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DSM 5, NIMH distances itself?
The American Psychiatric Association recently released its new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Dr. Insel( director NIMH) recently stated that “The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
As you can imagine, this has set off a firestorm about the whole validity of psychiatry in general. Numerous media outlets have gone as far as to say that NIMH abandoning the latest DSM is proof that psychiatry is not real science.
There is little doubt that psychiatry has often times in the past not served its’ patients well. There have been numerous times where the practice of psychiatry has bordered on bad medicine, and there is no need to defend its’ bad behavior. What does need to be underscored are all those who worked and treated the serious mentally ill with schizophrenia, bipolar disorder and major depression. What needs to be highlighted are the countless suicides that have been prevented. Yes, treating, preventing and helping people return to better quality of life should be the goal of the field. Not only with medication, talk therapy, and other rehabilitative programs such as Fountain House and similar programs. Housing for the homeless mentally ill, together with friends and families have been supportive interventions that are also part of this equation.
There is no blood test for schizophrenia, no x-ray for bipolar disorder and no genetic marker for major depression. Psychiatry bases its diagnostic criteria on symptoms, and history, and how persons are functioning in their daily routines. No, it is not precise, and mistakes happen, and yes, patients get misdiagnosed.
Hypertension, is predominately measured with a sfyngmometer, a devise developed around 1900. The problem is that it captures your blood pressure at that point in time, does not necessarily have the whole picture of how your blood pressure reacts to stressful conditions. Treatment therefore occurs based on that small window of time, leaving out the rest of ones life.
Psychosis, left untreated, can lead to very painful and dangerous moments. Auditory command hallucinations can lead to suicide or homicide.
The DSM is no bible or Rosetta stone, it’s a guide to assist in an often difficult task to help those or suffer from these terrible diseases.
2014-2015 Lilly Reintegration Scholarship
Please return in October 2013 to learn how to apply for the 2014-2015 school year.
The Lilly Reintegration Scholarship was established 16 years ago to help people with severe mental illness offset their tuition, books and lab fees. The program is designed to help persons with schizophrenia, schizophrenia related spectrum disorders , bipolar disorders and starting this October, major depressive disorders. The mission is to help persons with these illnesses acquire the educational and vocational skills needed to reintegrate into society. For more information on the program, click here.
Celebrate with our 2013 Reintegration Awards Winners!
Since 1997 the Lilly Reintegration Awards have recognized outstanding achievement in the work of reintegration. This year we partnered with the National Council for Community Behavioral Healthcare to increase visibility of wonderful people and programs that have gone above and beyond for Reintegration.
The Lilly Reintegration Awards recognize:
2013 Reintegration Award Winners:
Reintegration Awards: Achievement
First Prize: Elliott Steele, Executive Director, Vincent House, Pinnellas Park, FL
Second Prize: Carol Jean Garner, Director of Nonclinical Services, Midwestern Colorado Mental Health Center, Montrose, CO
Reintegration Awards: Advocacy
First Prize: Dylan Henry, Morgan Henry, Travis Henry, and Mari Antclif, Hope and Advocacy, Helena, MT
Second Prize: Fred Frese, MD, Hudson, OH
Reintegration Awards: Artistic Contribution
First Prize: Works of Heart Art Event and Auction Family Service & Guidance Center, Topeka, KS
Second Prize: Rebecca Atkins, Artistic Director, Second Step Players, Norwich, CT
Reintegration Awards: Clinical Medicine
First Prize: Child and Adolescent Bipolar Services (CABS), Western Psychiatric Institute and Clinic of UPMC Presbyterian-Shadyside, Pittsburgh, PA
Reintegration Awards: Education
First Prize: Fountain House, New York, NY
Second Prize: The Jed Foundation, New York, NY
Reintegration Awards: Employment
First Prize: Thresholds, Chicago, IL
Second Prize: Mental Health Center of Denver, Denver, CO
Reintegration Awards: Housing
First Prize: Main Street Housing, Inc., Baltimore, MD
Second Prize: Jewish Board of Family and Children’s Services, New York, NY
Reintegration Awards: Mentorship
First Prize: Bipolar Babe, Andrea Paquette, Executive Director, Victoria, British Columbia
Second Prize: Greg Dicharry, Magellan Health Services, Phoenix, AZ
Check out the 2012 Reintegration Awards Hall of Honor.
View former Reintegration Award Winners (2002-2010).
View all 2013 National Council Awards of Excellence Winners.
The National Council Awards of Excellence.
Each year, the National Council for Community Behavioral Healthcare honors those who inspire us to fight against mental illness and addiction. Through its Awards of Excellence, the National Council spotlights the innovative and inspirational efforts of those individuals and organizations - staff, board leaders, volunteers, consumers, families, and community partners - who are changing the lives of children, adults, and families living with mental illnesses and addiction disorders. Learn more...
Questions? Contact the National Council for Community Behavioral Healthcare
reintegration@thenationalcouncil.org.
202-684-7457
866-362-0505
Post-Sandy Commentary
Printed with permission from Tandcassociates
In the December 26, 2012 issue of the New York Times, an article:“Storm Weakened a Fragile System for Mental Care” discussed the problems associated with the loss of psychiatric services in New York as a result of Sandy’s destruction. In the discussion of this in the article and in the 127 comments posted so far in response to it, there are many complaints about the lack of non-institutional mental health services; no mention is made of such community-based programs as clubhouses.
One of the most affected hospitals, Beth Israel, recorded a 69 percent spike in psychiatric emergency room cases last month, with its inpatient slots overflowing. Instead of admitting more than one out of three such cases — as it did in November 2011, it admitted only one out of four of the 691 emergency arrivals this November, records show. Capacity was so overtaxed that ambulances had to be diverted to other hospitals 15 times in the month, almost double the rate of the same period in 2011, in periods typically lasting for eight hours, officials said.
Dr. Richard Rosenthal, Physician-in-Chief of Behavioral Services for Continuum Health Partners, Beth Israel Hospital’s parent organization, said he was proud of how much Continuum’s hospitals had done to handle psychiatric overflow. Yet these days, he said, as he walks on Amsterdam Avenue between Continuum’s Roosevelt Hospital on West 59th Street and its St. Luke’s Hospital on West 114th Street, he notices more mentally ill people in the streets than he has seen in years.
“When you have the most vulnerable folks, all you need is one chink in the system and you lose them,” Dr. Rosenthal said. “Whether they lost their housing, or the outpatient services they usually go to were closed and they were lost to follow-up, they have become disconnected, with predictable results.”
What this writer is both astonished and disheartened about Dr. Rosenthal’s comments is his total disregard of the role that community-based programs can and do play in such emergencies. In the NYT article he is pictured outside St. Luke’s-Roosevelt Hospital Center which works very closely with Fountain House (clubhouse) and the Sidney Baer Center (community-based psychiatric and primary care services center). After Sandy struck these outpatient services contacted over 1000 members to confirm their status and provide help, if needed.
There are 10 other New York City certified clubhouses that actively provide services throughout the metropolitan area. What Dr. Rosenthal, other hospital-based psychiatrists and mental health providers need to do is reach-out to these programs. One sure result, which has been documented at St. Luke’s-Roosevelt Hospital is the easing of demands for ER and inpatient services. If the problem in reaching-out is an inability to communicate, “interpreters” exist at the Sidney Baer Center, for example.
The bottom line being: Can we please learn from the Sandy disaster that communication and partnership development between hospitals and community-based services must be established.
As usual, your comments and opinions are welcomed either below or on our e-mail address: tandcassociates@gmail.com.
My Child Has Schizophrenia
What Should I Do, What Can I Do?
People with schizophrenia typically exhibit their first symptoms during adolescence or young adulthood, and thus are likely to be living with their parents. When parents first learn their child has schizophrenia, they usually experience a range of strong emotions - shock, confusion, dismay, sadness, and even anger. Parents often search frantically for answers that may not exist. They may even deny their child's illness or blame themselves or their circumstances for the illness. Read more>>
We See A Better Life ...
There are numerous forms of psychiatric rehabilitation available in our country; the sad fact is that less than 10% of persons with serious mental illness recieve any. The following is an article about one type of program that we encourage you to explore:
The Clubhouse and Psychiatry
By Thomas J. Malamud
Recently two activities of interest have transpired, concerning the relationship of clubhouse programs and the field of psychiatry. Just a few months ago a Utah-based clubhouse conducted a brief survey of ICCD programs asking if psychiatrists are present on Boards of Directors. Currently, Fountain House is planning on hosting a 2-day seminar exploring the ways that psychiatry and clubhouses can work together in the rehabilitation process.
Click here>>
The Journey...
Schizophrenia, Bipolar Disorder can be very traumatic words when presented to a person who has just had their first break. Losing your mind, not being able to distinguish reality from fiction can be a scary moment. Imagine if you are 20 years old and told you will never be able to move forward with your life because of it? Usually, many months to years pass before a person gets the appropriate attention for psychotic or mood labile symptoms. Often the person ends up in an ER brought in by police and if the ER isn’t equipped to deal with psychiatric emergencies, the injury gets compounded by the patient hearing derogatory terms thrown at them like “crazy”, wackadoo etc.
In our society there remains fear when dealing with psychotic thoughts that lead to aberrant behavior, including many health professionals. Much is said about quality mental health programs, but what does that mean? Symptom relief, staying out of the ER or inpatient unit, is this the best we can do, are these our standards of care?
Over the last ten years we have seen progress in the treatment of serious and persistent mental illness, many persons have moved forward with their lives, working, going back to school, reconnecting with friends and family. Unfortunately, many others have not. Large numbers of homeless persons have serious and persistent mental illness, large numbers of inmates in our prisons have serious and persistent mental illness, too many people are left floundering left to their own devises.
We know what works and we need to present persons struggling with these illnesses real hope and opportunities so they may heal and have productive and fulfilling lives. Programs like Fountain House in New York, the Village in California are two examples of mental health services that go beyond symptoms relief. These programs do reintegration, get people back to work, back to life.
Academic medicine has not embraced this concept; the Harvard’s, Mayo Clinics of the world have not integrated state of the psychiatric care with rehabilitation and reintegration. Without hope and real skills trainings persons with these illnesses will continue to struggle to turn their lives around. They will continue the revolving door of mental health care, they will continue to end up in our prisons, and we will continue to read about terrible incidents like Tuscon, Arizona.
It all begins with each of us understanding that schizophrenia is an illness, no different than any other medical condition. It is an illness that can be treated and that people do get better.
We are what we eat!
Recently, there has been a general revision of the food pyramid and an overall look at nutrition in our country. The FDA is now recomending that ultimately we reduce our total caloric intake, in other words eat less. As more information emerges around nutrition, we believe it is important to revisit how we approach food. Historically we have struggled with good nutrition, poverty being a major impediment to this goal. Today with a greater abundance of food in the western world, often times choices affect the quality of what we eat. Obesity is becoming a greater killer than smoking, and the cost of this disease is breaking the healthcare budget.
We would love to hear your thoughts and comments about this topic. Read more >>
Jury Duty for Persons with Serious and Persistent Mental Illness
A search of the literature for jury duty and mental illness shows the how’s and why's of getting out of jury duty.
However, there is no data that points out the frequency and adherence of persons with serious and persistent mental illness serving as jurors. In most mental health settings, both public and private, it is almost a knee jerk response to excuse persons with illnesses, such as schizophrenia, from taking on their responsibilities as citizens.
We believe, as part of Reintegration, persons in recovery from illness’s such as Schizophrenia or Bipolar Disorder disorder should participate in jury duty.
If anyone has any information on jury duty participation from persons with serious and persistent mental illness please let us know.
People Say I'm Crazy:
A Filmmaker with Schizophrenia Presents His Personal Experience
People Say I’m Crazy is the first documentary on schizophrenia that was crafted by someone who lives with the illness. John Cadigan produced the film to gain a better understanding of how his schizoaffective disorder—a combination of schizophrenia and depression—impacts himself and his family. Read More>>
Journey into the Brain with Dr. Jill Bolte Taylor
Jill Bolte Taylor, Ph.D., was a 37-year-old Harvard-trained and published brain scientist when a blood vessel exploded in her brain. Through the eyes of a curious neuroanatomist, she watched her mind completely deteriorate - she could not walk, talk, read, write, or recall any of her life. Because of her understanding of how the brain works, her respect for the cells composing her human form, and an amazing mother, Jill completely recovered her mind and body. In My Stroke of Insight: A Brain Scientist's Personal Journey, Jill shares with us her recommendations for recovery and the insight she gained from having this ironic and unusual voyage into, and back out of, the silent abyss of a wounded mind.
Jill Bolte Taylor is a spokesperson for the Harvard Brain Tissue Resource Center. Known familiarly as "The Singing Scientist," Jill has served on the NAMI National Board of Directors and has presented in San Angelo and at various NAMI Annual Meetings around the country, including many times at NAMI national meetings. She has a brother who is living in recovery from a serious mental illness.
You may purchase Jill’s book through her publisher at http://www.lulu.com/content/458594.
Helping the Mentally Ill and Homeless in Harlem Find a Home
Weston United Community Renewal, is a not-for-profit organization that has been meeting the needs of the mentally ill and homeless in Harlem since it began its work two decades ago. Its award-winning programs, in particular its housing programs, have been gaining widespread recognition ever since. Read more>>
Thresholds Program Helps Break the Cycle of Incarceration and Hospitalization
Before coming to Chicago’s Thresholds Jail & Prison Program four years ago, William Riley, 53, says he had “given up on life.” Managing schizophrenia for most of his adulthood, Riley lived on the city streets and spent nearly every winter in jail; mostly to get out of the cold, but also to get mental health services. Since becoming part of Thresholds, Riley has not been behind bars at all and has not been in a psychiatric hospital in more than a year. He is stable, has his own apartment, and for the first time, Riley sees a future for himself. Read More>>
Portals Celebrates 50 Years
PORTALS, one of the nation’s leading mental health rehabilitation agencies, celebrated its 50th anniversary on May 18, 2006. Los Angeles Mayor Antonio Villaraigosa served as Honorary Chair for the gala celebration, and literary and entertainment icon Sidney Sheldon served as Event Chair. The event honored five recipients of the Golden Bell Awards. Read more>>
Hearing Voices (Speaking in Tongues) by Michael Mack
Few works of art are as forceful a commentary on severe mental illnesses and how they affect individuals and their families than Michael Mack’s one-man play, “Hearing Voices (Speaking in Tongues).” The play’s subject: growing up with a mother who has schizophrenia. Read the review>>
Kristy Worthen: A Beacon of Light
She was the sweet, quiet girl who recoiled when asked to speak in front of class – but somehow her artwork spoke volumes. We all knew someone like her back in elementary school – but today, Kristy Worthen is definitely one-of-a-kind.
Now, Kristy regularly speaks to large groups. She shares with them her life experiences - because this shy little girl grew into a troubled young teen, complete with mood swings and depression; then things got worse, the delusions began. While neither Kristy nor her family knew it, she was battling bipolar disorder. Read more>>
I Don’t Need To Take Medicine
The symptoms of diseases such as schizophrenia, schizoaffective and bipolar disorders are both scary and devastating. The good news is, all of these symptoms can be greatly reduced or eliminated by the recently developed, so-called atypical antipsychotic drugs that have fewer of the problematic side effects. But the bad news is half of all consumers with these serious mental diseases stop taking their drugs, leading to a greater risk of relapse.
So why don’t many consumers take their medications? Many reasons are given by consumers including cost and side effects. But one commonly recurring theme is that many consumers simply don’t believe they are ill. Why would anyone take a medication they don’t need?
Read more>>
Reintegration Without Borders
See how the Intercultural Support Center of southeast Portland, OR provides programs and services to refugees with mental illnesses. Read more >>
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