in Washington DC co-sponsored with the Consortium for Psychoanalytic Research.

Publications and Out-Reach Activities

Psychodynamic Psychiatry (The Journal)

Psychodynamic Psychiatry, the official journal of The American Academy of Psychoanalysis and Dynamic Psychiatry, published by Guilford Press, was created in response to the need for the continued study and teaching of psychodynamic concepts in organised psychiatry. Psychodynamic Psychiatry is the only English-language psychiatric journal exclusively devoted to the study and discussion of these issues.

The central tenet of the journal is that psychodynamic principles are necessary for adequately understanding and treating people with psychiatric symptoms, syndromes and disorders. Its guiding framework is developmental and bio-psycho-social.

The journal publishes review articles, clinical discussions and research. Psychodynamic Psychiatry is edited by Richard C. Friedman MD. The Deputy Editors are Jennifer Downey, MD and Cesar Alfonso, MD.

From 1958 to 1972 the Academy published its proceedings in monograph form under the rubric “Science and Psychoanalysis” edited by Jules Masserman. In 1973 Silvano Arieti became the first editor of the Journal which was entitled Journal of The American Academy of Psychoanalysis. Subsequent Editors- in Chief included Morton Cantor, Jules Bemporad and Douglas Ingram. When Richard C. Friedman became Editor in Chief in 2012, the journal’s name was changed to Psychodynamic Psychiatry.

The Academy Forum

The Academy Forum is a magazine that is published twice yearly and focuses on psychoanalytic and psychodynamically oriented articles about art and culture.

The Academy Newsletter

The Academy Newsletter is published electronically 4 times a year and gives information about the organisation and its members.

Teichner Scholars Programme

The late Victor J Teichner was a former President of the AAPDPP. A grateful patient established a fund making it possible to impart the spirit of Teichner’s creative therapeutic perspective to psychiatric clinicians in training. The Victor J. Teichner Award is made annually to one psychiatric residency programme on the basis of an application to the Award Committee, composed of representatives of the AAPDPP and the AADPRT (American Association of Directors of Psychiatric Residency Training). Its focus is to promote the teaching of psychodynamic principles to psychiatrists-in-training. The Programme Awardee receives a one- to three-day visit from a Visiting Scholar chosen from a list maintained by the AAPDP. The choice of the Visiting Scholar and structure of the visit are made by the Programme. The visit must take place during the academic year beginning 01 July, after the announcement of the Awardee.

What is a Psychiatric Advance Directive?

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Introduction

A psychiatric advance directive (PAD), also known as a mental health advance directive, is a written document that describes what a person wants to happen if at some time in the future they are judged to be suffering from a mental disorder in such a way that they are deemed unable to decide for themselves or to communicate effectively.

It can inform others about what treatment they want or do not want from psychiatrists or other mental health professionals, and it can identify a person to whom they have given the authority to make decisions on their behalf. A mental health advance directive is one kind of advance health care directive.

Legal Foundations

Psychiatric advance directives are legal documents used by persons currently enjoying legal capacity to declare their preferences and instructions for future mental health treatment, or to appoint a surrogate decision maker through Health Care Power of Attorney (HCPA), in advance of being targeted by coercive mental health laws, during which they may be stripped of legal capacity to make decisions.

In the United States, although 25 states have now passed legislation in the past decade establishing authority for PADs, there is relatively little public information available to address growing interest in these legal documents. In addition in states without explicit PAD statutes, very similar mental health advance care planning can and does take place under generic HCPA statutes – expanding the audience for PADs to all 50 states (see National Resource Centre on Psychiatric Advance Directives).

In addition, states are beginning to recognise legal obligations under the federal Patient Self-Determination Act of 1991, which includes informing all hospital patients that they have a right to prepare advance directives and – with certain caveats – that clinicians are obliged to follow these directives.

Finally, the Joint Commission on the Accreditation of Healthcare Organisations (JCAHO) requires behavioural health facilities to ask patients if they have PADs. The Centres for Medicare and Medicaid Services announced that patients have the right to formulate advance directives and to have hospital staff and practitioners who provide coercive interventions in the hospital comply with these directives. Hospitals out of compliance risk loss of Medicare and Medicaid revenue.

Proponents of these directives believe thy of followed by treatment providers, crisis planning using PADs will help involuntary detainees retain control over their decision making – especially during times when they are labelled incompetent. Additionally, advocates argue that health care agents will be instrumental in providing inpatient clinicians with information that can be central to patients’ treatment, including history of side effects and relevant medical conditions.

Clinical Benefits

Recent data from a NIH-funded study conducted by researchers at Duke University has shown that creating a PAD with a trained facilitator increases therapeutic alliance with clinicians, enhances involuntary patients’ treatment satisfaction and perceived autonomy, and improves treatment decision-making capacity among people labelled with severe mental illness.

Moreover, PADs provide a transportable document – increasingly accessible through electronic directories – to convey information about a detainee’s treatment history, including medical disorders, emergency contact information, and medication side effects. Clinicians often have limited information about citizens detained and labelled as psychiatric patients who present or are coercively presented and labelled as in crisis. Nonetheless, these are the typical settings in which clinicians are called upon to make critical patient-management and treatment decisions, using whatever limited data may be available. With PADs, clinicians could gain immediate access to relevant information about individual cases and thus improve the quality of clinical decision-making – appropriately managing risk to patients and others’ safety while also enhancing patients’ long-term autonomy.

For these reasons, PADs are seen as an innovative and effective way of enhancing values of autonomy and social welfare for detainees labelled with mental illness. Since PADs are among the first laws that are specifically intended to promote autonomy among people detained under mental health laws, wider use of PADs would empower a traditionally disenfranchised group when targeted for coercive psychiatry.

Barriers

National surveys in the United States indicate that although approximately 70% of people targeted by coercive psychiatry laws would want a PAD if offered assistance in completing one, less than 10% have actually completed a PAD.

Some people detained and forcibly drugged under coercive psychiatry laws report difficulty in understanding advance directives, scepticism about their benefit, and lack of contact with a trusted individual who could serve as proxy decision maker. The sheer complexity of filling out these legal forms, obtaining witnesses, having the documents notarized, and filing the documents in a medical record or registry may pose a formidable barrier.

Recent studies of practitioners of coercive psychiatry’s attitudes about PADs suggest that they are generally supportive of these legal instruments, but have significant concerns about some features of PADs and the feasibility of implementing them in usual coercive intervention settings. Clinicians are concerned about lack of access to PAD documents in a commitment, lack of staff training on PADs, lack of communication between staff across different components of mental health systems, and lack of time to review the advance directive documents.

In a survey conducted of 600 psychiatrists, psychologists, and social workers showed that the vast majority thought advance care planning for crises would help improve patients’ overall mental health care. Further, the more clinicians knew about PAD laws, the more favourable were their attitudes toward these practices. For instance, while most psychiatrists, social workers, and psychologists surveyed believed PADs would be helpful to people detained and targeted for forced drugging and electroshock when labelled with severe mental illnesses, clinicians with more legal knowledge about PAD laws were more likely to endorse PADs as a beneficial part of patients’ treatment planning.

However, many clinicians reported NOT knowing enough about how PADs work and specifically indicated they lacked resources to readily help patients fill out PADs. Thus, if clinicians knew more about advance directives and had ready assistance for creating PADs, they said they would be much more likely to help their clients develop crisis plans.

Resources

It thus has become clear that the potential significance of PADs is becoming widely recognised among those targeted for coercive psychiatry, survivors of coercive psychiatry, influential policy makers, clinicians, family members, and patient advocacy groups but that significantly more concerted efforts at dissemination were needed. The community of stakeholders interested in PADs and the broader concept of self-directed care are in need of online resource and gathering place for exchange of views and information.

As a result, in the United States, a collaboration between the Bazelon Centre for Mental Health Law and Duke University has led to creation of the MacArthur Foundation-funded National Resource Centre on Psychiatric Advance Directives, the only web portal exclusively devoted to developing a learning community to help people targeted for coercive psychiatry, their families, and clinicians prepare for, and ultimately prevent, coercive psychiatry interventions. The NRC-PAD includes basic information, frequently asked questions, educational webcasts, web blog, most recent research, legal analyses, and state-by-state information on PADs and patient-centred crisis planning. The NRC-PAD website thus includes easy step-by-step information to help those targeted for forced drugging, family, and clinicians complete PADs that mirror the provisions in the PAD statutes.

On This Day … 21 May

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People (Births)

  • 1912 – John Curtis Gowan, American psychologist and academic (d. 1986).

John Curtis Gowan

John Curtis Gowan (21 May 1912 to 02 December 1986) was a psychologist who studied, along with E. Paul Torrance, the development of creative capabilities in children and gifted populations.

Graduating from Thayer Academy, Braintree, Massachusetts, in 1929, John Gowan was only 17 when he entered Harvard University, earning his undergraduate degree four years later. A master’s degree in mathematics followed; he then moved to Culver, Indiana, where he was employed as a counsellor and mathematics teacher at Culver Military Academy from 1941 to 1952. Earning a doctorate from UCLA, he became a member of the founding faculty at the California State University at Northridge, where he taught as a professor of Educational Psychology from 1953 until 1975, when he retired with emeritus status.

Dr. Gowan became interested in gifted children after the Russians gained superiority in space with the 1957 launch of Sputnik. He formed the National Association for Gifted Children the following year. He was the group’s executive director and president from 1975 to 1979 and over the years wrote more than 100 articles and fourteen books on gifted children, teacher evaluation, child development, and creativity.

While at Northridge, he developed a programme to train campus counsellors, was nominated in 1973 as outstanding professor, and had been a counsellor, researcher, Fulbright lecturer, and visiting professor at various schools including the University of Singapore, the University of Canterbury in Christchurch, New Zealand, the University of Hawaii, and Connecticut State College. He was a fellow of the American Psychological Association and was also a colleague of the Creative Education Foundation.

Besides his work in Educational Psychology as specifically related to gifted children, he also had an interest in psychic (or psychedelic) phenomena as it relates to human creativity. His work in this area was inspired by the writings of Aldous Huxley and Carl Jung. Based on his work in creativity and with gifted children, Dr. Gowan developed a model of mental development that derived from the work of Jean Piaget and Erik Erikson, but also included adult development beyond the ordinary adult successes of career and family building, extending into the emergence and stabilisation of extraordinary development and mystical states of consciousness. He described the entire spectrum of available states in his classic Trance, Art, & Creativity (1975), with its different modalities of spiritual and aesthetic expression. He also devised a test for self-actualisation, (as defined by Abraham Maslow), called the Northridge Developmental Scale.

What was Executive Order 13263?

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Introduction

The New Freedom Commission on Mental Health was established by then-US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings.

Executive Order 13316, signed on 17 September 2003, revoked Executive Order 13263.

Outline

President’s New Freedom Commission on Mental Health

By the authority vested in me as President by the Constitution and the laws of the United States of America, and to improve America’s mental health service delivery system for individuals with serious mental illness and children with serious emotional disturbances, it is hereby ordered as follows:

Section 1.⁠ Establishment.

There is hereby established the President’s New Freedom Commission on Mental Health (Commission).

Sec. 2.⁠ Membership.

(a) The Commission’s membership shall be composed of:

(i) Not more than fifteen members appointed by the President, including providers, payers, administrators, and consumers of mental health services and family members of consumers; and

(ii) Not more than seven ex officio members, four of whom shall be designated by the Secretary of Health and Human Services, and the remaining three of whom shall be designated—one each—by the Secretaries of the Departments of Labor, Education, and Veterans Affairs.

(b) The President shall designate a Chair from among the fifteen members of the Commission appointed by the President.

Sec. 3.⁠ Mission.

The mission of the Commission shall be to conduct a comprehensive study of the United States mental health service delivery system, including public and private sector providers, and to advise the President on methods of improving the system. The Commission’s goal shall be to recommend improvements to enable adults with serious mental illness and children with serious emotional disturbances to live, work, learn, and participate fully in their communities. In carrying out its mission, the Commission shall, at a minimum:

(a) Review the current quality and effectiveness of public and private providers and Federal, State, and local government involvement in the delivery of services to individuals with serious mental illnesses and children with serious emotional disturbances, and identify unmet needs and barriers to services.

(b) Identify innovative mental health treatments, services, and technologies that are demonstrably effective and can be widely replicated in different settings.

(c) Formulate policy options that could be implemented by public and private providers, and Federal, State, and local governments to integrate the use of effective treatments and services, improve coordination among service providers, and improve community integration for adults with serious mental illnesses and children with serious emotional disturbances.

Sec. 4.⁠ Principles.

In conducting its mission, the Commission shall adhere to the following principles:

(a) The Commission shall focus on the desired outcomes of mental health care, which are to attain each individual’s maximum level of employment, self-care, interpersonal relationships, and community participation;

(b) The Commission shall focus on community-level models of care that efficiently coordinate the multiple health and human service providers and public and private payers involved in mental health treatment and delivery of services;

(c) The Commission shall focus on those policies that maximize the utility of existing resources by increasing cost effectiveness and reducing unnecessary and burdensome regulatory barriers;

(d) The Commission shall consider how mental health research findings can be used most effectively to influence the delivery of services; and

(e) The Commission shall follow the principles of Federalism, and ensure that its recommendations promote innovation, flexibility, and accountability at all levels of government and respect the constitutional role of the States and Indian tribes.

Sec. 5.⁠ Administration.

(a) The Department of Health and Human Services, to the extent permitted by law, shall provide funding and administrative support for the Commission.

(b) To the extent funds are available and as authorized by law for persons serving intermittently in Government service (5 U.S.C. 5701-5707), members of the Commission appointed from among private citizens of the United States may be allowed travel expenses while engaged in the work of the Commission, including per diem in lieu of subsistence. All members of the Commission who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States.

(c) The Commission shall have a staff headed by an Executive Director, who shall be selected by the President. To the extent permitted by law, office space, analytical support, and additional staff support for the Commission shall be provided by executive branch departments and agencies.

(d) Insofar as the Federal Advisory Committee Act, as amended, may apply to the Commission, any functions of the President under that Act, except for those in section 6 of that Act, shall be performed by the Department of Health and Human Services, in accordance with the guidelines that have been issued by the Administrator of General Services.

Sec. 6.⁠ Reports.

The Commission shall submit reports to the President as follows:

(a) Interim Report. Within 6 months from the date of this order, an interim report shall describe the extent of unmet needs and barriers to care within the mental health system and provide examples of community-based care models with success in coordination of services and providing desired outcomes.

(b) Final Report. The final report will set forth the Commission’s recommendations, in accordance with its mission as stated in section 3 of this order. The submission date shall be determined by the Chair in consultation with the President.

Sec. 7.⁠ Termination.

The Commission shall terminate 1 year from the date of this order, unless extended by the President prior to that date.

What was the New Freedom Commission on Mental Health?

Published on by Andrew Marshall1 Comment

Introduction

The New Freedom Commission on Mental Health was established by then-US President George W. Bush through Executive Order 13263 on 29 April 2002 to conduct a comprehensive study of the US mental health service delivery system and make recommendations based on its findings.

The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.

The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximise the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance. The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.

A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission’s findings as a launching point for recommending widespread reform of the nation’s mental health system.

A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the Texas Medication Algorithm Project mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed ‘atypical antipsychotic drugs’, such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behaviour issues. These drugs were later found to cause increased rates of sudden death in patients.

In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people.

Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the pharmaceutical industry to foster psychotropic medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative’s wider objectives are to foster chemical behaviour control of American citizens, contrary to civil liberties and to basic human rights.

Executive Order 13316, signed on 17 September 2003, revoked Executive Order 13263.

Reports

Interim Report

The commission issued an interim report on 01 November 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final Report

On 22 July 2003, the President’s commission returned a report containing nineteen formal recommendations, organised under six proposed national goals for mental health. The commission emphasised recovery from mental illness, calls for consumer and family-centred care, and recommendations that states develop a more comprehensive approach to mental health.

The commission reported that “despite their prevalence, mental disorders often go undiagnosed,” so it recommended comprehensive mental health screening for “consumers of all ages,” including preschool children, because “each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders.”

In contradiction, the Congressional Research Service, stated the commission did not specifically recommend a nationwide screening programme for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country’s services for people with mental illness and disabilities were “fragmented,” the commission’s final report offered 19 recommendations within six larger goals to improve service coordination, move toward a recovery model, and help all individuals with mental illness and disability recover:

  1. Americans Understand that Mental Health Is Essential to Overall Health.
    • Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention.
    • Address mental health with the same urgency as physical health.
  2. Mental Health Care Is Consumer and Family Driven.
    • Develop an individualised plan of care for every adult with a serious mental illness and child with a serious emotional disturbance.
    • Involve consumers and families fully in orienting the mental health system toward recovery.
    • Align relevant Federal programmes to improve access and accountability for mental health services.
    • Create a Comprehensive State Mental Health Plan.
    • Protect and enhance the rights of people with mental illnesses.
  3. Disparities in Mental Health Services Are Eliminated.
    • Improve access to quality care that is culturally competent.
    • Improve access to quality care in rural and geographically remote areas.
  4. Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
    • Promote the mental health of young children.
    • Improve and expand school mental health programmes.
    • Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies.
    • Screen for mental disorders in primary health care, across the life span, and connect to treatment and supports.
  5. Excellent Mental Health Care Is Delivered and Research Is Accelerated.
    • Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses.
    • Advance evidence-based practices using dissemination and demonstration projects and create a public-private partnership to guide their implementation.
    • Improve and expand the workforce providing evidence-based mental health services and supports.
    • Develop the knowledge base in four understudied areas: mental health disparities, long-term effects of medications, trauma, and acute care.
  6. Technology Is Used to Access Mental Health Care and Information.
    • Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations.
    • Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry’s use of front organisations and the compromise of scientific integrity under colour of authority, look askance at the irony of the commission’s ‘freedom’ descriptor, contending the commission is yet another example of the excesses of drug industry marketing, and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.

Screening Recommendations

Mad in America author Robert Whitaker criticised the commission’s screening recommendations as “fishing for customers.” A coalition of over 100 advocacy organisations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of long-time member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. “He needs a lot of help. I’ll see him for free,” said Adams.

Others, including Congressman Ron Paul (R-TX14), were more concerned by the commission’s suggestion to use schools as a site for screening. Paul’s concern led to the introduction of H.R. 181 Parental Consent Act of 2005 in the US House of Representatives on 04 January 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (H.R. 2387), April 2009 (H.R. 2218), and August 2011 (H.R. 2769); those, likewise, died in committee.

TMAP Origin Criticism

Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.

TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public’s attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.

Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the “political/pharmaceutical alliance.” It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was “poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab.”

On This Day … 20 May

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People (Deaths)

  • 2014 – Sandra Bem, American psychologist and academic (b. 1944).

Sandra Bem

Sandra Ruth Lipsitz Bem (22 June 1944 to 20 May 2014) was an American psychologist known for her works in androgyny and gender studies. Her pioneering work on gender roles, gender polarisation and gender stereotypes led directly to more equal employment opportunities for women in the United States.

Education and Career

Bem attended Margaret Morrison Carnegie College, now known as Carnegie-Mellon University, and majored in psychology. She recalls the head of the counselling centre, Bob Morgan, encouraging her to study to become a psychiatrist. This was the first time such a high-status career had ever been suggested to her. Subsequently, she entered the University of Michigan in 1965 and obtained her Ph.D. in developmental psychology in 1968. Her dissertation focused primarily on cognitive processing and problem solving with young children. Her main influence while at the University of Michigan was experimental psychologist David Birch. Her early work focused on the behaviour of young children and their ability to solve problems, and utilize self-control and instruction.

After obtaining her Ph.D., Bem got a full-time tenure-track position as a professor at Carnegie-Mellon for three years and then moved on to work at Stanford University, where she worked until 1978. She left Stanford University because her application for tenure was denied. She and husband Daryl Bem both took tenured teaching positions at Cornell University in 1978, where she became a psychology professor and the director of the women’s studies programme. While at Cornell, Bem focused research on gender schema theory, sexuality, and clinical psychology until she retired in 2010.

Influences on the Field of Psychology

Bem was an American psychologist known for her works in androgyny and gender studies. Bem and her husband Daryl Bem advocated egalitarian marriage. The husband-wife team became highly demanded as speakers on the negative impacts of sex role stereotypes on individuals and society. At the time, there was a lack of empirical evidence to support their assertions because this was uncharted territory, and so Sandra Bem became very interested and determined to gather data that would support the detrimental and limiting effects of traditional sex roles. In her early career, she was heavily involved in women’s liberation movement, and she did work on sex-biased job advertising. Her involvement led to being a contributor to landmark cases concerning recruitment of women in the work force against companies such as AT&T and the Pittsburgh Press.

Early on in Bem’s career she created the Bem Sex-Role Inventory (BSRI), which is an inventory that acknowledges that individuals may exhibit both male and female characteristics. The BSRI is a scale developed to determine what kind of sex role an individual fulfils. It is a self-report inventory that asks participants how well 60 different attributes describe themselves by using a seven-point scale. These attributes reflect the definition of masculinity (20 questions) and femininity (20 questions), and the remaining 20 questions were merely filler questions (Bem, 1993). In this inventory the feminine and masculine items were chosen on what was culturally appropriate for males and females at that time in the early 1970s. The BSRI was later used to measure psychological flexibility and behavioural indicators. Bem also developed the gender schema theory. According to the gender schema theory, “the child learns to evaluate his or her adequacy as a person in terms of the gender schema, to match his or her preferences, attitudes, behaviours, and personal attributes against the prototypes stored within it.” This theory states that an individual uses gender as a way to organize various things in a person’s life into categories. Her research questioned the social beliefs and assumptions that sex roles are opposite, bipolar, and mutually exclusive. The data she collected were supportive of a merging of male and female traits to enable a person to be a fully functioning, adaptive human over an emphasis on gender stereotypes.

She asserted that masculine and feminine dimensions could be divided into two spheres, rather than one: A person with high masculine and low feminine identification would be categorised as “masculine”. A person with high feminine identification and low masculine identification, would be categorised as “feminine”. A person who had high identification with both characteristics would be categorised as “androgynous”. A person who has low identification with both dimensions would be considered “undifferentiated”.

One of Bem’s main arguments was that traditional gender roles are restrictive for both men and women, and can have negative consequences for individuals as well as society as a whole.

As previously mentioned, a person could be categorised as “androgynous” when taking the BSRI. Androgyny is defined as “the integration of both masculinity and femininity in a single individual”. Androgyny allows one to freely engage in both masculine and feminine behaviours. According to Bem, people’s behaviour can demonstrate what she defined as situational appropriateness. Situational appropriateness is demonstrated when behaviour is reflective of one’s environment. For example, a woman demonstrating knowledge of sports at a basketball game is appropriate. Androgyny may also blend modalities. An example of androgyny blending modalities would be a woman being both assertive and compassionate when firing someone from a job.

Awards and Honours

Sandra Bem received many awards for her research. Her first was the American Psychological Association Distinguished Scientific Award for an Early Career contribution to Psychology in 1976. In 1977 she was awarded the Distinguished Publication Award of the Association of Women in Psychology and in 1980 she received the Young Scholar Award of the American Association of University Women (Makosky, 1990). In 1995, she was selected as an “Eminent Woman in Psychology” by the Divisions of General Psychology and History of Psychology of the American Psychological Association. Critics of Bem’s work generally argued against the political nature of her theories and her objectivity in the material which she studied.

What is the Treatment Advocacy Centre?

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Introduction

The Treatment Advocacy Center (TAC) is a US non-profit organisation based in Arlington, Virginia, US.

The organization, originally announced as the NAMI Treatment Action Centre in 1997, was subsequently directed by psychiatrist E. Fuller Torrey, and identifies its mission as “dedicated to eliminating barriers to the timely and effective treatment of severe mental illness”.

The organisation is most well-known for proposed laws, policies, and practices in the areas of legally compelled outpatient services or outpatient commitment for people diagnosed with mental illness (also known as assisted outpatient treatment, AOT). The organisation identifies its other key issues as “anosognosia, consequences of non-treatment, criminalization of mental illness, psychiatric bed shortages, public service costs, violence and mental illness”. TAC has been subject to criticism by mental health advocates to be promoting coercion and forced treatment.

Brief History

Although according to the TAC website, E. Fuller Torrey founded the Treatment Advocacy Centre in 1998 as an offshoot of the National Alliance on Mental Illness (NAMI), other sources indicate that the original name was the NAMI Treatment Action Centre. Laurie Flynn, the NAMI director at the time, stated in a press release, “It’s a national disgrace that, in this age of remarkable progress in brain research and treatment, so many individuals are left out in the cold”. TAC received initial financial support from Theodore and Vada Stanley, founders of the Stanley Medical Research Institute; TAC was founded as an affiliate organisation with a separate executive director and board. The organisation operates with funding from the affiliated Stanley Medical Research Institute, a non-profit organization which provides funding for research into bipolar disorder and schizophrenia in the United States. Torrey is currently a member of the Treatment Advocacy Centre’s board and is executive director of the Stanley Medical Research Institute. The relationship between Torrey and NAMI seemed to sour according to sources, with Torrey being disinvited from NAMI’s national convention in 2012 after advocates protested his TAC involvement and promotion of outpatient commitment.

Areas of Focus

The Treatment Advocacy Centre activities and projects include:

  • Developed a template law for legally mandated outpatient mental health treatment.
    • Released in 2000, the draft text is meant as a legal framework for authorising court-ordered treatment of individuals diagnosed with mental illness who are determined by the court to meet certain legal criteria around dangerousness to self or others or inability to care for oneself due to a mental illness.
  • Research and study into public policy and other issues related specific to serious mental illness.
  • Education of policymakers and judges regarding TAC’s viewpoint on serious mental illness; TAC’s opinion is that more legally mandated treatment and increases in hospital beds will improve care.

Controversy

TAC’s major focus on legally mandated treatment is opposed by other advocacy groups. The Bazelon Centre for Mental Health Law in a statement on forced treatment states “[n]ot only is forced treatment a serious rights violation, it is counterproductive. Fear of being deprived of autonomy discourages people from seeking care. Coercion undermines therapeutic relationships and long-term treatment.” Daniel Fischer, founder of National Coalition for Mental Health Recovery, described outpatient commitment as a “a slippery slope” back to the kind of mass institutionalization seen in the 1940s and ’50s”.

What is the Mental Disability Advocacy Centre?

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Introduction

The Mental Disability Advocacy Centre (MDAC) is an international human rights organisation founded in Hungary in 2002.

It is headquartered in Budapest.

Background

The MDAC is an international human rights organisation which advances the rights of children and adults with learning, intellectual and psycho-social (mental health) disabilities.

MDAC uses the law to promote equality and social inclusion through strategic litigation, advocacy, research and monitoring and capacity-building.

MDAC operates at the global level as well as regional and domestic levels in Europe and Africa.

Brief History

MDAC was founded by The Open Society Foundations (OSF) and was registered as a foundation by the Budapest Capital Court (registration number 8689) in November 2002. MDAC has participatory status with the Council of Europe, and was granted a special consultative status with the United Nations Economic and Social Council in 2011. MDAC is a member of the Fundamental Rights Platform of the European Union Agency for Fundamental Rights.

Beneficiaries

People with learning, intellectual and psycho-social (mental health) disabilities are excluded from economic, civil, social and political rights, including the right to education, health and to vote. They are also denied their personhood under the law, and can be placed in institutions against their will.

Objectives

MDAC’s objectives focus on the rights of people with intellectual, learning and psycho-social (mental health) disabilities to be free from abuse, be persons recognised by the law and have access to justice, to live in the community, be educated and to take part in society.

  • Freedom from ill-treatment: for people with disabilities to be not secluded from the rest of society nor be subjected to physical and chemical restraints, and to be treated only with their consent.
  • Legal capacity: for people with disabilities to have their right to make their own choices protected by law.
  • Community living: for people with disabilities to have a legal right to live in the community, and a legally enforceable choice as to where and with whom to live.
  • Inclusive education: for children, youth and adults with disabilities to have a legal right to be educated and learn alongside the rest of the community, and not be segregated.
  • Political participation: for people with disabilities to have the right to vote and stand for election, and be assisted in doing so.

Activities

These include creating progressive jurisprudence and law reform, empowering people with disabilities and promoting participatory politics, supported by research.

  • Defending disabled people’s rights in courts across Europe and Africa, setting precedent at European Court of Human Rights and other courts, training lawyers and providing legal advice and representation.
  • Advocacy by connecting with governments to reform and implement legal structures, undertaking a watchdog role, reviewing the actions of the UN and the EU as well as governments, and monitoring bodies, so that torture and ill-treatment is prevented.
  • Working at grassroots level to engage, empower and train people with disabilities to participate in acquiring their own rights.
  • Research of human rights abuses

Achievements

Since 2002, MDAC has achieved the following:

  • Ending the practice of caged beds: in 2003, MDAC carried out research in the Czech Republic, Hungary, Slovakia and Slovenia on those countries’ use of cage beds.
    • Cage beds are a means of confinement and restraint for adults and children used within many mental health and social institutions.
    • As a direct result of MDAC’s work, Hungary has banned their use in all institutions, the Czech Republic and Slovakia has banned their use in social care institutions.
    • Very few, if any, are still used in Slovenia.
  • Creating progressive human rights jurisprudence:
    • MDAC has won cases at the European Court of Human Rights which has opened the way to further challenges to political and social attitudes to the care of people with intellectual and psycho-social disabilities.
    • As a result, it has lobbied for reform of laws on guardianship and the right to be legally recognised as a person in Central and Eastern Europe and Russia. Stanev v Bulgaria (2012), concerned the long-term placement, torture and ill-treatment of a man diagnosed with a mental illness in a remote care institution by his guardian.
    • He had no recourse to legally challenge the decision in Bulgarian courts.
    • This was the first time the Court found a violation of Article 3 of the European Convention on Human Rights (prohibition of torture) in a disability case.
    • It was also the first time the court found that a person in a social care institution was unlawfully detained. Shtukaturov v Russia (2008), concerned the detention of a man diagnosed with schizophrenia.
    • He was placed under guardianship without being informed of the decision.
    • His guardian unlawfully allowed for his detention in a psychiatric hospital for seven months without a court review, and he was forcibly injected with psychiatric medication against his will.
    • MDAC took his case to the European Court of Human Rights and he won.
  • The right to education:
    • In 2008, MDAC won an international case under the European Social Charter (MDAC v. Bulgaria) on behalf of up to 3,000 Bulgarian children with intellectual disabilities – the first case on a child’s right to education in Eastern Europe.
  • The right to vote:
    • MDAC’s ‘Save the Vote’ campaign resulted in the Venice Commission, a constitutional law expert group, supporting universal suffrage for people with disabilities.
  • In 2013, MDAC was long-listed for the Václav Havel Human Rights Prize.
  • In 2014, MDAC released a report on cage beds in the Czech Republic, after its ground-breaking first report published in 2003.
    • This was covered by Lancet Psychiatry.