What is the Institute of Psychiatry, Psychology and Neuroscience?

Introduction

The Institute of Psychiatry, Psychology and Neuroscience (IoPPN) is a research institution dedicated to discovering what causes mental illness and diseases of the brain. In addition, its aim is to help identify new treatments for them and ways to prevent them in the first place. The IoPPN is a faculty of King’s College London, England, previously known as the Institute of Psychiatry (IoP).

The institute works closely with South London and Maudsley NHS Foundation Trust. Many senior academic staff also work as honorary consultants for the trust in clinical services such as the National Psychosis Unit at Bethlem Royal Hospital.

The impact of the institute’s work was judged to be 100% ‘world-leading’ or ‘internationally-excellent’ in the Research Excellence Framework (REF 2014). The research environment of the institute was also rated 100% ‘world-leading’. King’s College London was rated the second for research in Psychology, Psychiatry and Neuroscience in REF 2014. According to the 2021 US News Ranking, King’s College London was ranked second in the world in Psychiatry and Psychology.

Refer to Maudsley Bipolar Twin Study.

Brief History

The IoPPN shares a great deal of its history with the Maudsley Hospital, with which it shares the location of its main building. It was part of the original plans of Frederick Mott and Henry Maudsley – inspired by the Munich institute of Emil Kraepelin – that the hospital would include facilities for teaching and research in 1896. In 1914, London County Council agreed to establish a hospital in Denmark Hill and Mott’s plan began to take shape. The Maudsley Hospital was opened in 1923 as a result of a donation by Henry Maudsley.

Originally established as the “Maudsley Hospital Medical School” in 1924, it changed its name to the Institute of Psychiatry in 1948, with Aubrey Lewis appointed to the inaugural Chair of Psychiatry (which he held until his retirement in 1966). The main Institute building was opened in 1967 and contains lecture theatres, administrative offices, library and canteen.

In 1959 a group of genetic researchers led by Eliot Slater were given Medical Research Council funding to establish themselves as the ‘MRC Psychiatric Genetics Unit’. Although this closed down in 1969, psychiatric genetics continued, eventually as the MRC Social, Genetic and Developmental Psychiatry Centre (SGDP Centre) which moved into new purpose-built building in 2002.

In 1997, the institute had split from the Maudsley and become instead a school of King’s College London. The Henry Wellcome building was opened in 2001 and houses most of the IoPPN’s psychology department. In 2004, a new Centre for Neuroimaging Sciences (CNS) was opened which provides offices, lab space, and access to two MRI scanners for neuroimaging research. In 2014 the institute was renamed to the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), as the remit of the institute was broadened to include all brain and behavioural sciences.

Departments

Addictions

The Addictions Department specialises in research into tobacco, alcohol and opiate addiction policy and treatment. In March 2010 the addiction research unit and the sections of alcohol research, tobacco research and behavioural pharmacology were brought together to form the current The Addictions Department, also known as the National Addiction Centre (NAC).

Biostatistics

This department provides advice in the interpretation and use of statistical techniques in psychological research. They work closely with members of the Neuroimaging section in their work using brain scanners.

The Biostatistics department opened in 1964, then as the Biometrics Unit. The department holds particular expertise in multivariate statistical methods for measurement, life-course epidemiology and the analysis of experimental, genetic and neuropsychiatric data.

The department provides both introductory and advanced training in applied statistical methodology, collaborate on studies of mental health based here and internationally, and undertake research in relevant applied methodology.

The department also hosts the UKCRN accredited King’s Clinical Trials Unit which provides randomisation, data management, analysis and trial management – all of which are available to researchers across King’s Health Partners. The CTU provides support to both medicinal and non-medicinal clinical trials assisting researchers in the conduct of carrying out clinical trials.

Child and Adolescent Psychiatry

The department is dedicated to the study of developmental disorders such as ADHD, clinical depression, autism and learning difficulties. The department has close links with the Michael Rutter Centre for Children and Young People at the Maudsley Hospital which has a number of specialist services for children and adolescents.

Forensic Mental Health Science

Forensic Mental Health Science is the study of antisocial, violent, and criminal behaviours among people with mental disorders. The department’s research focuses on antisocial behaviour as it appears in people with either major mental disorders or personality disorders. The department is closely allied to the Forensic Psychiatry Teaching Unit.

Neuroscience

Researchers in this department carry out a range of studies into diseases such as Alzheimer’s disease and motor neuron disease. The Institute of Psychiatry now houses the Medical Research Council Centre for Neurodegeneration Research, where pioneering research is conducted investigating disease of the CNS. The Department of Clinical Neuroscience in Windsor Walk also contains the MRC London Neurodegenerative Disease Brain Bank.

Department of Neuroimaging and Centre for Neuroimaging Sciences

The Centre for Neuroimaging Sciences (CNS) is a joint venture of the King’s College London Institute of Psychiatry and the South London and Maudsley NHS Trust (SLAM). Completed in early 2004, the centre provides an interdisciplinary research environment.

The Clinical Neuroimaging Department, situated at the Maudsley Hospital, provides a full range of neuroradiographic imaging services, including Magnetic Resonance Imaging (MRI). Within the CNS, the academic Department of Neuroimaging’s Major Research Facility (MRF) manages a range of MRI facilities for research studies. The Department of Neuroimaging also runs an EEG laboratory, re-launched in 2010.

Psychology

The IoPPN Psychology department was founded in 1950. The department conducts research in neuropsychology, forensic psychology, and cognitive behavioural therapy. Hans Eysenck set up the UK’s first qualification in clinical psychology in the department, which has now evolved into a three-year doctoral ‘DClinPsych’ qualification.

Clinically, members of the department offer expert services to the Maudsley Hospital, Bethlem Royal Hospital, King’s College Hospital, Guy’s Hospital and community mental health teams in the South London area. Members of the department also teach psychology to undergraduate medical students from the United Medical and Dental Schools of Guy’s and St Thomas’ Hospitals. Psychiatric geneticist Peter McGuffin was awarded a fellowship at the institute.

Psychological Medicine

The Department of Psychological Medicine, chaired by Professor Ulrike Schmidt, addresses many of the commonest mental disorders which affect adults including depression, anxiety, post traumatic stress disorder, eating disorders, somatoform disorders, and medically unexplained symptoms and syndromes. Its research spans basic science, experimental medicine, epidemiology and public policy. It includes the King’s Centre for Military Health Research, led by the department’s former chair, Professor Simon Wessely, and is responsible for studying the psychological impacts of the 2003 Iraq War. The department also contains a programme of work on liaison psychiatry and studies the many complex interactions between mental and physical illness.

Social, Genetic and Developmental Psychiatry

The SGDP centre is a multi-disciplinary research centre devoted to the study of the interplay between “nature” (genetics) and “nurture” (environment) as they interact in the development of complex human behaviour. Research at the SGDP acknowledges that there is no simple solution to the “nature versus nurture” debate; instead, expertise is combined across fields such as social epidemiology, child and adult psychiatry, developmental psychopathology, development in the family, personality traits, cognitive abilities, statistical genetics, and molecular genetics. In this way it is hoped that a greater understanding can be achieved in risk factors that might predispose an individual to depression, ADHD, or autism.

Brief History

The MRC Social, Genetic and Developmental Psychiatry (SGDP) Centre was founded in 1994 by the Medical Research Council, in partnership with the Institute of Psychiatry (now a school of King’s College London).

The research in social, genetic and developmental psychiatry have already existed at the Institute of Psychiatry since its establishment in 1948. However, the streams of research were not integrated and there have even been times when genetic researchers and social psychiatrists were in a state of hostility. The intellectual warfare between nature and nurture reached its peak in the 1960s and 1970s.

Aubrey Lewis, who was the first Professor of Psychiatry at the institute and the director of the MRC Social Psychiatry Research Unit (first MRC unit at the institute), noticed that social psychiatry was a broad field that included both biological substrate of disorders and social causes. Eliot Slater, the ‘founding father’ of psychiatric genetics in the United Kingdom, was encouraged by Lewis to study genetics in 1930s. In 1959, Slater established another MRC unit at the institute (MRC Psychiatric Genetics Unit), but the unit was closed in 1969 on Slater’s retirement. In 1984, MRC Child Psychiatry Unit was established at the Institute of Psychiatry by Michael Rutter, a member in the MRC Social Psychiatry Research Unit led by Lewis. The unit brought together experts in many overlapping fields, and the mix proved highly successful as the unit had a major impact on child psychiatric research throughout the world.

The MRC Social Psychiatry Research Unit was closed in 1993. The MRC and the institute found that there was a need for refocusing and reintegration with other strands of research including psychiatric genetics and disorders of adult life. Rutter and David Goldberg discussed with the MRC about the establishment of an interdisciplinary research centre that could comprehensively study the interplay of nature and nurture in the development of psychiatric disorders. In 1994, MRC SGDP Centre was established in Denmark Hill, and Rutter was appointed as the first director of the centre. The SGDP Centre has moved into its new purpose-built building in 2002.

Psychosis Studies

The department is the most highly cited group of scientists working on schizophrenia and related disorders. Work focuses on integrating cognitive measures and multimodal neuroimaging techniques, with perinatal, genetic and developmental data. The central aim is to characterise the core pathophysiological dimensions of schizophrenia and bipolar disorder. The section has initiated or participated a number of such treatment studies of new atypical antipsychotics and potential mood stabilising medication and is also developing computerised and web-based applications for disease self-management.

Maurice Wohl Clinical Neuroscience Institute

The Maurice Wohl Clinical Neuroscience Institute is a centre for neuroscience research opened by The Princess Royal in 2015. It is one of the leading neuroscience institutes in the world. The centre is named after British philanthropist Maurice Wohl, who supported many medical projects and had a long association with King’s College London, and was funded by several philanthropic donors, organisations and King’s Health Partners.

The Maurice Wohl Clinical Neuroscience Institute focuses on the development of new treatments to patients affected by neurodegenerative diseases (such as Alzheimer’s disease, Parkinson’s disease and motor neurone disease), mental disorders (depression, schizophrenia) and neurological diseases (including epilepsy and stroke), and the understanding of disease mechanisms. The research institute has 250 clinicians and research scientists from neuroimaging, neurology, psychiatry, genetics, molecular and cellular biology and drug discovery.

The current three major goals of the institute is to determine the underlying genetic and environmental risk factors for disease, to identify tests for early diagnosis and biomarkers that measure disease progression, and to develop informative cellular and animal disease models of disease to accelerate drug discovery.

Funding

Approximately 70% of the IoPPN’s income comes from the research it conducts. Approximately 20% is from clinical work performed for the South London and Maudsley NHS Foundation Trust. Approximately 10% of gross income is from taught courses offered to postgraduate students.

Sources include the government’s National Institute for Health Research and Higher Education Funding Council for England, grant-giving bodies such as the Medical Research Council (UK) and the Wellcome Trust, as well as other governmental, charitable and private-sector organisations. Individual research teams secure around £130 million of funds for their projects each year. Many projects are carried out in partnership with other university and health services, charities and private companies.

The IoPPN and the pharmaceutical company Lundbeck are led one of the largest ever academic-industry collaborations in research, known as NEWMEDS – Novel Methods leading to New Medications in Depression and Schizophrenia. The project is part of the Innovative Medicines Initiative developed by the European Federation of Pharmaceutical Industries and Associations and the European Commission. NEWMEDS aims to facilitate the development of new psychiatric medications by bringing top scientists and academics together in partnership with nearly every major global drug company.

Another key project is the KCL and Janssen led pre competitive public private consortium RADAR-CNS (Remote Measurement of Disease and Relapse in Central Nervous System Disorders), which uses smartphones and wearable devices to track clinical outcomes in disorders like depression, multiple sclerosis and epilepsy.

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What is the United Kingdom Council for Psychotherapy?

Introduction

The United Kingdom Council for Psychotherapy (UKCP) is a professional association of psychotherapy organisations and practitioners in the United Kingdom. It is restricted to registered clinical psychotherapists and psychotherapeutic counsellors (similar, but with shorter training).

Refer to Centre for Freudian Analysis and Research.

Constitution

The UKCP exists to “promote and maintain the profession of psychotherapy and the highest standards in the practice of psychotherapy throughout the United Kingdom, for the benefit of the public.” Only psychotherapists or psycho-therapeutic counsellors who meet UKCP’s training requirements and abide by its ethical guidelines are included in its online “Register of Psychotherapists”.

The UKCP was initially founded in the 1980s as the United Kingdom Standing Conference for Psychotherapy following the Foster Report (1971) and the Sieghart Report (1978), which recommended regulation of the psychotherapy field. It was formally inaugurated as a council in 1993.

The UKCP has since evolved into a national umbrella organisation for most major psychotherapeutic modalities. As of 2012, there are more than 70 member organisations representing all the main traditions in the practice of psychotherapy.

The council is run by a board of trustees which is elected by the council’s members. A number of subcommittees, including the ethics committee, report directly to the board of trustees.

UKCP also represents the United Kingdom in the European Association for Psychotherapy (EAP) – a Vienna-based umbrella organisation which sets standards for equivalence of training and practice throughout Europe – and is part of the National Awarding Organisation (NAO) overseeing the European Certificate of Psychotherapy (ECP) award in the UK.

Objectives

  • To promote the art and science of psychotherapy and psychotherapeutic counselling for the public benefit.
  • To promote research in psychotherapy and psychotherapeutic counselling, and to disseminate the results of any such research.
  • To promote high standards of education, training and practice in psychotherapy and psychotherapeutic counselling.
  • To promote the wider provision of psychotherapy and psychotherapeutic counselling for all sections of the public.

Campaigns

The UKCP’s campaign work has included collaboration with NICE and the Health Professions Council. Campaigns have included:

  • NICE under scrutiny.
  • NICE consultations.
  • Reparative therapy.
  • Services under threat.
  • Skills for Health.

Regulatory Role

The UKCP regards the regulation of psychotherapists and the public accountability of their practice as important means to safeguard the interests of patients, clients, and the reputation of registered practitioners. The present Register is voluntary – it is not required by any Act of Parliament – but the UKCP is campaigning with other related organisations for the statutory regulation of the “talking therapy” professions.

The UKCP delegates the accreditation and re-accreditation of members to UKCP organisational members. Organisational members may be designated as “training”, “accrediting” or both. Individual psychotherapists can join the UKCP register only following accreditation by one of these organisations. At present there is no way of registering directly with UKCP.

The UKCP does not run courses leading to UKCP accreditation; courses are provided by its organisational members. Some training organisations also accredit and will award Accreditation of Prior Learning (APL) or give credit for previous training experience.

Candidates for registration who trained on a course that does not lead directly to membership need to seek accreditation by an accrediting organisation member.

Despite the UKCP stating that “We exist to promote and maintain high standards of practice of psychotherapy and psychotherapeutic counselling for the benefit of the public throughout the United Kingdom”, there have been numerous complaints and instances of UKCP registered therapists violating the rights of their clients, harming them psychologically, emotionally and sexually. Some of these instances have resulted in therapists escaping any concrete punishments for their actions and being allowed to continue practicing. One case involved the sexual abuse of a mentally ill client by a therapist registered with the Guild of Analytical Psychologists, a member organisation of the UKCP, with the therapist receiving a suspension only. A report carried out by unsafespaces.com found that one in four therapists continue to practice despite being struck off by member institutions.

Structure

  • Board of Trustees.
  • UKCP colleges.
  • UKCP committees.
  • Faculties and groups.
  • Members’ Forum.
  • Special interest groups.

UKCP Colleges

There are 11 UKCP colleges:

  • Cognitive Psychotherapies College (CPC).
  • College of Child and Adolescent Psychotherapies (C-CAP).
  • College for Family, Couple and Systemic Therapy (CFCST).
  • College of Hypno-psychotherapists (CH-P).
  • College of Medical Psychotherapists (CMP).
  • College for Sexual and Relationship Psychotherapy (CSRP).
  • Constructivist and Existential College (CEC).
  • Council for Psychoanalysis and Jungian Analysis College (CPJAC).
  • Humanistic and Integrative Psychotherapy College (HIPC).
  • Psychotherapeutic Counselling and Intersubjective Psychotherapy College (PCIPC).
  • Universities Training College (UTC).

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What is the Centre for Freudian Analysis and Research?

Introduction

Centre for Freudian Analysis and Research (CFAR) is a psychoanalysis research, training and low-cost treatment centre located in London, United Kingdom.

CFAR is a member organisation of the United Kingdom Council for Psychotherapy (UKCP). CFAR operates within the psychoanalytic tradition of Sigmund Freud and Jacques Lacan.

Brief History

The centre was founded in 1985 by Bice Benvenuto, Professor Bernard Burgoyne, Richard Klein and Darian Leader. It was established as a charity with the purpose of advancing education for the benefit of the public in particular by the provision of training and seminars in psychoanalysis.

Courses

CFAR offers introductory and advanced courses in psychoanalysis, and trains psychoanalysts within the context of its clinical training programme. Seminars are given by visiting Lacanian analysts from France, Belgium, Spain and Australia.

Publications

The Centre publishes a Journal JCFAR which contains articles on psychoanalytic themes from a Freudian and Lacanian perspective. In association with Karnac Books CFAR has published The Centre for Freudian Analysis and Research Library which aims to make classic Lacanian texts available in English for the first time, as well as publishing original research in the Lacanian field:

  • Sexual Ambiguities by Geneviève Morel.
  • The Trainings of the Psychoanalyst by Annie Tardits.
  • Freud and the Desire of the Psychoanalyst by Serge Cottet.
  • Lacan and Levi-Strauss or The Return to Freud (1951-1957) by Markos Zafiropoulos.

Challenge to Health Professions Council

In February 2007 the UK Government published a white paper (‘Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century’) which stated that “The government is planning to introduce statutory regulation for…psychotherapists and counsellors…” and that “…psychotherapists and counsellors will be regulated by the Health Professions Council, following that Council’s rigorous process of assessing their regulatory needs and ensuring that its system is capable of accommodating them”.

As a response to this proposed regulation by the Health Professions Council (HPC), CFAR was one of the organisations that contributed to the Maresfield report which opposed the suitability of the HPC as a regulating body for the professions of counselling and psychotherapy in the UK.

Following on from this report, CFAR was one of six organisations that called for a judicial review of whether or not the HPC had, in fact, fully assessed the regulatory needs of the professions or properly determined if it was the most appropriate body to provide such regulation. On Friday 10 December 2010, a Judicial Review Permission Hearing under The Hon. Mr Justice Burton at the Royal Courts of Justice found against the Health Professions Council and granted permission to proceed towards a Judicial Review of the proposals for regulation under the HPC. On 16 February 2011 the UK government – in its command paper ‘Enabling Excellence’ – halted the project to regulate counselling, psychotherapy and other talking treatments via the HPC.

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What is BPDFamily.com?

Introduction

BPDFamily.com is an online support group for the family members of individuals with borderline personality disorder (BPD).

The group is one of the first “cyber” support groups to be recognised by the medical providers and receive professional referrals.

Outline

BPDFamily.com provides articles and message boards for family members to learn and share their experiences. The articles explain borderline personality disorder in understandable terms, and the discussion groups help to normalise the experiences of family members. The site appeals to family members who care about someone with BPD, but are frustrated with the relationship demands and conflict.

The site educates its members on concepts developed by Shari Manning PhD, Margalis Fjelstad PhD, Robert O. Friedel MD, and the NEA-BPD Family Connections Programme and reached out to academia for collaborations. The site has an interactive web program that teaches the basic principles of cognitive behavioural therapy (CBT).

The website and support group are certified as a reputable health information resource by the Health On the Net Foundation.

Funding has come from benefactors and member donations.

Use by Healthcare Professionals

BPDFamily.com is a listed reference site of the National Health Service (England), the National Alliance on Mental Illness, the National Education Alliance for Borderline Personality Disorder, and the Personality Disorders Awareness Network.

The group’s services and programmes are recommended in Primer on Borderline Personality Disorder, Abnormal and Clinical Psychology: An Introductory Textbook, Resources to Improve Emotional Health and Strengthen Relationships, I Hate You–Don’t Leave Me: Understanding the Borderline Personality, The Essential Family Guide to Borderline Personality Disorder, Stop Walking on Eggshells, and Discovering Your Inner Child: Transforming Toxic Patterns and Finding Your Joy. The site has been recommended by about.com expert Kristalyn Salters-Pedneault, PhD, Salon advice columnist Cary Tennis, PsychCentral columnist Kate Thieda, and by Randi Kreger at BPDCentral.

The organisation has been involved and referenced in clinical research studies conducted by: Columbia University, University of Wollongong (Australia), California State University, Sacramento, University of Toronto (Canada), University of Nevada, Bowling Green State University, Wright Institute (California), Colorado School of Professional Psychology, Long Island University, Alliant International University (California), Macquarie University (Australia), Middle Tennessee State University, Simon Fraser University (Canada) and Walden University. The organisation also supports industry research studies conducted by the Treatment and Research Advancements Association for Personality Disorder (TARA-APD).

In a January 2013 column, Kristalyn Salters-Pedneault at Boston University School of Medicine says that although she highly recommends this group for family members, readers with borderline personality disorder should keep in mind that some people have been hurt by their family member with BPD and are speaking from this perspective

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What was TeenScreen?

Introduction

The TeenScreen National Centre for Mental Health Checkups at Columbia University was a national mental health and suicide risk screening initiative for middle- and high-school age adolescents.

On 15 November 2012, according to its website, the programme was terminated. The organisation operated as a centre in the Division of Child and Adolescent Psychiatry Department at Columbia University, in New York City.

The programme was developed at Columbia University in 1999, and launched nationally in 2003. Screening was voluntary and offered through doctors’ offices, schools, clinics, juvenile justice facilities, and other youth-serving organisations and settings. As of August 2011, the programme had more than 2,000 active screening sites across 46 states in the United States, and in other countries including Australia, Brazil, India and New Zealand.

Screening Programme

Organisation

The programme was developed by a team of researchers at Columbia University, led by David Shaffer. The goal was to make researched and validated screening questionnaires available for voluntary identification of possible mental disorders and suicide risk in middle and high school students. The questionnaire they developed is known as the Columbia Suicide Screen, which entered into use in 1999, an early version of what is now the Columbia Health Screen. In 2003, the New Freedom Commission on Mental Health, created under the administration of George W. Bush, identified the TeenScreen program as a “model” programme and recommended adolescent mental health screening become common practice.

The organisation launched an initiative to provide voluntary mental health screening to all US teens in 2003. The following year, TeenScreen was included in the national Suicide Prevention Resource Centre’s (SPRC) list of evidence-based suicide prevention programmes. In 2007, it was included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programmes and Practices. In 2009, the organisation launched the TeenScreen Primary Care initiative to increase mental health screening by paediatricians and other primary care providers, the same year the US Preventive Services Task Force recommended annual adolescent mental health screening as part of routine primary care, and the Institute of Medicine recommended expansion of prevention and early identification programmes.

As of 2011, the programme was led by executive director Laurie Flynn, deputy executive director Leslie McGuire and scientific advisor Mark Olfson, M.D., alongside a National Advisory Council of healthcare professionals, educators and advocates.

As of 15 November 2012, TeenScreen has been terminated, will no longer train or register new programmes, and will cease all operations by the end of the year.

Mission and Locations

The mission of the TeenScreen National Centre was to expand and improve the early identification of mental health problems in youth. In particular, TeenScreen aimed to find young people at risk of suicide or developing mental health disorders so they could be referred for a comprehensive mental health evaluation by a health professional. The programme focuses on providing screening to young people in the 11-18 age range. From 2003 until 2012, the programme was offered nationally in schools, clinics, doctors’ offices and in youth service environments such as shelters and juvenile justice settings. As of August 2011, more than 2,000 primary care providers, schools and community-based sites in 46 states offered adolescent mental health screening through the TeenScreen National Centre. In addition, the screening was also being provided in other countries including Australia, Brazil, India, New Zealand and Scotland.

Screening Process

TeenScreen provided materials, training and technical help through its TeenScreen Primary Care and Schools and Communities programmes for primary care providers, schools and youth-serving organisations that provided mental health screening to adolescents. A toolkit was provided, including researched and validated questionnaires, instructions for administering, scoring and interpreting the screening responses. Primary care programme materials included information on primary care referrals for clinical evaluation. In the school and community setting, the screening process was voluntary and required active parental consent and participant assent prior to screening sessions.

The validated questionnaires included items about depression, thoughts of suicide and attempts, anxiety, and substance use. The screening questionnaires typically took up to ten minutes for an adolescent to complete. Once the responses to the questionnaire had been reviewed, any adolescent identified as being at possible risk for suicide or other mental health concerns would then assessed by a health or mental health professional. The result of this assessment determined whether the adolescent could be referred for mental health services. If this was the case, parents were involved and provided with help locating the appropriate mental health services.

Research, Endorsements and Responses

Recommendations and Research

Mental health screening has been endorsed by the former US Surgeon General David Satcher, who launched a “Call to Action” in 1999 encouraging the development and implementation of safe, effective school-based programmes offering intervention, help and support to young people with mental health issues. TeenScreen is included as an evidence-based programme in the US Substance Abuse and Mental Health Services Administration (SAMHSA)’s National Registry of Evidence-based Programs and Practices as a scientifically tested and reviewed intervention. In addition, the US Preventive Services Task Force recommended in 2009 that mental health screening for teenagers be integrated into routine primary care appointments.

Studies have been conducted on the effectiveness and impact of mental health screening for young people. In a 2004 systematic evidence review, the US Preventive Services Task Force found that there were no studies that addressed whether screening as part of primary care reduced morbidity and mortality, nor any information of the potential risks of screening. In a later review, published in 2009, the task force found that there was evidence supporting the efficacy of screening tools in identifying teenagers at risk of suicide or mental health disorders.

A team of researchers from Columbia University and the New York State Psychiatric Institute completed a randomised controlled clinical trial on the impact of suicide screening on high school students in New York State from 2002-2004. The study found that students who were given a questionnaire about suicide were no more likely to report suicidal thoughts after the survey than students in the control group who had not been questioned. Neither was there any greater risk for “high risk” students. A subsequent study by the researchers, in 2009, found that screening appeared to increase the likelihood that adolescents would receive treatment if they were at risk for mental health disorders or suicide.

A study published in 2011, involving 2,500 high school students, examined the value of routine mental health screening in school to identify adolescents at-risk for mental illness, and to connect those adolescents with recommended follow-up care. The research, conducted between 2005 and 2009 at six public high schools in suburban Wisconsin, found that nearly three out of four high school students identified as being at-risk for having a mental health problem were not in treatment at the time of screening. Of those students identified as at-risk, a significant majority (76.3%) completed at least one visit with a mental health provider within 90 days of screening. More than half (56.3%) received minimally adequate treatment, defined as having three or more visits with a provider, or any number of visits if termination was agreed to by the provider.

A separate study published in 2011, found that mental health screening was effective at connecting African-American middle school students from a predominantly low-income area with school-based mental health services. Researchers have also found evidence to support the addition of mental health screenings for adolescents while undergoing routine physical examinations.

Acceptance and Critical Responses

Recommendations endorsing adolescent mental health screening have been issued by the Institute of Medicine (IOM) and the US Preventative Services Task Force (USPSTF). The American Academy of Paediatrics recommends assessment of mental health at primary care visits and suggests the use of validating screening instruments. These add to statements and recommendations to screen adolescents for mental illness from the American Medical Association (AMA), the Society for Adolescent Health and Medicine, the American Academy of Family Physicians and the National Association of Paediatric Nurse Practitioners. TeenScreen has been endorsed by a number of organizations, including the National Alliance for the Mentally Ill, and federal and state commissions such as the New Freedom Commission.

There is opposition to mental health screening programmes in general and TeenScreen in particular, from civil liberties, parental rights, and politically conservative groups. Much of the opposition is led by groups who claim that the organization is funded by the pharmaceutical industry; however, in 2011, an inquiry launched by Senator Charles E. Grassley into the funding of health advocacy groups by pharmaceutical, medical-device, and insurance companies demonstrated to Senator Grassley’s satisfaction that TeenScreen does not receive funding from the pharmaceutical industry. Senator Grassley sent a letter to TeenScreen and 33 other organisations like the American Cancer Society asking about their financial ties to the pharmaceutical industry. TeenScreen replied saying they did not accept money from medical companies.

In 2005, TeenScreen was criticised following media coverage of a suit filed a local screening programme in Indiana by the parents of a teenager who had taken part in screening. The suit alleged that the screening had taken place without parents’ permissions. The complaint led to a change in how parental consent was handled by TeenScreen sites. In 2006, the programme’s policy was amended so that active rather than passive consent was required from parents before screening adolescents in a school setting.

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What is the Substance Abuse and Mental Health Services Administration?

Introduction

The Substance Abuse and Mental Health Services Administration (SAMHSA) is a branch of the US Department of Health and Human Services.

It is charged with improving the quality and availability of treatment and rehabilitative services in order to reduce illness, death, disability, and the cost to society resulting from substance abuse and mental illnesses. The Administrator of SAMHSA reports directly to the Secretary of the US Department of Health and Human Services. SAMHSA’s headquarters building is located outside of Rockville, Maryland.

Brief History

SAMHSA was established in 1992 by Congress as part of a reorganisation stemming from the abolition of Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA). ADAMHA had been established in 1973, combining the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH). The 1992 ADAMHA Reorganisation Act consolidated the treatment functions that were previously scattered amongst the NIMH, NIAAA, and NIDA into SAMHSA, established as an agency of the Public Health Service (PHS). NIMH, NIAAA, and NIDA continued with their research functions as agencies within the National Institutes of Health.

Congress directed SAMHSA to target effectively substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and rapidly into the general health care system.

Charles Curie was SAMHSA’s Director until his resignation in May 2006. In December 2006 Terry Cline was appointed as SAMHSA’s Director. Dr. Cline served through August 2008. Rear Admiral Eric Broderick served as the Acting Director upon Dr. Cline’s departure, until the arrival of the succeeding Administrator, Pamela S. Hyde, J.D. in November 2009. She resigned in August 2015 and Kana Enomoto, M.A. served as Acting Director of SAMHSA until Dr. Elinore F. McCance-Katz was appointed as the inaugural Assistant Secretary for Mental Health and Substance Abuse. The title was changed by Section 6001 of the 21st Century Cures Act.

Organisation

SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on American’s communities.

Four SAMHSA offices, called Centres, administer competitive, formula, and block grant programs and data collection activities:

  • The Centre for Mental Health Services (CMHS) focuses on prevention and treatment of mental disorders.
  • The Centre for Substance Abuse Prevention (CSAP) seeks to reduce the abuse of illegal drugs, alcohol, and tobacco.
  • The Centre for Substance Abuse Treatment (CSAT) supports effective substance abuse treatment and recovery services.
  • The Centre for Behavioural Health Statistics and Quality (CBHSQ) collects, analyses, and publishes behaviour health data.

The Centres give grant and contracts to US states, territories, tribes, communities, and local organisations. They support the provision of quality behavioural-health services such as addiction-prevention, treatment, and recovery-support services through competitive Programmes of Regional and National Significance grants. Several staff offices support the Centres:

  • Office of the Administrator.
  • Office of Policy, Planning, and Innovation.
  • Office of Behavioural Health Equity.
  • Office of Financial Resources.
  • Office of Management, Technology, and Operations.
  • Office of Communications.
  • Office of Tribal Affairs and Policy.

Centre for Mental Health Services

The Centre for Mental Health Services (CMHS) is a unit of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the US Department of Health and Human Services. This US government agency describes its role as:

The Center for Mental Health Services leads federal efforts to promote the prevention and treatment of mental disorders. Congress created CMHS to bring new hope to adults who have serious mental illness and children with emotional disorders.

As of March 2016, the director of CMHS is Paolo del Vecchio.

CMHS is the driving force behind the largest US children’s mental health initiative to date, which is focused on creating and sustaining systems of care. This initiative provides grants (now cooperative agreements) to States, political subdivisions of States, territories, Indian Tribes and tribal organisations to improve and expand their Systems Of Care to meet the needs of the focus population – children and adolescents with serious emotional, behavioural, or mental disorders. The Children’s Mental Health Initiative is the largest Federal commitment to children’s mental health to date, and through FY 2006, it has provided over $950 million to support SOC development in 126 communities.

Centre for Substance Abuse Prevention

The Centre for Substance Abuse Prevention (CSAP) aims to reduce the use of illegal substances and the abuse of legal ones.

CSAP promotes self-esteem and cultural pride as a way to reduce the attractiveness of drugs, advocates raising taxes as a way to discourage drinking alcohol by young people, develops alcohol and drug curricula, and funds research on alcohol and drug abuse prevention. CSAP encourages the use of ‘evidence-based programmes’ for drug and alcohol prevention. Evidence-based programmes are programmes that have been rigorously and scientifically evaluated to show effectiveness in reducing or preventing drug use.

Brief History and Legal Definition

CSAP was established in 1992 from the previous Office of Substance Abuse Prevention by the law called the ADAMHA Reorganisation Act. Defining regulations include those of Title 42.

Centre for Substance Abuse Treatment

The Centre for Substance Abuse Treatment (CSAT) was established in October 1992 with a Congressional mandate to expand the availability of effective treatment and recovery services for alcohol and drug problems. CSAT supports a variety of activities aimed at fulfilling its mission:

To improve the lives of individuals and families affected by alcohol and drug abuse by ensuring access to clinically sound, cost-effective addiction treatment that reduces the health and social costs to our communities and the nation.

CSAT works with States and community-based groups to improve and expand existing substance abuse treatment services under the Substance Abuse Prevention and Treatment Block Grant Programme. CSAT also supports SAMHSA’s free treatment referral service to link people with the community-based substance abuse services they need. Because no single treatment approach is effective for all persons, CSAT supports the nation’s effort to provide multiple treatment modalities, evaluate treatment effectiveness, and use evaluation results to enhance treatment and recovery approaches.

Centre for Behavioural Health Statistics and Quality

The Centre for Behavioural Health Statistics and Quality (CBHSQ) conducts data collection and research on ‘behavioural health statistics’ relating to mental health, addiction, substance use, and related epidemiology. CBHSQ is headed by a Director. Subunits of CBHSQ include:

  • Office of Programme Analysis and Coordination.
  • Division of Surveillance and Data Collection.
  • Division of Evaluation, Analysis and Quality.

Regional Offices

CMS has its headquarters outside of Rockville, Maryland with 10 regional offices located throughout the US:

  • Region I – Boston, Massachusetts:
    • Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island and Vermont.
  • Region II – New York, New York:
    • New York State, New Jersey, US Virgin Islands and Puerto Rico.
  • Region III – Philadelphia, Pennsylvania:
    • Delaware, Maryland, Pennsylvania, Virginia, West Virginia and the District of Columbia.
  • Region IV – Atlanta, Georgia:
    • Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
  • Region V – Chicago, Illinois:
    • Illinois, Indiana, Michigan, Minnesota, Ohio and Wisconsin.
  • Region VI – Dallas, Texas:
    • Arkansas, Louisiana, New Mexico, Oklahoma and Texas.
  • Region VII – Kansas City, Missouri:
    • Iowa, Kansas, Missouri, and Nebraska.
  • Region VIII – Denver, Colorado:
    • Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming.
  • Region IX – San Francisco, California:
    • Arizona, California, Hawaii, Nevada, American Samoa, Guam, and the Northern Marina Islands.
  • Region X – Seattle, Washington:
    • Alaska, Idaho, Oregon, and Washington.

Strategic Direction

In 2010, SAMHSA identified 8 Strategic Initiatives to focus the Agency’s work. Below are the 8 areas and goals associated with each category:

  • Prevention of Substance Abuse and Mental Illness – Create prevention-prepared communities in which individuals, families, schools, workplaces, and communities take action to promote emotional health; and, to prevent and reduce mental illness, substance (including tobacco) abuse, and, suicide, across the lifespan
  • Trauma and Justice – Reduce the pervasive, harmful, and costly public-health impacts of violence and trauma by integrating trauma-informed approaches throughout health and behavioural healthcare systems; also, to divert people with substance-abuse and mental disorders away from criminal-/juvenile-justice systems, and into trauma-informed treatment and recovery.
  • Military Families – Active, Guard, Reserve, and Veteran – Support of our service men & women, and their families and communities, by leading efforts to ensure needed behavioural health services are accessible to them, and successful outcomes.
  • Health Reform – Broaden health coverage and the use of evidence-based practices to increase access to appropriate and high quality care; also, to reduce existing disparities between: the availability of substance abuse and mental disorders; and, those for other medical conditions.
  • Housing and Homelessness – To provide housing for, and to reduce the barriers to accessing recovery-sustaining programmes for, homeless persons with mental and substance abuse disorders (and their families)
  • Health Information Technology for Behavioural Health Providers – To ensure that the behavioural-health provider network – including prevention specialists and consumer providers – fully participate with the general healthcare delivery system, in the adoption of health information technology.
  • Data, Outcomes, and Quality – Demonstrating Results – Realise an integrated data strategy that informs policy, measures program impact, and results in improved quality of services and outcomes for individuals, families, and communities.
  • Public Awareness and Support – Increase understanding of mental and substance abuse prevention & treatment services, to achieve the full potential of prevention, and, to help people recognise and seek assistance for these health conditions with the same urgency as any other health condition.
  • Their budget for the Fiscal Year 2010 was about $3.6 billion. It was re-authorized for FY2011. Most recently, the FY 2016 Budget requests $3.7 billion for SAMHSA, an increase of $45 million above FY 2015.

Controversy

In February 2004, the administration was accused of requiring the name change of an Oregon mental health conference from “Suicide Prevention Among Gay/Lesbian/Bisexual/Transgender Individuals” to “Suicide Prevention in Vulnerable Populations.”

In 2002, then-President George W. Bush established the New Freedom Commission on Mental Health. The resulting report was intended to provide the foundation for the federal government’s Mental Health Services programmes. However, many experts and advocates were highly critical of its report, Achieving the Promise: Transforming Mental Health Care in America.

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What is the Abraham Low Self-Helps Systems?

Introduction

Abraham Low Self-Help Systems (ALSHS) is a non-profit organisation formed from the merger of Recovery International and the Abraham Low Institute.

ALSHS facilitates the estimated 600 worldwide Recovery International meetings and all projects formerly run by the Abraham Low Institute including the Power to Change programme. The organisation is named after Abraham Low, founder of the mental health self-help organisation now known as Recovery International.

Brief History

Recovery, Inc., often referred to simply as Recovery, was officially formed 07 November 1937, by neuropsychiatrist Abraham Low in Chicago, Illinois. Low created the organisation to facilitate peer support self-help groups for former mental patients and later allowed for participation of those who had not been hospitalised, but with a desire to improve their mental health. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. As of 2008 there were over 600 weekly Recovery International meetings held throughout North America, Ireland, the United Kingdom, Israel and India.

The Abraham Low Institute was founded in 1989 to develop programmes, in addition to Recovery, based on Low’s self-help principles. The Institute awarded grants to further scholarly research on Low’s work, provided research resources for people interested in Low’s methods, and developed the Power to Change programme and The Relatives Project.

On 01 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). Celinda Jungheim, a community volunteer from Los Angeles, was elected as president of the Board of Directors. Abraham Low Self-Help Systems was incorporated on 01 January 2009, completing the merger of Recovery International and The Abraham Low Institute. Abraham Low Self-Help Systems is now the provider of Recovery International community, phone and online meetings and The Power to Change programme, which was a programme of The Abraham Low Institute.

The Relatives Project

The Relatives Project, found in 1993, provides support for family and friends of people who have mental and emotional problems. The Relatives Project teaches coping skills and stress management through meetings similar to those held in Recovery International groups, but using literature written by Abraham Low specifically for the families of his patients. Relatives are taught to maintain empathy and unconditional positive regard for their ill relative, while reframing their domestic environment to provide an empowering atmosphere for all members. The Relatives Project groups are open to adults and teenagers, and allow professionals to observe but only to participate if it is in support of a family member’s mental health. Mental health becomes a shared goal for a family, and all family members share in responsibility to achieve it.

Power to Change

Power to Change is a cognitive-behavioural peer-to-peer programme based on Low’s self-help principles. Power to Change primarily teaches at-risk students and ex-prisoners principles of Low’s Self-Help system in peer-to-peer groups. Power to Change groups generally consist of 8-12 members, meeting weekly, who learn the principles of the Low Self-Help System by describing their personal experience of disturbing events and commenting on each other’s experiences using a highly structured format.

Specifically, Power to Change consists of five components:

  • A peer-to-peer process intended to provide a safe environment for members to disclose their experiences to a supportive group,
  • A meeting structure intended to keep discussion on topic,
  • A four-part format to help members frame their experiences as useful examples, and
  • Group feedback utilising a set of tools (principles of Abraham Low’s therapeutic technique).

The four-part example consists of an objective description an event; a report of the feelings, sensations, thoughts, and impulses experienced in the members mind and body; how the member used the Power to Change tools to manage the experience; and a self-endorsement to remind the member of the progress made and to reward their effort. The Power to Change groups use much of the language suggested in the Recovery International programme, such as identifying “temper” and avoiding judgment of right and wrong.

The W.K. Kellogg Foundation has provided grants for Power to Change since 2003. The most recent grant was awarded in November 2008, and will provide funding until November 2010.

Chicago Public Schools

In 2007 Urban Networks Associates (UNA) conducted an evaluation of Power to Change as it was implemented in seventeen secondary and middle schools in the Chicago Public School system. In each school 12-24 group sessions were held and facilitated by either staff from the Abraham Low Institute or by a local facilitator trained by the Abraham Low Institute. Participating students showed significant improvement in prosocial behaviour as measured by pre-testing and post-testing of emotional intelligence, specifically increasing self-restraint and decreasing violent behaviours. Although statistically significant, the effect sizes of changes were low or medium.

UNA’s SEM evaluation of the Power to Change logic model, the required steps and conditions for the program to be effective, found it fit the data collected well. To improve the effectiveness of the program UNA recommended improving communication with and training of local facilitators, encouraging students to develop plans to apply programme tools outside of the group, updating the literature used to make it more age appropriate for the young students, adding activities to encourage confidentiality of what was said in group meetings and developing more interactive activities to teach programme concepts. UNA also suggested asking for a commitment from participating schools to guarantee facilities were always available and that students would not be prohibited from attending group sessions.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Abraham_Low_Self-Help_Systems >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is Recovery International?

Introduction

Recovery International (formerly Recovery, Inc., often referred to simply as Recovery or RI) is a mental health self-help organisation founded in 1937 by neuropsychiatrist Abraham Low in Chicago, Illinois.

Recovery’s programme is based on self-control, self-confidence, and increasing one’s determination to act. Recovery deals with a range of people, all of whom have difficulty coping with everyday problems, whether or not they have a history of psychiatric hospitalisation. It is non-profit, secular, and although it uses methods devised by Low, most groups are currently led by experienced non-professionals.

Brief History

In 1937, Abraham Low, a neuropsychiatrist, was on the faculty at the University of Illinois at Chicago, and participants in Recovery were limited to those who had been hospitalised in the Psychiatric Institute at the University. At that time, Recovery Inc. was an entity of the Neuropsychiatric Institute at the University of Illinois Research and Education Hospital. The original thirty-seven founding members had recovered their mental health after receiving insulin shock treatments at the Institute.

Low began the groups as part of an attempt to improve the patient’s care following discharge from his hospital. In the early years of the organisation he encouraged members to advocate for improvements in social policies regarding state mental health regulations. Following backlash from the medical community to these efforts, Low disbanded the group in 1941. His patients, however, asked to be trained to teach Recovery’s methods to others and in 1942 Low began to teach members to lead groups in their homes.

The organization separated from the Psychiatric Institute in 1942, operating out of private offices in Chicago. New membership at this time was drawn largely from patients in Low’s private psychiatry practice. During the first years following its separation Low remained in close contact with all Recovery groups and received regular reports from group leaders. As the membership and number of meetings grew, it made this level of cooperation with the groups untenable. In 1952, Low allowed expansion of Recovery outside of Illinois, giving control of local groups to former patients who had become group leaders. Following Low’s death in 1954, Recovery transitioned completely from a professionally run treatment adjunct, to a peer-run self-help group.

Effective 01 January 2007 Recovery, Inc. formally changed its name to Recovery International. On 02 January 2008 Recovery International merged with The Abraham Low Institute and provisionally renamed the new organisation Recovery International / The Abraham Low Institute (RI/TALI). On 01 January 2009, Abraham Low Self-Help Systems was incorporated to umbrella several new programmes, and the group continues operations as Recovery International and Abraham Low Self-Help Systems in various states and internationally.

Fundamental Concepts

Symptoms

The causes and classification of mental illnesses are considered irrelevant in the Recovery method. Recovery members are simply viewed as people who have developed disturbing symptom-reactions leading to ill-controlled behaviour. Symptoms are threatening sensations; including feelings, impulses, and obsessive thoughts. The phrase, “symptomatic idiom” describes the mental association of danger with symptoms.

The symptomatic idiom implies that there is an impending catastrophe of physical collapse, mental collapse, or permanent handicap. In the first instance, for example, a person may consider heart palpitations as signalling that sudden death is imminent, or that a painful headache is caused by a brain tumour; phobias, compulsions, and ruminations would eventually cause a mental collapse. The fear of permanent handicap insists that there is no cure or relief for one’s mental illness and that recovery is impossible.

Temper

Temper is a combination of a feeling and a judgement about oneself or others. The feeling is related to one of the two types of temper, fear or anger. The judgment is that one has been wronged by another, or that one has done something wrong. “Fearful temper” arises from thoughts that one has made a mistake (has done something wrong) which in turn causes feelings such as fear, shame and inadequacy. “Angry temper” results from the belief that one has been wronged which in turn creates feelings of indignation and impatience. There is a two-way relationship between temper and symptoms. Symptoms induce emotions such as fear and anger, which in turn induce temper, which increases the intensity of the symptoms.

“Temperamental lingo” describes language related to judgments of right and wrong, and the use of defeatist language when discussing symptoms. When discussing symptoms, temperamental lingo includes the use of adjectives such as “intolerable,” “uncontrollable,” “unbearable,” and similar language that places an emphasis on the dangerous and fatalistic implications of feelings, impulses, or thoughts.

Will

Free will is fundamental to Recovery’s method. The subconscious, as it is known in psychoanalysis, as well as viewpoints emphasizing unconscious motivations, drives, and instincts are considered to be self-defeating. Recovery considers adults as capable of behaving based on deliberate plans, settled decisions, reasoned conclusions and firm determinations. Will gives adults the ability to accept or reject thoughts and impulses. Recovery members achieve mental health by training their Wills to reject self-defeating thoughts and impulses, countering them with self-endorsing thoughts and wellness-promoting actions.

External and Internal Environment

Recovery distinguishes between the External Environment, the realities of a situation, and the Internal Environment, one’s own subjective feelings, thoughts, impulses, and sensations. Two components of the Internal Environment, thoughts and impulses, can be directly controlled by Will. Control of thoughts and impulses allows indirect control over sensations and feelings. For instance, thoughts of insecurity and anxiousness can be replaced with thoughts of security. Similarly, a feeling of fear can be disposed by removing the associated belief of danger (symptomatic idiom). While the Internal Environment can be changed with cognitive reframing, changing one’s External Environment may or may not be possible.

Nervousness

Recovery focuses on treating former mental patients, sometimes referred to as post-psychotic persons, as well as psychoneurotic persons. The latter group is most often referred to as “nervous” or “nervous patients”. Recovery members may refer to themselves as “nervous patients” regardless of whether they are being treated by a physician or other professional. Sociologist Edward Sagarin described this as a compromise between the term neurotic and the more colloquial phrase “nervous breakdown”.

Common Techniques

Recovery encourages members to cognitively reframe their experiences using several techniques. Spotting, reframing defeatist language, self-endorsement and creating Examples are the most commonly cited in scholarly reviews of Recovery.

Spotting

Spotting is an introspective relabelling of thoughts and symptoms. When a thought arises related to angry temper, fearful temper, or associating danger with a symptom it must be spotted and reframed. Members practice spotting and reacting appropriately to the distressing thought or symptom.

Reframing Language

Recovery developed its own language for labelling psychiatric symptoms and responding to them. This language is centred around two concepts, “authority” and “sabotage.” It is suggested that members rely on the authority of a physician’s diagnosis with respect to their symptoms. For instance, if a member self-diagnoses a headache as being caused by a brain tumour, but a physician has diagnosed it otherwise, then the member is said to be sabotaging the physician’s authority. This is similarly true for the member’s prognosis, if a member despairs that their condition is hopeless, but a physician has found the prognosis to be good, this is also sabotage of the physician’s authority. Using the physician’s perspective to reframe defeatist thoughts is intended to help members recognise that they have not lost control, and their situation can be coped with.

Self-Endorsement

Members practice self-endorsement of every effort made to use a Recovery method, no matter how small and regardless of the outcome. In this way, similar subsequent efforts will require less work and are more likely to be successful. Similarly members are taught to change their behaviour in “part acts” (small steps), to simply “move their muscles” to complete tasks, however small, to eventually complete larger overwhelming tasks.

Creating Examples

The Example format was created by Low as a means to allow Recovery to function as a stand-alone lay self-help group that would not require professional supervision. Members create Examples by following a four-part outline, each part requiring a description.

  • Details of an event that caused distress.
  • The symptoms and discomfort that the event aroused.
  • How Recovery principles were utilised to cope with the event.
  • How the member would have behaved in response to the event before joining Recovery.

Examples are a formalised way to practice the Recovery programme. A successful outcome is not required to create an Example, as all attempts at practicing Recovery methods are endorsed.

Meetings

1937 to 1952

During the first fifteen years of Recovery, Low required members to attend classes and meetings for at least six months at a cost of ten dollars per month, not including the membership dues of two dollars per year. Members would meet at least three days a week and on Wednesdays take part in panel discussions as panellists or audience members held at a private home. Panel discussions would consist of three to four panellists with considerable experience in Recovery discussing a topic from Low’s literature, focusing on spotting and conquering symptoms. Dr. Low would address the audience at the end of each panel discussion summing up the discussion and correcting any misinformation given about Recovery. Every Thursday Low would conduct a group psychotherapy class for Recovery members.

No meetings were held between Saturday and Wednesday. Commonly, novice members would have a “setback,” a relapse of psychiatric symptoms, during this time. As setbacks were considered unavoidable, the novice members were assigned to a more experienced member to call or visit should they need assistance. If the assistance provided by the experienced member was not helpful, they could contact a chairperson in their area (a member who functioned like the physician’s deputy), and if that was still not satisfactory they could contact the physician, Dr. Low.

1952 to Present

At the meetings, members share examples from their lives that caused nervous symptoms, the thoughts that occurred just beforehand, how they spotted them and reacted to them. Other members offer alternative ways of looking at the situation and suggest how to better handle similar symptoms in the future. Meetings range in size from 6 to 30 members and follow a rigid schedule to ensure adherence to Recovery methods. Each meeting has a leader in a permanent position; leadership duties do not rotate from meeting to meeting. Each meeting is split into five parts. Members introduce themselves by first name only, as is practiced in Alcoholics Anonymous.

Impact of Pandemic (2020-2021)

Due to COVID-19, more than 300 community meetings were closed, and many new telephone and online meetings were added. This gives people access to more meetings at various times during the week, regardless of geography.

Reading of Recovery Literature

The beginning of a meeting is generally reserved for reading from Recovery literature. Members take turns reading sections of a chapter or article. Group leaders will often call on new members during this period, or members who are hesitant to volunteer. After finishing a paragraph a group leader will often ask a member if they experienced any symptoms while reading the literature and will endorse them for the efforts to continue reading despite feelings of discomfort or fear of making mistakes.

Presentation of Examples

Only members who have read Mental Health Through Will Training are allowed to participate in this portion of the meeting. Those participating form a “panel” although they are usually seated face-to-face around a table. The group leader reminds the members that examples should be constructed around day-to-day events as Recovery is a non-professional organisation and cannot help people with major problems. This statement is qualified, however, with Low’s opinion that the majority of a nervous patient’s problems are related to “trivial” incidents. Rather than being a limitation of Recovery’s programme, this is intended to be a novel treatment approach. A day-today trivial event may generalise to other problems experienced by the member. Discussion of trivialities is less threatening than complex problems, making a discussion of coping mechanisms possible.

A survey of groups in Chicago in 1971 and 1977 found that most examples presented were stories of successful application of the Recovery method, less than 10% represented “problem examples” where the application was not successful.

Group participation

After an Example has been given, the meeting is opened for “group spotting”. During this period other members of the panel are allowed to comment on the Example based on Recovery principles. This group leader usually makes the first comments, and if there are no volunteers to continue, he or she may call on panel members to provide commentary. Comments not based on Recovery’s concepts or not related to the example are stopped by the group leader. Comments are either classed as positive, praise for application of a Recovery method, or negative, related to an instance where a method was not applied. An Example rarely passes without mention of additional Recovery techniques that could be applied to it. This serves as a constant reminder that Recovery’s method can never be practiced perfectly; members can always learn from experience and benefit from group practice.

For example, a person may experience “lowered feelings” (depression) because they are aiming for a perfect performance. Trying to be perfect or trying to appear perfect leads one to feel down if one makes even the slightest mistake. All improvements, no matter how small, are acknowledged and members are encouraged to endorse themselves for their efforts – not for their successes. Longstanding members are encouraged to share their success with the Recovery methods to help newcomers. Low saw the sharing of successes by veteran members as an essential component of meetings, as it demonstrates that distressing sensations can be endured, impulses can be controlled, and obsessions can be checked.

Question and Answer

Following the panel presentation, about fifteen minutes are set aside for a question and answer period. Any member may ask a question of the panel during this time, newcomers are especially encouraged to participate. Discussion, however, must be limited to the Examples given and related Recovery concepts. Discussion questioning Recovery’s method is not allowed. Discussion of psychological theories outside of Recovery is similarly discouraged. In a case where a member brings up a disagreement between his physician and a Recovery concept, he or she is told that the panel is not qualified to provide an answer not related to the Examples presented. Members are expected to follow the advice of their professional; Recovery is not intended as a substitute for psychiatric services, but a self-directed programme that can be used as an adjunct to professional treatment, or alone when professional treatment is not available.

Mutual Aid Meeting

The formal meeting ends with the question and answer period, and an informal “mutual-aid” gathering usually follows. During this time refreshments are usually served. Members may speak freely with one another and discuss problems or ask for advice, although there is an attempt to keep the discussion within the bounds of Recovery concepts. By convention, discussion of problems are limited to five minutes in an attempt to discourage self-pity and complaining.

Organisational Structure

From 1952 to 2008, Recovery was run from its office in Chicago by a twelve-member Board of Directors, a number of committees, organisation officers, and a full-time paid administrative staff. The Board of Directors was elected at Recovery’s annual meeting and served for a period of three years. Authority from the Board of Directors was passed to Area Leaders then to Assistant Area Leaders, District Leaders, and lastly to Group Leaders. Leaders are trained to run Recovery meetings, but are not considered experts or authorities. Policies and practices of Recovery were made by the Board of Directors.

Family Participation

In the early years of Recovery, an event was held on Saturday afternoons at Recovery’s office in Chicago for Recovery members as well as their relatives and friends. Later, family and friends of members were allowed to attend meetings, although not to participate. In 1943 Low published a book, Lectures to Relatives of Former Patients to help assist them with the recovery effort; this information was later reprinted in Peace Versus Power in the Family: Domestic Discord and Emotional Distress in 1967.

Effectiveness

In 1945, Abraham Low found the average member improved considerably after the first or second week in the programme as it existed at that time. However, members were required to lose their major symptoms within two months of membership and class attendance. If they did not, this was taken as an indication that the member was still sabotaging the physician’s efforts.

A 1984 study found that following participation in Recovery, former mental patients reported no more anxiety about their mental health than the general public. Members rated their life satisfaction levels as high, or higher, than the general public. Members who had participated two years or more reported the highest levels of satisfaction with their health. Members who participated for less than two years tended to still be taking medication and living below the poverty level with smaller social networks.

A 1988 study found that participation in Recovery decreased members’ symptoms of mental illness and the amount of psychiatric treatment needed. About half of the members had been hospitalised before joining. Following participation, less than 8% had been hospitalised. Members’ scores of neurotic distress decreased, and scores of psychological well-being for longstanding members were no different from members of a control group in the same community. Long-term members were being treated with less psychiatric medication and psychotherapy than newer members.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Recovery_International >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Paranoia Network?

Introduction

The Paranoia Network, founded in November 2003, is a self-help user-run organisation in Sheffield, England, for people who have paranoid or delusional beliefs.

Background

In contrast to mainstream psychiatry, that tends to see such beliefs as signs of psychopathology, the Paranoia Network promotes a philosophy of living with unusual and compelling beliefs, without necessarily pathologising them as signs of mental illness. It was partly inspired by the Hearing Voices Network’s approach to auditory hallucinations.

What would otherwise seem to be a relatively minor disagreement over theory is complicated by the fact that people diagnosed as delusional can often be detained under mental health law and treated without their consent. Therefore, many of the criticisms of the diagnosis or definition have important ethical and political implications, which often leads to heated public debate.

This page is based on the copyrighted Wikipedia article < https://en.wikipedia.org/wiki/Paranoia_Network >; it is used under the Creative Commons Attribution-ShareAlike 3.0 Unported License (CC-BY-SA). You may redistribute it, verbatim or modified, providing that you comply with the terms of the CC-BY-SA.

What is the Hearing Voices Network?

Introduction

Hearing Voices Networks, closely related to the Hearing Voices Movement, are peer-focused national organisations for people who hear voices (commonly referred in western culture as auditory hallucinations) and supporting family members, activists and mental health practitioners. Members may or may not have a psychiatric diagnosis.

Networks promote an alternative approach, where voices are not necessarily seen as signs of mental illness. Networks regard hearing voices as a meaningful and understandable, although unusual, human variation. In themselves voices are not seen as the problem. Rather it is the relationship the person has with their voices that is regarded as the main issue.

Development

Twenty-nine national Hearing Voices Networks have been established worldwide. There are also regional networks in Australia (Western Australia, Victoria, Tasmania and southwest Australia), Quebec, UK (Greater London, southwest England) and the United States. The National and Regional Networks are affiliated to the international umbrella organisation known as INTERVOICE (The International Network for Training Education and Research into Hearing Voices) and often referred to as the Hearing Voices Movement. Within these international networks, the combined experience of voice-hearers and professionals have overseen the development of ways of working with people who hear voices that draw on the value of peer support and which help people to live peacefully and positively with their experiences.

Purpose

The principal roles of Hearing Voices Networks are as follows:

  • To support and develop local Hearing Voices Support Groups.
  • Raise awareness of the hearing voices approach.
  • To campaign for human rights and social justice for people who hear voices.
  • To provide information, advice and support to people who hear voices, their family, friends.
  • To provide training and education for mental health services and practitioners.

Description and Philosophy

The first hearing voices network was founded in the Netherlands in 1987 by the Dutch psychiatrist Marius Romme, the science journalist, Sandra Escher and voice hearer, Patsy Hage. This was followed by the founding of the UK network in 1988 based in Manchester, England. Subsequently Networks have been established in 29 countries over the world, including Australia (2005), Austria, Belgium, Bosnia, Canada, Denmark (2005), England (1988), Finland (1996), France (2011), Hungary (2013), Germany (1998), Greece, Ireland (2005), Italy, Japan, Kenya, Palestine, Malaysia, New Zealand (2007), Netherlands (1987), Norway, Northern Ireland, Scotland, Sweden, Switzerland, Tanzania, Uganda, USA (2010) and Wales (2001). The first 15 years of the development of the global networks is outlined by Adam James in his book Raising Our Voices (2001).

These networks provide support to voice hearers specifically through the establishment of local hearing voices support groups, where people who hear voices are afforded the opportunity in a non-medical setting to share their experiences, coping mechanisms and explanatory frameworks. These groups are run in different ways and some are exclusive to individuals who hear voices, whilst others are supported by mental health workers.

National networks have developed considerably over the years and host websites, publish newsletters, guides to the voice hearing experience and workbooks where individuals can record and explore their own experiences with voice hearing.

Dutch psychiatrist Marius Romme, the co-author of Accepting Voices, has provided an intellectual basis for these group. He advocates a view that the hearing of voices is not necessarily an indication of mental illness, and that patients should be encouraged to explore their voices and negotiate with them.

Hearing Voices Groups

The development of peer support groups for voice-hearers, known as “hearing voices groups” (HVGs), are an essential part of the work of Hearing Voices Networks throughout the world. For instance there are over 180 groups in England, 60 in Australia and growing numbers of groups in the USA. The groups are based in a range of settings including community centres, libraries, pubs, churches, child and adolescent mental health services, prisons and inpatient units.

Hearing Voices Groups are based on an ethos of self-help, mutual respect and empathy. They provide a safe space for people to share their experiences and support one another. They are peer support groups, involving social support and belonging, not therapy or treatment. Hearing Voices Groups are intended to help people to understand and come to terms with their voices and begin to recover their lives.

Members are encouraged to talk about their experiences, to learn what the voices mean for them and how to gain control over their experiences. In voices groups, people are enabled to choose the way they want to manage their experiences. Voices groups assist people to access information and resources so they can make their own choices. Furthermore, voices groups allow people to explore the relationship between their life history and their experience of hearing voices, should they want to do so.

Studies have found that after attending hearing voices groups, members’ hospital bed use decreased. There was also a trend for less formal admissions. People used far more coping strategies and were able to talk to far more people about their voices after attending groups. Learning coping strategies was something people valued about groups and one of the common topics was to explore and experiment with different coping strategies. After attending groups, self-esteem increased. User empowerment also increased. Feeling more empowered is one of the aims of groups particularly valued by voice hearers and may be associated, not only with the voices themselves, but also with other aspects of recovery and getting better. People’s relationships with the voices were mostly improved. They heard the voices less frequently. The voices were perceived as less powerful (omnipotent) relative to them. People felt much better able to cope with their voices, and there were trends towards people feeling less controlled by their voices and feeling less alone. Perhaps most importantly, evaluations show that people improved in relation to what they had identified as their own goals for the group.

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