What is the British Psychoanalytical Society?

Introduction

The British Psychoanalytical Society was founded by the British neurologist Ernest Jones as the London Psychoanalytical Society on 30 October 1913.

It is one of two organisations in Britain training psychoanalysts, the other being the British Psychoanalytic Association.

The society has been home to a number of important Psychoanalysts, including Wilfred Bion, Donald Winnicott, Anna Freud and Melanie Klein. Today it has over 400 members and is a member organisation of the International Psychoanalytical Association.

Establishment and Name

Psychoanalysis was founded by Sigmund Freud, and much of the early work on Psychoanalysis was carried out in Freud’s home city of Vienna and in central Europe. However, in the early 1900’s Freud began to spread his theories throughout the English speaking world. Around this time he established a relationship with Ernest Jones, a British neurosurgeon who had read his work in German and met Freud at the inaugural Psychoanalytical Congress in Salzburg. Jones went on to take up a teaching post at the University of Toronto, in which capacity he established the American Psychoanalytic Association.

When Jones returned to London, he established the society in 1913, as the London Psychoanalytical Society. The society had 9 founding members including William Mackenzie, Maurice Nicoll and David Eder. Almost immediately, the society was caught up in the international controversy between Carl Jung and Sigmund Freud. Many of the society’s membership were followers of Jung’s theories, although Jones himself enjoyed a close relationship with Freud and wished for the society to be unambiguously Freudian. Jones had joined Freud’s Inner circle in 1912, and helped to oust Jung from the International Psychoanalytical Association.

However, the outbreak of World War One in 1914 meant that the nascent society, which depended heavily on correspondence with psychoanalysts in Vienna, then part of Austria-Hungary, had to be suspended. There were a few informal meetings during the war, but these became less and less frequent as the war went on.

In 1919, Ernest Jones re-founded the society as the British Psychoanalytical Society, and served as its President. He took the opportunity to define the society as Freudian in nature, and removed most of the Jungian members. With the help of John Rickman, the society established a clinic and a training arm, known as the Institute of Psychoanalysis.

Interwar Years

In the 1920s, Ernest Jones and the society grew increasingly under the influence of Melanie Klein. Jones was inspired by her writings to develop several of his own psychoanalytical concepts. In 1925, Klein delivered a series of talks at the society on her theories. Klein’s work was well received in London, but it attracted increasing controversy on the continent, where the majority of psychoanalysts were still based. Realising that her ideas were not warmly received at the Berlin Psychoanalytic Institute, where Klein was based, Jones invited her to move to London, which she did later in 1925.

The rise of the Nazi Party in Germany and later in Austria, led to increasing numbers of German and Austrian Psychoanalysts fleeing to London, where they joined the burgeoning society. By 1937, 13 out of 71 members were refugees from Europe. Ernest Jones personally intervened to bring Sigmund Freud and his daughter, Anna Freud, to London. In 1938, Sigmund Freud wrote to Jones:

“The events of recent years have made London the principal site and center of the psychoanalytical movement. May the society carry out the functions thus falling to it in the most brilliant manner.”

By the start of the second world war, 34 out of 90 members were emigres from the continent.

However, the assimilation of so many prominent Psychoanalysts from continental Europe created tensions. The huge difference in the approaches of Anna Freud and Melanie Klein led to the development of several factions. Increasingly, presentations of papers at the society became thinly veiled attacks on opposing factions theories. For example, in March 1937 Melitta Schmideberg (Klein’s daughter) presented her paper: “After the Analysis – Some Phantasies of Patients”, which viciously attacked almost all of Klein’s ideas, though it did not mention her by name.

The views of the different Psychoanalysts: Kleinian, Freudian, and those who were not affiliated with either, led to increasing dysfunction, and things became so bad that a specific committee had to be established to deal with the problem.

The ‘Controversial Discussions’

By 1942, relations between the factions within the society had become so heated that a committee had to be convened to facilitate monthly discussions on the scientific nature of the society. The committee was chaired by three members of the society, each representing one of the major factions:

  • James Strachey: A member of the British Independent Group.
  • Marjorie Brierley: An ally of Melanie Klein.
  • Edward Glover: Who identified as ‘pure Freudian’, in opposition to Melanie Klein. Glover resigned from the society in 1944, along with several other Freudian psychoanalysts.

After heated debate, the committee resolved to a “gentleman’s agreement” – which ensured that each faction would have equal representation within all committees within the society. It was also agreed that training of future psychoanalysts at the institute would be organised into two pathways: one Kleinian, and one Freudian.

After World War Two

With the resolution of the controversial discussions, the society became dominated by independent psychoanalysts such as Donald Winnicott, Michael Balint or Wilfred Bion.

The Society Today

Through its related bodies, the Institute of Psychoanalysis and the London Clinic of Psychoanalysis, it is involved in the teaching, development, and practice of psychoanalysis at its headquarters at Byron House, west London. It is a constituent organisation of the International Psychoanalytical Association and a member institution of the British Psychoanalytic Council.

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What is Schizophrenics Anonymous?

Introduction

Schizophrenics Anonymous is a peer support group to help people who are affected by schizophrenia and related disorders including bipolar disorder, schizoaffective disorder, psychotic depression and psychosis.

Brief History

The programme was established in Detroit in 1985. The founder was Joanne Verbanic, who was diagnosed with schizophrenia in 1970. Shortly before forming SA, Verbanic publicly disclosed her diagnosis and discussed her illness on national television in an effort to challenge the stigma associated with the condition. She was a 2006 recipient of a Lilly Reintegration Award in recognition of her lifetime contributions to the mental health community, and she continued to be active as a spokesperson for persons with schizophrenia and other mental illness until her death on 07 May 2015.

By 2007, more than 150 local SA groups operated in 31 of the 50 United States, and in Australia, Brazil, Canada, Mexico, France, India and Venezuela.

Technical support for Schizophrenics Anonymous was provided by the National Schizophrenia Foundation (NSF) until 2007 when NSF ceased operations. In response to the loss of a national sponsor, a group of consumers, family members, and mental health providers came together to form a not-for-profit organisation, Schizophrenia and Related Disorders Alliance of America (SARDAA).

SARDAA promotes recovery for persons with schizophrenia and related brain disorders including bipolar disorder, schizoaffective disorder, depression with psychosis, and experience with psychosis. They envision a future in which every person with a schizophrenia-related brain disorder has the opportunity to recover from their disorders. The name Schizophrenics Anonymous was changed to Schizophrenia Alliance in 2015 and added Psychosis Support and Acceptance in 2018. They provide an online directory of SA groups, sponsor five weekly SA conference calls, and one Family and Friends conference call. At their annual conference, the group trains individuals and groups who have started or would like to start an SA group.

Although some SA groups are organised by mental health professionals, research has suggested that peer-led SA groups are more sustainable and longer lasting. Some groups are organised in psychiatric hospitals or jails and are not open to the public.

Programme Principles

The SA programme is based on the twelve-step model, but includes just six steps. The organisation describes the programme’s purpose of helping participants to learn about schizophrenia, “restore dignity and sense of purpose,” obtain “fellowship, positive support, and companionship,” improve their attitudes about their lives and their illnesses, and take “positive steps towards recovery.”

Joanne Verbanic wrote the original “Schizophrenics Anonymous” book, better known as “The Blue Book,” which describes the six steps to recovery. The steps require members to admit they need help, take responsibility for their choices and consequences, believe they have the inner strength to help themselves and others, forgive themselves and others, understand that false beliefs contribute to their problems and change those beliefs, and decide to turn their lives over to a higher power.

Research

One study about the risks of professional partnerships centres on the partnership between Schizophrenics Anonymous (SA) and the Mental Health Association of Michigan (MHAM) over a 14-year period. The study shows that the professional partnership resulted in increased access to SA Groups across Michigan and organisation expansion and development within SA. The professional influence also lead more SA Groups to be held in more traditional mental health treatment settings and led to more professional-led SA groups.

Self-help groups are more available to people who live independently. Researchers at Michigan State University studied whether SA would be successful in group homes. The results were positive: the groups had high attendance and participation and were well liked. However, staff members controlled who could lead and who could attend the meetings, and how the meetings should be run. The programs fell apart. The same obstacle occurred in SA groups started in prisons and monitored by employees.

This page is based on the copyrighted Wikipedia article <https://en.wikipedia.org/wiki/Schizophrenics_Anonymous&gt;; 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 Foundation for People with Learning Disabilities?

Introduction

The Foundation for People with Learning Disabilities is part of the Mental Health Foundation, a UK charity founded in 1949, and operates as a directorate within the charity.

Background

The Mental Health Foundation originally funded research in both learning disabilities and mental health.

In 1999, it created the separate Foundation for People with Learning Disabilities.

The aim of the Foundation is to promote the rights, quality of life and opportunities of people with learning disabilities and their families.

What is the Mental Health Foundation (UK)?

Introduction

The Mental Health Foundation is a UK charity, whose mission is “to help people to thrive through understanding, protecting, and sustaining their mental health.”

Refer to Foundation for People with Learning Disabilities.

Brief History

The Mental Health Foundation was founded in 1940 as the Mental Health Research Fund. It was founded by Derek Richter, a neurochemist and director of research at Whitchurch Hospital. Richter enlisted the help of stockbroker Ian Henderson, who became the chair, while Victoria Cross recipient Geoffrey Vickers became chair of the research committee.

In 1972, the Mental Health Foundation took its current name, shifting its “focus away from laboratory research and towards working directly with—and learning from—people [who] experience mental health problems.”

The Foundation has also focussed on “overlooked and under-researched areas,” including personality disorders and issues affecting various ethnic groups. In 1999, the Foundation took their work with learning disabilities forwards, creating the Foundation for People with Learning Disabilities.

Mental Health Awareness Week

Each year, starting on the second Monday of May, the Mental Health Foundation hosts Mental Health Awareness Week, the UK’s national week to raise awareness of mental health and mental health problems and inspire action to promote the message of good mental health for all.

Mental Health Awareness Week was first held in 2001, and became one of the biggest mental health awareness events in the world.

Themes

  • 2019 Body Image: How We Think and Feel About Our Bodies.
  • 2018 Stress: Are We Coping?.
  • 2017 Surviving or Thriving?.
  • 2016 Relationships.
  • 2015 Mindfulness.
  • 2014 Anxiety.
  • 2013 Physical Activity and Wellbeing.

Green Ribbon

The green ribbon is the “international symbol for mental health awareness.”

The Foundation’s green ribbon ambassadors, include: Olly Alexander, Aisling Bea, Olivia Colman, Matt Haig, David Harewood, Nadiya Hussain, Grant Hutchison, Alex Lawther, and Graham Norton.

The movement uses the hashtag #PinItForMentalHealth.

Funding

The Foundation’s total income for the financial year ending 31 March 2018 was £5.8m, with sources including donations (individual and corporate), legacies and grants.

Organisation

The Foundation is an incorporated UK charity headed by a board of 12 trustees. Keith Leslie was appointed Chairman of the board of trustees in 2014.

The president of the Foundation is Dinesh Bhugra and the patron is Princess Alexandra.

What is GROW (Support Group)?

Introduction

GROW is a peer support and mutual-aid organisation for recovery from, and prevention of, serious mental illness. GROW was founded in Sydney, Australia in 1957 by Father Cornelius B. “Con” Keogh, a Roman Catholic priest, and psychiatric patients who sought help with their mental illness in Alcoholics Anonymous (AA).

Consequently, GROW adapted many of AA’s principles and practices. As the organisation matured, GROW members learned of Recovery International, an organisation also created to help people with serious mental illness, and integrated pieces of its will-training methods. As of 2005 there were more than 800 GROW groups active worldwide. GROW groups are open to anyone who would like to join, though they specifically seek out those who have a history of psychiatric hospitalisation or are socioeconomically disadvantaged. Despite the capitalisation, GROW is not an acronym. Much of GROW’s initial development was made possible with support from Orval Hobart Mowrer, Reuben F. Scarf, W. Clement Stone and Lions Clubs International.

Processes

GROW’s literature includes the Twelve Stages of Decline, which indicate that emotional illness begins with self-centeredness, and the Twelve Steps of Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW members view recovery as an ongoing life process rather than an outcome and are expected to continue following the Steps after completing them in order to maintain their mental health.

The Twelve Stages of Decline

  1. We gave too much importance to ourselves and our feelings.
  2. We grew inattentive to God’s presence and providence and God’s natural order in our lives.
  3. We let competitive motives, in our dealings with others, prevail over our common personal welfare.
  4. We expressed our suppressed certain feelings against the better judgement of conscience or sound advice.
  5. We began thinking in isolation from others, following feelings and imagination instead of reason.
  6. We neglected the care and control of our bodies.
  7. We avoided recognising our personal decline and shrank from the task of changing.
  8. We systematically disguised in our imaginations the real nature of our unhealthy conduct.
  9. We became a prey to obsessions, delusions and hallucinations.
  10. We practised irrational habits, under elated feelings of irresponsibility or despairing feelings of inability or compulsion.
  11. We rejected advice and refused to co-operate with help.
  12. We lost all insight into our condition.

The Twelve Steps of Recovery and Personal Growth

  1. We admitted to personal disorder in our lives.
  2. We firmly resolved to restore order in our lives and co-operated with the help that we needed.
  3. We surrendered to the healing power God or We surrendered to the healing power of truth.
  4. We made personal inventory and accepted ourselves.
  5. We made moral inventory and cleaned out our hearts.
  6. We endured until ‘cured’.
  7. We took care and control of our bodies.
  8. We learned to think by reason rather than by feelings and imagination.
  9. We trained our wills to regulate our feelings.
  10. We took our responsible and caring place in the wider community.
  11. We grew daily closer to maturity.
  12. We carried GROW’s hopeful, healing, and transforming message to others in need.

GROW suggests atheists and agnostics use “We became inattentive to objective natural order in our lives” and “We trusted in a health-giving power in our lives as a whole” for the Second Stage of Decline and Third Step of Personal Growth, respectively.

Results of Qualitative Analysis

Statistical evaluations of interviews with GROW members found they identified self-reliance, industriousness, peer support, and gaining a sense of personal value or self-esteem as the essential ingredients of recovery. Similar evaluations of GROW’s literature revealed thirteen core principles of GROW’s program. They are reproduced in the list below by order of relevance, with a quote from GROW’s literature, explaining the principle.

  1. Be Reasonable: “We learned to think by reason rather than by feelings and imagination.”
  2. Decentralize, participate in community: “…decentralization from self and participation in a community of persons is the very process of recovery or personal growth.”
  3. Surrender to the Healing Power of a wise and loving God: “God, who made me and everything connected with me, can overcome any and every evil that affects my life.”
  4. Grow Closer to Maturity: “Maturity is a coming to terms with oneself, with others, and with life as a whole.”
  5. Activate One’s Self to Recover and Grow “Take your fingers off your pulse and start living.”
  6. Become Hopeful: “I can, and ultimately will, become completely well; God who made me can restore me and enable me to do my part. The best in life and love and happiness is ahead of me.”
  7. Settle for Disorder: “Settle for disorder in lesser things for the sake of order in greater things; and therefore be content to be discontent in many things.”
  8. Be Ordinary: “I can do whatever ordinary good people do, and avoid whatever ordinary good people avoid. My special abilities will develop in harmony only if my foremost aim is to be a good ordinary human being.”
  9. Help Others: We carried the GROW message to others in need.
  10. Accept One’s Personal Value: “No matter how bad my physical, mental, social or spiritual condition I am always a human person, loved by God and a connecting link between persons; I am still valuable, my life has a purpose, and I have my unique place and my unique part in my Creator’s own saving, healing and transforming work.”
  11. Use GROW: “Use the hopeful and cheerful language of GROW.”
  12. Gain Insight: “We made moral inventory and cleaned out our hearts.”
  13. Accept Help: “We firmly resolved to get well and co-operated with the help that we needed.”

Effectiveness

Participation in GROW has been shown to decrease the number of hospitalisations per member as well as the duration of hospitalisations when they occur. Members report an increased sense of security and self-esteem, and decreased anxiety. A longitudinal study of GROW membership found time involved in the programme correlated with increased autonomy, environmental mastery, personal growth, self-acceptance and social skills. Women in particular experience positive identity transformation, build friendships and find a sense of community in GROW groups.

Literature

The Programme of Growth to Maturity, generally referred to as the ‘Blue Book’, is the principal literature used in GROW groups. The book is divided into three sections based on the developmental stages of members: ‘Beginning Growers’, ‘Progressing Growers’ and ‘Seasoned Growers’. Additionally, there are three related books written by Cornelius B. Keogh, and one by Anne Waters, used in conjunction with the Blue Book.

  • GROW (1983). GROW: World Community Mental Health Movement: The Program of Growth to Maturity (the “Blue Book”). Sydney, Australia: GROW Publications. OCLC 66288113.
  • Keogh, Cornelius B. (1975). Readings for mental health (the “Brown Book”). Sydney, Australia: GROW Publications. ISBN 0-909114-00-5. OCLC 47699449.
  • Keogh, Cornelius B.; GROW (Australia) (1967). Readings for recovery (the “Red Book”). Sydney Australia: GROW. OCLC 154602570.
  • Keogh, Cornelius B. (1967). Recovery. Sydney, Australia. OCLC 57499165.
  • Waters, Anne (2005). GROWing to Maturity: A Potpourri of Readings for Mental Health (the “Lavender Book”). GROW in Ireland Ltd. ISBN 0-9529198-2-6.

What is the Hearing Voices Movement?

Introduction

The Hearing Voices Movement (HVM) is the name used by organisations and individuals advocating the “hearing voices approach”, an alternative way of understanding the experience of those people who “hear voices”.

In the medical professional literature, ‘voices’ are most often referred to as auditory verbal hallucinations. The movement uses the term ‘hearing voices’, which it feels is a more accurate and ‘user-friendly’ term.

The movement was instigated by Marius Romme, Sandra Escher and Patsy Hage in 1987. It challenges the notion that to hear voices is necessarily a characteristic of mental illness. Instead it regards hearing voices as a meaningful and understandable, although unusual, human variation. It therefore rejects the stigma and pathologisation of hearing voices and advocates human rights, social justice and support for people who hear voices that is empowering and recovery focused. The movement thus challenges the medical model of mental illness, specifically the validity of the schizophrenia construct.

Refer to Hearing Voices Network.

Brief History

The international Hearing Voices Movement is a prominent mental health service-user/survivor movement that promotes the needs and perspectives of experts by experience in the phenomenon of hearing voices (auditory verbal hallucinations). The main tenet of the Hearing Voices Movement is the notion that hearing voices is a meaningful human experience.

The Hearing Voices Movement regards itself and is regarded by others as being a post-psychiatric organisation. It positions itself outside of the mental health world in recognition that voices are an aspect of human difference, rather than a mental health problem. One of the main issues of concern for the Hearing Voices Movement is empowerment and human rights as outlined in its Melbourne Hearing Voices Declaration 2013 and Thessaloniki Declaration 2014.

The Hearing Voices Movement also seeks holistic health solutions to problematic and overwhelming voices that cause mental distress. Based on their research, the movement espouses that many people successfully live with their voices. 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. Research indicates that mindfulness-based interventions can be beneficial for people distressed by hearing voices.

The Hearing Voices Movement has developed interventions for mental health practitioners to support people who hear voices and are overwhelmed by the experience.

Position

The position of the hearing voices movement can be summarised as follows:

  • Hearing voices is not in itself a sign of mental illness.
  • Hearing voices is part of the diversity of being a human, it is a faculty that is common (3-10% of the population will hear a voice or voices in their lifetime) and significant.
  • Hearing voices is experienced by many people who do not have symptoms that would lead to diagnosis of mental illness.
  • Hearing voices is often related to problems in life history.
  • If hearing voices causes distress, the person who hears the voices can learn strategies to cope with the experience.
  • Coping is often achieved by confronting the past problems that lie behind the experience.

Theoretical Overview

The work of Marius Romme, Sandra Escher and other researchers provides a theoretical framework for the movement. They find that:

  • Not everyone who hears voices becomes a patient. Over a third of 400 voice hearers in the Netherlands they studied had not had any contact with psychiatric services. These people either described themselves as being able to cope with their voices and/or described their voices as life enhancing.
  • Demographic (epidemiological) research carried out over the last 120 years provides evidence that there are people who hear voices in the general population (2%-6%) who are not necessarily troubled by them). Only a small minority fulfil the criteria for a psychiatric diagnosis and, of those, only a few seek psychiatric aid indicating that hearing voices in itself is not necessarily a symptom of an illness. Even more (about 8%) have peculiar delusions and do so without being ill.
  • People who cope well with their voices and those who did not, show clear differences in terms of the nature of the relationship they had with their voices.
  • People who live well with their voice experience use different strategies to manage their voices than those voice hearers who are overwhelmed by them.
  • 70% of voice hearers reported that their voices had begun after a severe traumatic or intensely emotional event such as an accident, divorce or bereavement, sexual or physical abuse, love affairs, or pregnancy. Romme and colleagues found that the onset of voice hearing amongst a patient group was preceded by either a traumatic event or an event that activated the memory of an earlier trauma.
  • Specifically, there is a high correlation between voice hearing and abuse. These findings are being substantiated further in on-going studies with voice hearing amongst children.
  • Some people who hear voices have a deep need to construct a personal understanding for their experiences and to talk to others about it without being designated as mad.

Romme, colleagues and other researchers find that people who hear voices can be helped using methods such as voice dialoguing cognitive behaviour therapy (CBT) and self-help methods.

Romme theorises a three phase model of recovery:

StartlingInitial confusion; emotional chaos, fear, helplessness and psychological turmoil.
OrganisationThe need to find meaning, arrive at some understanding and acceptance. The development of ways of coping and accommodating voices in everyday living. This task may take months or years and is marked by the attempt to enter into active negotiation with the voice(s).
StabilisationThe establishment of equilibrium, and accommodation, with the voice(s), and the consequent re-empowerment of the person.

Alternative to Medical Model of Disability

The Hearing Voices Movement disavows the medical model of disability and disapproves of the practises of mental health services through much of the Western world, such as treatment solely with medication. For example, some service users have reported negative experiences of mental health services because they are discouraged from talking about their voices as these are seen solely as symptoms of psychiatric illness. Slade and Bentall conclude that the failure to attend to hallucinatory experiences and/or have the opportunity for dialogue about them is likely to have the effect of helping to maintain them.

In Voices of Reason, Voices of Insanity, Leudar and Thomas review nearly 3,000 years of voice-hearing history. They argue that the Western World has moved the experience of hearing voices from a socially valued context to a pathologised and denigrated one. Foucault has argued that this process can generally arise when a minority perspective is at odds with dominant social norms and beliefs.

Organisation

The Hearing Voices Movement was established in 1987 by Romme and Escher, both from the Netherlands, with the formation of Stichting Weerklank (Foundation Resonance), a peer led support organisation for people who hear voices. In 1988, the Hearing Voices Network was established in England with the active support of Romme. Since then, networks have been established in 35 countries.

INTERVOICE (The International Network for Training, Education and Research into Hearing Voices) is the organisation that provides coordination and support to the Hearing Voices Movement. It is supported by people who hear voices, relatives, friends and mental health professionals including therapists, social workers, nurses, psychiatrists and psychologists.

INTERVOICE was formed in 1997, at a meeting of voice hearers, family members and mental health workers was held in Maastricht, Netherlands to consider how to organise internationally further research and work about the subject of voice hearing. The meeting decided to create a formal organisational structure to provide administrative and coordinating support to the wide variety of initiatives in the different involved countries.

The organisation is structured as a network and was incorporated in 2007 as a non-profit company and charity under UK law. It operates under the name of International Hearing Voices Projects Ltd. The president is Marius Romme and the governing body is made up of people who hear voices and mental health practitioners.

Activities

Hearing Voices Groups

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 to support one another. They are peer support groups, involving social support and belonging, not necessarily therapy or treatment. Groups offer an opportunity for people to accept and live with their experiences in a way that helps them regain some power over their lives. There are hundreds of hearing voices groups and networks across the world. In 2014 there were more than 180 groups in the UK. These include groups for young people, people in prison, women and people from Black and Minority Ethnic communities.

World Hearing Voices Congress

INTERVOICE hosts the annual World Hearing Voices Congress. In 2015 the 7th Congress was held in Madrid, Spain, the 2016 Congress will be held in Paris, France. Previous conferences have been held in Maastricht, Netherlands, (2009); Nottingham, England (2010), Savona, Italy (2011), Cardiff, Wales (2012); Melbourne, Australia (2013); Thessaloniki, Greece (2014); Madrid, Spain (2015).

Annual World Hearing Voices Day

This is held on 14 September and celebrates hearing voices as part of the diversity of human experience, It seeks to increase awareness of the fact that you can hear voices and be healthy. It also challenges the negative attitudes towards people who hear voices and the assumption that hearing voices, in itself, is a sign of mental illness.

Website and Social Media Platforms

INTERVOICE maintains several forums on Twitter, Facebook and other social media platforms.

Research Committee

INTERVOICE has an international research committee, that commissions research, encourages and supports exchanges and visits between member countries, the translation and publication of books and other literature on the subject of hearing voices and other related extraordinary experiences.

Impact

Appearances in Media

  • Hearing Voices, Horizon Documentary, BBC, UK (1995).
  • Angels and Demons directed by Sonya Pemberton, f2003; produced by ABC Commercial, in Enough Rope, Episode 162.
  • The Doctor Who Hears Voices, Channel 4, UK.
  • The voices in my head TED2013, Filmed February 2013.

Hearing Voices Network Cymru (Wales) maintains a media archive of articles and news items about hearing voices for the last seven years.

A study investigating media reports of the experience of hearing voices found that 84% of the articles in the study contained no suggestion that voice-hearing can be ‘normal’. Half of those that did, put voice-hearing in a religious or spiritual context, for example considering the case of Joan of Arc. Most of the articles (81.8%) connected voice-hearing to mental illness. In some cases, auditory verbal hallucinations were simply equated with insanity.

Criticism of the Hearing Voices Movement

The Hearing Voices Movement has been criticised for its stance on medication and schizophrenia and for promoting non-medical and non-evidence-based approaches to severe mental illnesses in articles by Susan Inman from the Huffington Post, such as “People Who Hear Voices Need Science-Based Advice” in 2013, and “What You’re not Hearing About the Hearing Voices Movement” in 2015.

Specific criticisms of the hearing voices approach include:

  • Using ideas that do not support science-based ways of understanding illness.
  • Undermines people’s trust in medical help that might be crucial to their wellbeing.
  • Encourages people to focus on their voices when they may be having a hard time differentiating between what is real and what is not real.
  • Does not recognise the very different needs of people with severe mental illnesses.
  • By failing to differentiate between the needs of people who actually have psychotic disorders and those who do not, HVM poses serious risks.
  • Poses real danger for the substantial number of people who lack insight into their psychotic disorder.
  • People struggling with psychotic symptoms should not be advised to emphasize the meaning of auditory hallucinations.

What is the Depression and Bipolar Support Alliance?

Introduction

The Depression and Bipolar Support Alliance (DBSA), formerly the National Depressive and Manic Depressive Association (NDMDA), is a non-profit organisation providing support groups for people who live with depression or bipolar disorder as well as their friends and family.

Refer to Depression and Bipolar Support Alliance (Greater Houston).

Background

DBSA’s scope, also includes outreach, education and advocacy regarding depression and bipolar disorder. DBSA employs a small staff and operates with the guidance of a Scientific Advisory Board.

DBSA sponsors online and “face to face” support groups. A nonrandomized study found participants in such groups reported their coping skills, medication compliance, and acceptance of their illness correlated with participation. Member hospitalization decreased by 49% (from 82% to 33%). Following an initial meeting, members were found to be 6.8 times more likely to attend subsequent meetings if accompanied by a member the first time.

DBSA is a not-for-profit 501(c)(3) organisation and receives over 21 million hits per year on their combined websites. Each month, DBSA distributes nearly 20,000 educational materials free of charge to anyone requesting information about mood disorders. DBSA reaches nearly five million people through their educational materials and programs, exhibit materials, and media activities.

What is the Depression and Bipolar Support Alliance (Greater Houston)?

Introduction

The Depression and Bipolar Support Alliance (DBSA) Greater Houston is a 501(c)(3) non-profit organisation located in Houston, Texas.

DBSA provides free and confidential support groups for individuals living with, or family and friends affected by, depression or bipolar disorder. Each support group is led by a facilitator trained by the organisation. Select groups target specific populations including veterans, adolescents, and parents of adolescents, young adults, senior citizens, LGBT Community, homeless individuals and Spanish-speaking individuals.

Refer to Depression and Bipolar Support Alliance (DBSA).

Brief History

Established in 1979, the Depressive and Manic Disorder Association (DMDA) of Greater Houston sponsored up to five weekly support groups for those with depressive or manic depressive disorders. In 2003, DMDA Greater Houston changed its name to DBSA Greater Houston and formed its own 501(c) (3) corporation. Currently, DBSA Greater Houston sponsors nearly 70 weekly support groups at 50 different locations throughout the Houston metropolitan area. The Houston organisation is the largest of the nation’s DBSA chapters, serving over 1,000 support group participants annually.

Affiliation

The Depression and Bipolar Support Alliance of Greater Houston is a chapter member of the National Depression and Bipolar Support Alliance organisation based in Chicago, Illinois. Additionally, the organisation has developed collaborations with a number of Houston area mental health and social service providers including the Texas Department of Corrections, the Harris County judicial system, the Michael DeBakey VA Hospital, Mental Health of America, National Alliance on Mental Illness and the AIDS Foundation of Houston. Every group provided by DBSA Greater Houston is a collaboration with another organisation in the community. For a list of collaborations, visit the organisations website.

Statistics

DBSA Greater Houston utilises 75 trained volunteer and professional facilitators to provide nearly 70 weekly support groups. According to an independently conducted demographics study in 2008, 64% of DBSA Greater Houston participants were female, 36% were male; 77% were diagnosed individuals while 23% were family members; 66% reported a diagnosis and/or symptoms of depression, 69% were diagnosed with bipolar disorder; 88% were prescribed psychotropic medications and 65% were in professional therapy.

The Depression and Bipolar Support Alliance of Greater Houston conducts an annual satisfaction survey for participants. In 2013, the results continued to show a high rating of satisfaction with a score of 4.28 out of a possible 5, which represents excellence. Also, it was found that the longer a person attends group, the more satisfied they are with the experience and the more skills they learn to manage their disorder.

In 2006 DBSA Greater received the Chapter of the Year award from the national Depression and Bipolar Support Alliance.

Recent Developments

On 24 September 2013, the Depression and Bipolar Support Alliance of Greater Houston hosted its second annual Help, Hope, and Healing Luncheon with speakers Jessie Close and actress, Glenn Close. Jessie lives with Bipolar Disorder and Glenn talked about the perspective of the family and gave 2 monologues.

The Depression and Bipolar Support Alliance of Greater Houston hosted its first annual Help, Hope, and Healing luncheon at the River Oaks Country Club on 24 September 2012 featuring Jane Pauley as the speaker. Jane Pauley is known for her work on Dateline NBC and the Today Show. Ms. Pauley lives with Bipolar Disorder.

In the fall of 2008, DBSA Greater Houston published an outcome study independently conducted by Dr. Ralph Culler, former Associate Dean of Research at the Hogg Foundation for Mental Health. The outcome study was designed to analyse the effectiveness of the DBSA Greater Houston support group model. The study provided tools for DBSA Greater Houston to:

  • Provide quantitative and qualitative evidence that its support group model is effective;
  • Prove DBSA Greater Houston’s accountability to individuals utilising its services; and
  • Learn how the benefits of DBSA occur.

This study provided evidenced-based results that the DBSA Greater Houston support group model was effective in a number of areas. The study used an outcome questionnaire which asked a broad range of questions regarding demographics, medical data, outcome assessments and satisfaction with the support group experience. On average 89% of group participants experienced an improvement in their quality of life as a direct benefit of their participation in the DBSA groups. 93% of participants reported high or very high satisfaction with their DBSA support group experience.

What is the Centre for Addiction and Mental Health?

Introduction

The Centre for Addiction and Mental Health (CAMH, French: Centre de toxicomanie et de santé mentale) is a psychiatric teaching hospital located in Toronto and ten community locations throughout the province of Ontario, Canada.

The hospital was formed in 1998 from the amalgamation of four separate institutions – the Queen Street Mental Health Centre, the Clarke Institute of Psychiatry, the Addiction Research Foundation, and the Donwood Institute. It is Canada’s largest mental health teaching hospital, and the only stand-alone psychiatric emergency department in Ontario. CAMH has 90 distinct clinical services across inpatient, outpatient, day treatment, and partial hospitalisation models. CAMH has been the site of major advancements in psychiatric research, including the discovery of the Dopamine receptor D2.

Brief History

CAMH was formed from the 1998 merger of the Queen Street Mental Health Centre with the Clarke Institute of Psychiatry, Addiction Research Foundation, and Donwood Institute.

Queen Street Mental Health Centre

The Provincial Lunatic Asylum opened on 26 January 1850. It was subsequently renamed Asylum for the Insane, then Hospital for the Insane, then Ontario Hospital (1919), and then the Queen Street Mental Health Centre (1966). It had also been called the Toronto Lunatic Asylum and 999 Queen Street West.

The original buildings were constructed in a series of rigid lines and sharp angles, consistent with the belief at the time that orderly physical structure would facilitate orderly mental states for the patients. High walls segregated the patients from the community, establishing a long-standing stigma about the facility.

The Queen Street Site of CAMH contained the Samuel A. Malcolmson Lecture Theatre, named for the site’s Chief Psychiatrist and Clinical Director of Forensics. In 2009, however, Malcolmson was subject to a disciplinary hearing of Ontario’s College of Physicians and Surgeons, following that he sexually abused a patient and fathered a child with her. Malcomson pleaded “no contest” and resigned his license to practice. The lecture hall was renamed the Queen Street Auditorium.

Reforms were made after a series of deaths at the Queen Street Mental Health Centre and newspaper accounts of involuntary drug treatment, electroshock therapy, and prison-like conditions.

Clarke Institute of Psychiatry

The institute was founded in 1966 and officially opened by Ontario Premier John P. Robarts. It was named the Clarke Institute of Psychiatry, after Charles Kirk Clarke, a pioneer in mental health in Canada. The institute took over the clinical, teaching, and research functions of the Toronto Psychiatric Hospital, located at 2 Surrey Place, which opened in 1925 under Clarence B. Farrar. The Institute served as the main psychiatry teaching hospital for the University of Toronto and was the headquarters for the Department of Psychiatry in the Faculty of Medicine. The first Medical and Executive Director of the Clarke was Charles Roberts, and the first Psychiatrist-in-Chief (and Professor and Head of the Department of Psychiatry at the University of Toronto) was Aldwyn B. Stokes. When Stokes retired in 1967, the administration was reorganised, and Robin Hunter became Medical Director and Psychiatrist-in-Chief.

Fredrick H. Lowy served as Psychiatrist-in-Chief of the Clarke from 1974 until 1980, followed by Vivian Rakoff from 1980 to 1990, and Paul E. Garfinkel from 1990 until the Clarke’s 1998 merger into CAMH.

Upon its merger into CAMH in 1998, the Clarke building become known as the CAMH College Street site. Conrad Black has been a generous supporter of the Clarke Institute of Psychiatry.

Rent Increase

In 2015, CAMH’s facilities at the College St. site were put in jeopardy following notice of a rent increase from $1.2 million to $4 million per year, at the renewal of its 20-year lease. CAMH valued its property at $25 million, whereas the hospital’s landlord, Brookfield Asset Management, valued it at $100 million. Brookfield turned down CBC’s interview requests. A government arbitrator was appointed who valued the property at $55 million, yielding a rent increase that CAMH was reportedly able to pay.

Addiction Research Foundation

The Addiction Research Foundation (ARF), then named the Alcoholism Research Foundation was founded in 1949, when H. David Archibald, who had studied at the School of Alcohol Studies at Yale University, was hired by the Liquor Control Board of Ontario. His mandate was to determine the scope of alcoholism in Ontario. He was named executive director when ARF opened and remained in that post until 1976. Focusing initially on outpatient treatment, their first facility was Brookside Hospital in 1951, expanding to branch offices and new locations in 1954, the same year they set up in-house research. In 1961, formally renamed the Alcoholism and Drug Addiction Research Foundation of Ontario, ARF expanded its mission to include drugs. In 1971, they expanded to a clinical teaching hospital called the Clinical Research and Treatment Institute. In 1978 ARF opened the School for Addiction Studies and expanded their international role in policy development and research. Following provincial hospital restructuring in the 1990s, ARF was folded in 1998 into CAMH.

Donwood Institute

In 1946, R. Gordon Bell opened a clinic in his own home for people needing mental health services. There existed an Ontario statute allowing doctors to take up to four patients into their homes without a hospital license. To his surprise, his only patients all suffered from alcoholism. It soon became necessary to move to larger facilities. To expand capacity, Bell opened Shadow Brook, which operated from 1947 to 1954, and then the Bell Clinic, which operated from 1954 to 1966. The Donwood Institute then opened in 1967, with 47 beds and a 4-month waiting list in the 1980s. Still focused on substance use, it claimed a 65% recovery rate for general population and an 85% recovery rate among physicians with addictions.

CAMH Queen St. Site Redevelopment

CAMH has been undergoing a three phase redevelopment centred at its Queen Street site, with four goals:

  • Deliver a new model of care and provide a healthy environment that promotes recovery;
  • Bring together the best research, clinical, education, health promotion, and policy experts in one place to change the future of mental health and addictions;
  • Revitalise the City of Toronto by opening up their site and by creating an inclusive new nine-block neighbourhood that benefits all; and
  • Change attitudes by breaking down barriers to eliminate the stigma of mental health.

Phase 1A was undertaken by Eastern Construction and completed in 2008 and Phase 1B was undertaken by Carillion and completed in 2012. Phase 1C is being undertaken by PCL Construction and is expected to be complete in 2020.

In 2008, CAMH announced the completion of four new buildings (forming Phase 1A of the project) to accommodate CAMH’s Addiction and Mood & Anxiety Programmes.

The Campbell Family Mental Health Research Institute was established with a $30 million donation in 2011 from Linda Campbell, Gaye Farncombe, and Susan Grange, each granddaughters of Canadian magnate Roy Thomson and nieces of Ken Thomson. CAMH CEO, Catherine Zahn, said research on the brain is the most promising pathway to progress in mental illness research. Bell donated $10 million to CAMH in 2011, reportedly the largest corporate gift in Canada to mental illness.

In 2012, CAMH announced the completion of three new buildings (forming Phase 1B of the project): the Bell Gateway Building for the central administration, a utilities and parking building, and the Intergenerational Wellness Centre which includes 12 new beds for youth ages 14–18.[28]

Margaret McCain, the former lieutenant-governor of New Brunswick and widow of McCain Foods co-founder Wallace McCain, donated $10 million to CAMH in 2012 to establish the Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health. In 2013, the Slaight Family donated to $50 million to health care institutions, of which CAMH received $10 million. The donation permitted the opening of a centre dedicated to identifying and treating early signs of mental illness in youth.

In 2014, philanthropist and business executive Andrew Fass donated $1,000,000 to CAMH for the hospital to create a wellness program for its staff. In 2016, Fass withdrew his donation, saying that CAMH was unable to show how they were spending the money. The grant was to be used for CAMH’s “Well@Work” program, an initiative to provide Canadian workplaces with training to identify risks of mental illness and strategies to support employees in need.

CAMH opened the Emergency Department in 2014, funded by a $2.5 million private donation and a $4.2 million grant from the Ontario Ministry of Health and Long-Term Care.

In 2016, CAMH constructed a sweat lodge for Aboriginal patients in order to promote spiritual, physical, and emotional healing. Also in 2016, CAMH opened walk-in clinics for youth.

In 2020, the eight-storey, 110 patient bed McCain Complex Care & Recovery Building and five-storey 125 patient bed Crisis & Critical Care Building and 24-hour psychiatric emergency department were opened.

Research

CAMH reports being the largest research facility in Canada for mental health and addictions, including over 100 scientists over 150 research trainees. In the 2014-2015 fiscal year, CAMH received $44,384,230 in research funding and published more than 500 research articles.

Administration

Psychiatrist and Clarke Institute President Paul E. Garfinkel was appointed the first President and CEO of CAMH in 1998. He was followed by neurologist Catherine Zahn in 2009.[40]

Upon CAMH’s formation, Peter Catford was appointed vice president for Information Technology. In 2002, Catford outsourced the public hospital’s computer needs to H.I. Next, a private company which Catford founded and co-owned. When the Toronto Star reported on what it deemed an apparent conflict of interest regarding the spending of public money, the hospital would not reveal how much it paid Catford or his company, nor would CAMH disclose any details of its contract with H.I. Next or what other firms bid on the work. Catford commented only that “I feel honoured to work with (CAMH) and I feel like it has been done ethically.” In interviews with the Toronto Star, Dev Chopra, executive vice-president of CAMH first said there was nothing inappropriate about Catford’s role. “We got into it with our eyes open. There is no conflict.” However, Chopra later said there were “some optics from a conflict perspective” noting the hospital might revisit the issue that day. Catford left his CAMH position two days later, but the Star reported that hospital officials said changes were being considered months before the Star published its story about the issue.

Criticisms

CAMH’s administration has come under criticism including from staff who report safety problems and from donors who withdrew their funding citing accountability problems.

David Healy Affair

Soon after CAMH was founded, its administration was embroiled in a scandal involving Eli Lilly and Company, which donated $1.5 million to CAMH, and David Healy, a prominent critic of Prozac, the widely used antidepressant manufactured by Eli Lilly. CAMH hired Healy to be the head of its Mood and Anxiety Program, but withdrew the job offer after hearing about Healy’s views.

CAMH aggressively recruited Healy, and CAMH Physician-in-Chief, David Goldbloom, offered Healy a job as the head of the Mood and Anxiety Programme. Healy accepted and soon after gave a lecture in which he reiterated his views about Prozac increasing risk of suicide. A few days later, Goldbloom withdrew the job offer, saying “Essentially, we believe that it is not a good fit between you and the role as leader of an academic program in mood and anxiety disorders at the centre and in relation to the university….We do not feel your approach is compatible with the goals for development of the academic and clinical resource that we have.”

The decision caused an “uproar” among Canadian academics, with the Canadian Association of University Teachers calling CAMH actions “an affront to academic freedom in Canada.” Scientists from 13 countries, including Nobel laureates Julius Axelrod and Arvid Carlsson, protested CAMH’s actions as did the Society for Academic Freedom and Scholarship (SAFS).

Healy sued CAMH and the University of Toronto, alleging breach of contract, defamation, and denial of academic freedom. The lawsuit sought damages of $9.4 million, including $2.6 million from CAMH CEO Paul Garfinkel, and $1.4 million from the U of T Dean of Medicine. The university distanced itself from CAMH: According to U of T President, Robert Birgeneau, “Everyone is trying to blame the university for something that happened at one of our hospitals.”

The lawsuit was settled with Healy receiving an appointment as visiting professor as the University of Toronto. The president of the Canadian Association of University Teachers, Vic Catano, said “We see the settlement as a complete vindication for Dr. Healy.”

Child Gender Identity Clinic

In 1975, psychiatrist Susan Bradley founded a clinic in CAMH to work with gender dysphoric children. Bradley collaborated for many years with psychologist Kenneth Zucker, and they established the clinic as the largest gender identity service in Canada and an international centre for research. In their studies, 80% of the children grow out of the behaviour. They therefore use different approaches with children than adolescents because, over time, children are more likely to identify with their birth sex.

Regarding adolescents, Zucker “will support a teenager or adult who wants to transition using hormones and surgeries.” Regarding children, however, Zucker says “We are trying to help a child feel more comfortable with the gender identity that matches their birth sex” and that they use a variety of techniques to “help a child think more flexibly” about their gender. According to The New York Times, Zucker does this by “encouraging same-sex friendships and activities like board games that move beyond strict gender roles.” He said a child could be asked to make a list of pros and cons about being different genders so that the child realises that “there are both good and not so good things about being a boy and being a girl.”

Activists have criticized Zucker’s approach, claiming that it amounts to a form of conversion therapy. In 2015, following complaints from activists, CAMH commissioned an external review of the clinic. The review was inconclusive, reporting it “cannot state that the clinic does not practice reparative approaches.” Upon the release of the report, CAMH announced that it was closing the clinic and that Zucker was no longer at CAMH. Activists celebrated the news, calling upcoming community consultations “a major step toward establishing a service that will support families, and hopefully receive government funding to do so.” A petition of over 500 sexuality and gender diversity experts decried it, calling CAMH’s decisions “politically motivated” and showing an “indifference to research and scholarship.” In 2018, CAMH paid Zucker $586,000 and issued a public apology as part of a settlement.

Forensics

CAMH’s forensic department and its leadership have been the subject of criticism from Ontario judges and the public for issues including public safety, patient civil rights violations, and turning away patients ordered to CAMH by judges. This culminated in Ontario Superior Court Justice Maureen Forestell who reportedly “tore a strip off of” CAMH for its actions. Dr. Graham Glancy, a forensic psychiatrist at the Maplehurst Correctional Complex accused CAMH of focusing too much on patients and treatments to enhance its international reputation, but at the expense of the less glamorous forensic patients. He added “Cities like Ottawa and London are better resourced but Toronto is terrible. It’s a disgrace, really.” Toronto defence counsel Chris Hynes also attributed the problems to the CAMH leadership, saying “CAMH front-line workers pay the price for decisions made by the centre’s privatized board of directors.”

AWOL Patients

One recurrent issue has been the number of violent or dangerous patients who escape custody from CAMH’s forensic wards. After filing a freedom of information act request with the police, the Toronto Star reported that CAMH had nearly as many AWOLs as all other Toronto hospitals combined (2,060 and 2,371 for the period 2004 to 2014).

One of the most widely reported incidents involved Thomas Brailsford, who was institutionalised at CAMH after beheading his mother and being deemed a “danger to himself and others.” Brailsford took off from a taxicab on his way to a medical appointment, representing his second escape in a year.

In an interview with Toronto columnist Jerry Agar, CAMH’s chief of forensic psychiatry, Sandy Simpson said “Clearly, we will be reviewing this carefully to look at how we assessed the risk in this case.” Kate Richards of CAMH media relations subsequently said “We have tightened aspects of these procedures and…We are confident that the changes implemented in this case have been effective.” Agar wrote that he has “been eager to have Simpson back on the radio show to discuss what measures have been put in place” but had not received any response. Five months later, CAMH told Agar “Dr. Simpson is not available for a follow-up interview.”

In 2019, the Ontario government ordered a review of CAMH patient passes and privileges after a series of patient escapes from the secure forensic psychiatry units. In one case, a not criminally responsible (NCR) patient who absconded the hospital later left the country by plane.

Workplace Safety

In 2007, following a series of attacks on staff by patients, the Ontario Ministry of Labour asked CAMH to develop a workplace violence and policy programme. In 2008, the Ministry of Labour laid nine workplace safety charges against CAMH in response to allegations by staff that they had been attacked by patients. CAMH was fined $70,000 in 2009 for two attacks against nursing staff in 2007 and 2008. In 2014, the Ontario Ministry of Labour laid charges against CAMH for failing to protect workers from workplace violence following an attack earlier that year.

In 2014, the Ontario Ministry of Labour laid more charges against CAMH for failing to implement procedures to protect staff from workplace violence following another attack that year. The prosecution asked the court to send “a clear message” that the CAMH situation was unacceptable. CAMH was found guilty and fined again. CAMH’s Chief of Nursing, Rani Srivastava, said that CAMH accepted the court’s decision adding that the violence had a “devastating impact” on “all of us at CAMH.”

Three months later, another nurse was punched, kicked in the face, and dragged into a locked utility room where she was repeatedly kicked in the head, suffering fractures and nerve damage. Vicki McKenna of the Ontario Nurses’ Association reported that CAMH has not been taking part in government committees to improve workplace safety and called for CAMH senior management to be held personally responsible for the continued workplace violence. Rani Srivastava said that the incident was “completely unexpected,” that CAMH is “saddened” and “shocked” by what happened, and that “any incident is one too many.”

Reporting Failures

Simpson has also been criticised by the Ontario Review Board for secluding a patient for two months but not informing the board, as required. Simpson claimed that the regulation “was unclear” about whether CAMH had a duty to report what it was doing. The board disagreed, ruling against CAMH.

Public Policy Statements

CAMH issues statements about local and provincial regulations on addictive behaviours.

Alcohol

CAMH policy opposes the privatisation of alcohol sales, citing evidence that the increase in availability increases alcohol-related harms and associated costs. They supported that the Liquor Control Board of Ontario should maintain its monopoly on alcohol sales. CAMH referred to “the plan to allow the sale of VQA wines at farmers’ markets across the province” as “cause for concern” because it would increase access to alcohol. Similarly, together with other health organisations, CAMH called for a provincial alcohol strategy, ahead of Ontario’s plan to permit the sale of beer in grocery stores.

Marijuana

In a 2014 policy document, CAMH expressed support for the legalisation of marijuana with strict control regulations. According to CAMH CEO, Catherine Zahn, “Only through legalization can we implement a public-health approach, treating cannabis use as a health issue and not one to be addressed through law enforcement and the court system. This is the approach we take with tobacco and alcohol. As with alcohol, a legal cannabis market can be regulated with controls that address risk factors associated with use”.

Gambling

CAMH has opposed the expansion of Toronto’s Woodbine Racetrack. In a policy statement, CAMH said increased availability of gambling results in increased harms and predicted that a large portion of any increased revenues from the racetrack would come from people with gambling problems.

What was the National Registry of Evidence-Based Programmes and Practices (US)?

Introduction

National Registry of Evidence-Based Programmes and Practices (NREPP) Logo.

The National Registry of Evidence-based Programmes and Practices (NREPP) was a searchable online database of interventions designed to promote mental health or to prevent or treat substance abuse and mental disorders.

The registry was funded and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the US Department of Health and Human Services. The goal of the Registry was to encourage wider adoption of evidence-based interventions and to help those interested in implementing an evidence-based intervention to select one that best meets their needs.

The NREPP website was phased out in 2018.

Background

In the behavioural health field, there is an ongoing need for researchers, developers, evaluators, and practitioners to share information about what works to improve outcomes among individuals coping with, or at risk for, mental disorders and substance abuse. Discussing how this need led to the development of NREPP, Brounstein, Gardner, and Backer (2006) write:

It is important to note that not all prevention programs work. Still other programs have no empirically based support regarding their effectiveness. […] Many others have empirical support, but the methods used to generate that support are suspect. This is another reason to highlight the need for and use of scientifically defensible, effective prevention programs. These are programs that clearly demonstrate that the program was well implemented, well evaluated, and produced a consistent pattern of positive results.

The focus of NREPP is on delivering an array of standardised, comparable information on interventions that are evidence based, as opposed to identifying programmes that are “effective” or ranking them in effectiveness. Its peer reviewers use specific criteria to rate the quality of an intervention’s evidence base as well as the intervention’s suitability for broad adoption. In addition, NREPP provides contextual information about the intervention, such as the population served, implementation history, and cost data to encourage a realistic and holistic approach to selecting prevention interventions.

As of 2010, the interventions reviewed by NREPP have been implemented successfully in more than 229,000 sites, in all 50 States and more than 70 countries, and with more than 107 million clients. Versions of ura review process and rating criteria have been adopted by the National Cancer Institute and the Administration on Aging.

The information NREPP provides is subject to certain limitations. It is not an exhaustive repository of all tested mental health interventions; submission is a voluntary process, and limited resources may preclude the review of some interventions even though they meet minimum requirements for acceptance. The NREPP home page prominently states that “inclusion in the registry does not constitute an endorsement.”

Submission Process

NREPP holds an open submission period that runs 01 November through 01 February. For an intervention to be eligible for a review, it must meet four minimum criteria:

  • The intervention has produced one or more positive behavioural outcomes (p ≤ .05) in mental health, mental disorders, substance abuse, or substance use disorders use among individuals, communities, or populations.
  • Evidence of these outcomes has been demonstrated in at least one study using an experimental or quasi-experimental design.
  • The results of these studies have been published in a peer-reviewed journal or other professional publication, or documented in a comprehensive evaluation report.
  • Implementation materials, training and support resources, and quality assurance procedures have been developed and are ready for use by the public.

Once reviewed and added to the Registry, interventions are invited to undergo a new review four or five years after their initial review.

Review Process

The NREPP review process consists of two parallel and simultaneous review tracks, one that looks at the intervention’s Quality of Research (QOR) and another that looks at the intervention’s Readiness for Dissemination (RFD). The materials used in a QOR review are generally published research articles, although unpublished final evaluation reports can also be included. The materials used in an RFD review include implementation materials and process documentation, such as manuals, curricula, training materials, and written quality assurance procedures.

The reviews are conducted by expert consultants who have received training on NREPP’s review process and rating criteria. Two QOR and two RFD reviewers are assigned to each review. Reviewers work independently, rating the same materials. Their ratings are averaged to generate final scores.

While the review process is ongoing, NREPP staff work with the intervention’s representatives to collect descriptive information about the intervention, such as the program goals, types of populations served, and implementation history.

The QOR ratings, given on a scale of 0.0 to 4.0, indicate the strength of the evidence supporting the outcomes of the intervention. Higher scores indicate stronger, more compelling evidence. Each outcome is rated separately because interventions may target multiple outcomes (e.g. alcohol use, marijuana use, behaviour problems in school), and the evidence supporting the different outcomes may vary. The QOR rating criteria are:

  • Reliability of measures.
  • Validity of measures.
  • Intervention fidelity.
  • Missing data and attrition.
  • Potential confounding variables.
  • Appropriateness of analysis.

The RFD ratings, also given on a scale of 0.0 to 4.0, indicate the amount and quality of the resources available to support the use of the intervention. Higher scores indicate that resources are readily available and of high quality. These ratings apply to the intervention as a whole. The RFD criteria are:

  • Availability of implementation materials.
  • Availability of training and support resources.
  • Availability of quality assurance procedures.

Reviewers

QOR reviewers are required to have a doctoral-level degree and a strong background and understanding of current methods of evaluating prevention and treatment interventions. RFD reviewers are selected from two categories: direct services experts (including both providers and consumers of services), or experts in the field of implementation. Direct services experts must have previous experience evaluating prevention or treatment interventions and knowledge of mental health or substance abuse prevention or treatment content areas.

Products and Publications

NREPP publishes an intervention summary for each intervention it adds to the Registry. The summaries, which are accessed through the Registry’s search engine, contain the following standardised information:

  • A brief description of the reviewed intervention, including targeted goals and theoretical basis.
  • Study populations (age, gender, race/ethnicity).
  • Study settings and geographical locations.
  • Implementation history.
  • Funding information.
  • Comparative evaluation research conducted with the intervention.
  • Adaptations.
  • Adverse effects.
  • List of studies and materials reviewed.
  • List of outcomes.
  • Description of measures and key findings for each outcome.
  • Research design of the studies reviewed.
  • Quality of Research and Readiness for Dissemination ratings.
  • Reviewer comments (Strengths and Weaknesses).
  • Costs.
  • Replication studies.
  • Contact information.

NREPP also maintains an online Learning Centre. Offerings include learning modules on implementation and preparing for NREPP submission; a research paper on evidence-based therapy relationships; and links to screening and assessment tools for mental health and substance use.

Predecessor System

The registry originated in 1997 and has gone through several changes since then. The predecessor to today’s NREPP was the National Registry of Effective Prevention Programmes (later renamed the National Registry of Effective Programmes and Practices), which was developed by SAMHSA’s Centre for Substance Abuse Prevention as part of the Model Programmes initiative. Procedures under this earlier registry were developed to review, rate, and designate programmes as Model, Effective, or Promising. Based on extensive input from scientific communities, service providers, expert panels, and the public, the procedures were revised. Reviews using the new NREPP system began in 2006, and the redesigned Web site debuted in March 2007.

Phase out in 2018

According to an email from SAMHSA:

“SAMHSA is committed to advancing the adoption of evidence-based interventions related to mental health and substance use. Consistent with the January 2018 announcement from the Assistant Secretary for Mental Health and Substance Use related to discontinuing the National Registry of Evidence-based Programs and Practices (NREPP), SAMHSA has now phased out the NREPP website, which has been in existence since 1997. In April 2018, SAMHSA launched the Evidence-Based Practices Resource Center (Resource Center) that aims to provide communities, clinicians, policy makers, and others in the field with the information and tools they need to incorporate evidence-based practices into their communities or clinical settings. The Resource Center contains a collection of science-based resources; however, it does not replace NREPP and does not contain all of the resources that were previously available on NREPP.

“The Resource Center is a component of SAMHSA’s new comprehensive approach to identify and disseminate clinically sound and scientifically based policy, practices, and programs. Under this new approach, we are continuing to develop and add additional resources to the Resource Center as they become available. In the meantime, please use our Resource Center as well as the SAMHSA Store to find information on evidence-based practices and other resources related to mental health and substance use. For products and resources not developed by SAMHSA, please contact the developers for more information.”

Further Reading

  • Hennessy, K., Finkbiner, R., & Hill, G. (2006) The National Registry of Evidence-Based Programs and Practices: A Decision-Support Tool to Advance the Use of Evidence-Based Services. International Journal of Mental Health. 35(2), pp.21-34. doi: 10.2753/IMH0020-7411350202.
  • Brounstein, P. J., Gardner, S. E., & Backer, T. (2006) Research to Practice: Efforts to Bring Effective Prevention to Every Community. Journal of Primary Prevention. 27(1), pp.91-109. doi: 10.1007/s10935-005-0024-6. PMID 16421654. These criteria and the accompanying rating anchors are unique to NREPP but share common elements with the types of standards used by other Federal agencies to assess evidence-based programmes.
  • Official Website (Phased Out in 2018): https://www.nrepp.samhsa.gov/.
  • SAMHSA Evidence-based Practices Resource Centre: https://www.samhsa.gov/resource-search/ebp.
  • SAMHSA: https://www.samhsa.gov/.